AUGUSTA, Maine — As the federal government reviews Maine’s request to make about $20 million in cuts to its Medicaid program, the debate is still brewing over whether Gov. Paul LePage’s administration has the legal authority to make those cuts.
And the side you take largely revolves around one question: How far-reaching is the Supreme Court’s June ruling that largely upheld the Obama administration’s health care reform law?
Not very, for those who think the Medicaid cuts are illegal.
Maine Equal Justice Partners, an organization that provides legal aid to low-income residents, rekindled the debate on Thursday when it sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius urging her to reject the LePage administration’s request to cut coverage for about 36,000 residents.
At issue is the court decision’s effect on the “maintenance of effort” requirements of the Affordable Care Act, which largely prohibited states from scaling back existing Medicaid services in advance of the law’s 2014 Medicaid expansion.
“We believe the Supreme Court decision had very limited holding, and it was specifically to the enforcement mechanism of the Medicaid expansion,” said Sara Gagne-Holmes, the group’s executive director. “We didn’t believe it impacted maintenance of effort. These cuts would be contrary to the federal law.”
While the Supreme Court in June largely upheld the health care law as constitutional, the court ruled it unconstitutional for the federal government to withhold funds for existing Medicaid services as a way to enforce the Medicaid expansion.
The LePage administration read that part of the ruling more broadly and took it as a sign it could make cuts to its existing Medicaid program through a routine process — an amendment to Maine’s Medicaid State Plan. Attorney General William Schneider said earlier this month that the maintenance of effort requirements are “part and parcel of the Medicaid expansion that was struck down.”
And Thomas Barker, who served as general counsel under Health and Human Services Secretary Michael Leavitt during the Bush administration, told the Bangor Daily News earlier this month that he read the court ruling to more broadly strike down the mechanism the Affordable Care Act planned to use to enforce the Medicaid expansion.
“The maintenance of effort requirements are enforced the same way,” he said. “To me, the Supreme Court has said, ‘You cannot enforce a Medicaid requirement by conditioning 20-27 percent of a state’s budget on compliance with the requirement.’”
But the Obama administration appears to be reading the Supreme Court decision more narrowly as it enforces its health care law. In a letter to governors last month, Sebelius acknowledged the court struck down the requirement that states participate in a Medicaid expansion or risk all of their Medicaid funds. However, she wrote, “[t]he court’s decision did not affect other provisions of the law.”
The Congressional Research Service, the U.S. Congress’ nonpartisan research arm, weighed in later with an opinion similar to Sebelius’, saying that the maintenance of effort provision was “unaffected by the Supreme Court’s ruling.”
The Supreme Court decision makes no mention of the maintenance of effort requirements. And in a few places, “the Court emphasized that its holding was limited to the Medicaid expansion,” said Nicole Huberfeld, a health law expert at the University of Kentucky College of Law.
“It is important to keep in mind that no provision of the [Affordable Care Act] was struck down and no Medicaid Act provision was struck down,” she wrote in an email. “Only the Secretary’s administrative remedy for state noncompliance was limited.”
It’s best to interpret the court’s health care decision narrowly, Huberfeld said, because a plurality of justices — and not a clear majority — ultimately issued the prevailing decision, and there’s historical precedent to interpret “fractured” opinions narrowly.
Supreme Court opinions can be limited in their reach, but it’s also logical to look to the nation’s highest court for broader guidance, said Joseph Reisert, who teaches constitutional law at Colby College in Waterville.
In the case of the health care ruling, Reisert said, it’s the first time the Supreme Court has labeled any sort of conditions on spending federal money “unconstitutionally coercive,” so it’s natural to ask questions about how far-reaching that label is.
“The precise question at issue didn’t actually get resolved, and that’s why you get competing interpretations about what the law means, which are really competing predictions about what the federal courts are ultimately going to decide,” Reisert said.
And it’s possible a federal court will weigh in on Maine’s attempts to scale back its Medicaid program. Schneider, the attorney general, has promised legal action if the federal government doesn’t off on Maine’s request to make its proposed Medicaid cuts.
Come on, we don’t need a story for the question in the headline, all you need is a flow chart. Are you a Democrat? Then the answer is yes. Then move over to the next bubble “Read the ruling, you can’t cut it”
Then the other section reads “Are you Paul Lepage, a member of the tea party or someone who voted for Lepage” then you move to yes and the next bubble reads “Yes you can cut it why are you asking?”
LePage can’t read a court order either, The Consent Decree requires the State of Maine to provide services to the mentally ill in the least restrictive environment, yet he cuts spending on mental illness to the bone in defiance of court order. It matters little who you are, a judge, or head of the Federal DHHS, LePage will do whatever he wants regardless of the law.
Time to read “The Emperor’s New Clothes” and ask ourselves, “Does the emperor have clothes?” Those of us in Maine can only say, “Yes, from Marden’s.” If we ask, ” Does our emperor have brains?” we have to acknowledge the answer is an obvious, “No.”
If this comes down to whether the Federal government knows what they’re talking about or whether Paul Richard LePage knows more, then I think the conversation is pretty much over. Only because Paul has yet to show Maine and the rest of the world that he knows ANYTHING except how say crude, rude, or nasty things about everybody and anybody who’s last name isn’t LePage.
It look pretty straight forward. The state is in charge of its budget.
Maine has an Attorney General that couldn’t even issue an opinion on if Treasurer Poliquin was in violation of the Maine Constitution. Does anyone really feel he is qualified to go up against the feds? Good luck with that. Plus it it very possible that Maine will have a new Democrat Attorney General come January.
I sure hope ME can make these cuts, we need to stop this stealing of taxpayer money by thousands of Medicare recipients and do not really need it. This is another reason we have get Obama out of office or the economy will completely go off the cliff. Obama has never developed a usable budget and never will.
Sorry, Bonny, Medicare has nothing to do with Maine and you might want to check your facts.
Good Gawd, woman, do you realize how programmed you sound? Is there a secret Stepford Wives cult somewhere around here?
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We are already trillions in debt. How can the federal government afford this? The states are poor. If they could afford it, don’t you think they would have taken care of the people?
It’s like cutting budget to have property taxes cover the expenses, which don’t and more people become homeless.
The State did take care of people…The rich! That’s why we have no money for the ones who need it most. LePage is taking it away from the poor to give it to the rich. Middle class won’t see that money.
We are trillions of dollars in debt because people like Paul Ryan voted to simultaneously start unnecessary wars while cutting tax rates – including disproportionate cuts for the wealthiest Americans. We are not trillions of dollars in debt because we are spending too much providing healthcare to the poorest Americans.
LePage should save state dollors by having people that are on SSDI that have Medicare only have Medicare and not be able to get Mainecare to pick up thier co-payments and monthly Medicare payments.
Why?
SenecaDoane why should tax payers pay twice and have someone be 100% covered. When there are people that have 0% covorage?
That’s right.
Let’s not raise revenue.
Let’s not raise taxes, slightly, for the most wealthy.
Let’s not tax corporations.
Let’s not regulate Wall Street.
Instead, let’s take healthcare away from poor people and their families.
That’s how the “new” Tea/Republican Party views the future.
And if they get control, it’s
Bye Bye Medicare!
The Teatards might try on the Federal level to do some damage to Medicare but they will be going up against the largest majority in this country. The old folks! With Romney’s new running mate, Eddie Munster, we’ll see how this goes over early.
Crapola….
That’s their goal-bye, bye humans. The only ones left will be the sponge-brained, Neanderthal Tea Partiers. Sad there will be nobody left to see them eventually turn on each other…oh wait, we can see previews at the RNC.
IF Maine just followed the National Guidelines for Medicaid, we woudn’t be giving out so much in benefits. Maine has adjusted it’s guidelines so that more people qualify than would nationally. Maybe going back to following hte National guidelines could help and there wouldn’t be an issue of cutting, it would be an issue of following the Federal govt???
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Cut, cut!!!
There are far too many able-bodied people on welfare. Cut! Cut!! Cut!!!
Data, please.
Welfare Fraud and Abuse –
http://www.commonwealthfoundation.org/research/detail/welfare-fraud-and-abuse
welfare rules maine
No, LePage thinks he does.
Does anyone else think that painting in the background of LePage’s photo is funny? I think it’s hilarious. Talk about matching personalities.
He’s more of the Cowardly Lion in the Wizard, when you weigh his “furious” retaliation against the Canadian Lobster Blockade.
Snip-snip Le Page just won’t let up. Cuts here, cuts there. He’s worse than a kid with a pair of hedge cutters.
A kid, however, would show more respect and humaneness in dealing with the less fortunate. Unfortunately, Le Page has none.
He’s cursed us, mocked us, taunted and belittled our state before the world.
For all of the bad he’s uttered, he has surprisingly curbed his wrath in damning the Canadians for blocking Maine lobstermen, and expelling them across the border under police escort.
Just weeks into his act as governor, to cheering lobstermen, he told them he would tell the president to go to hell because of a ruling on fishing. Instead of chiding the Canadians, he weakly noted – we have just three canneries in Maine.
Meanwhile, he intends to build a highway for the Canadians. He allows Canadian woods workers to harvest our trees. He encourages Canadian scalping of our mountains for mining. He says nothing – God forbid – that Irving ships thousands of gallons of oil across our sate each week on the most poorly maintained railway in the world – an environmental disaster in the wings.
No. Don’t look for Le Page to criticize the Canadians on their blockade of our trucks and police action against them. They can have anything they want – gas lines, power lines, oil lines.
When it comes to this issue, Adrienne Bennett can relax. She won’t have to explain what she thought he was trying to say, because he said absolutely nothing to upset his Canadian pals. Perhaps he should ride a lobster truck into Canada.