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Affordable Care Act: Medicaid Expansion. Medicaid Expansion. I. NFIB v. Sebelius : Constitutionality of Medicaid Expansion under the Affordable Care Act. Constitutionality of Expansion. Supreme Court holds in NFIB v. Sebelius : .

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medicaid expansion
Medicaid Expansion

I. NFIB v. Sebelius: Constitutionality of Medicaid Expansion under the Affordable Care Act

constitutionality of expansion
Constitutionality of Expansion

Supreme Court holds in NFIB v. Sebelius:

  • Medicaid expansion violates Congress’ spending power as unconstitutionally coercive of states because:

1. States not given adequate notice to voluntarily consent to expansion, and

2. HSS Secretary could potentially withhold all of a state’s existing federal Medicaid funds for non-compliance

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Constitutionality of Expansion

Medicaid Expansion is a “gun to the head” because the “threatened loss of over 10 percent of a state’s overall budget….is economic dragooning that leaves the states with no real option but to acquiesce.”

- Sebelius, at 54.

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Constitutionality of Expansion

Coercive But.........

Supreme Court fashions a “remedy” to overcome the coercion

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Constitutionality of Expansion

Supreme Court’s remedy for coercion:

  • Remedy is to limit HHS Secretary’s power to withhold existing federal Medicaid funds for state non-compliance with Medicaid expansion
  • Makes Medicaid expansion optional for states
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Medicaid Expansion

I. NFIB v. Sebelius: Constitutionality of Medicaid Expansion under the Affordable Care Act

II. Past, Present, and Future: A glimpse at Medicaid Establishment and Expansion

past medicaid establishment
Past: Medicaid Establishment

Establishment of Medicaid

  • Established in 1965 as a jointly funded cooperative between federal and state governments
  • Purpose: Provide medical benefits to those who have either no or inadequate medical insurance
  • Program requirements: Established by each state and eligibility varies per state
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Past: Medicaid Establishment

Tennessee’s Response to Medicaid Enactment

  • Established TennCare in 1994
  • Serves roughly 18-19% of the state’s population
  • Two types of TennCare: TennCare Medicaid and TennCare Standard
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Past: Medicaid Establishment

TennCare Medicaid

TennCare Standard

For:

  • Tennesseans who are eligible for Medicaid
  • Groups covered include: Children under 21, pregnant women, single parents of minor child, elderly, and disabled
  • Income limits are applicable

For:

  • Children under 19 who are already enrolled in TennCare Medicaid AND
  • Lack access to group health insurance OR
  • Time of eligibility for TennCare Medicaid is ending and they no longer qualify
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Present: Tennessee without Medicaid Expansion

Current source of Tennesseans HealthCare coverage

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Present: Tennessee without Medicaid Expansion

Tennessee Compared to United States

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Future: Medicaid Expansion
  • Affordable Care Act gives states the option to expand Medicaid coverage to nonelderly adults with incomes up to 138% of the federal poverty level (FPL)
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Future: Medicaid Expansion
  • Means that Tennessee can extend TennCare coverage to individuals up to 138% FPL
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Future: Medicaid Expansion
  • No deadline by which states must decide whether to expand or not
  • No partial expansion- all or nothing
  • Effects of expansion
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Future: Medicaid Expansion

Effects of Expansion

  • Effect on people below 100% FPL
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Future: Medicaid Expansion

Effects of Expansion

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Future: Medicaid Expansion

Effects of Expansion

  • Effect on people below 100% FPL
  • Financial Effects of Expansion
financial effects of expansion
Financial Effects of Expansion

Federal Government will pay

Tennessee’s Increased Costs

  • 100% for first three years (2014, 2015, 2016)
  • 95% in 2017
  • 94% in 2018
  • 93% in 2019
  • 90% thereafter
  • Approx. $31 million in 2017
  • Approx. $95 million in 2019
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Future: Medicaid Expansion

Effects of Expansion

  • Effect on people below 100% FPL
  • Financial Effects of Expansion
  • Effects of the Eligible but not Enrolled (EBNE)
effects of the ebne
Effects of the EBNE
  • Individuals who are currently eligible for Medicaid but not enrolled will likely go to exchanges and be automatically moved to TennCare
  • State will pay approximately 35% of the cost of covering this group
  • “Woodwork effect”
  • May be over 60,000 EBNE individuals who enroll in TennCare
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Future: Medicaid Expansion

Effects of Expansion

  • Effect on people below 100% FPL
  • Financial Effects of Expansion
  • Effects of the Eligible but not Enrolled (EBNE)
  • Effects on healthcare availability
effects on healthcare availability
Effects on Healthcare Availability
  • More than 220,000 (and possibly up to 370,000) additional Tennesseans who are not currently eligible for TennCare would become eligible if expanded
  • Expansion would result in 24.7% reduction in overall number of uninsured in Tennessee
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Future: Medicaid Expansion

Where do States stand on Expansion?