Dismiss the Florida Lawsuit: Health Care Reform Law Preserves Constitutional Federalism

Co-authored by Elizabeth Wydra, Chief Counsel of Constitutional Accountability Center, and Jack Hatch, who represents Central Des Moines in Iowa’s Senate and chairs the Health & Human Services Budget Subcommittee. Jack is also a member of Progressive States Network’s State Legislators for Progressive Health Reform.

The federal government this week asked the U.S. District Court in Pensacola, Florida to dismiss the lawsuit that a group of state governors and Attorneys General have brought to challenge the constitutionality of the Patient Protection and Affordable Care Act, this year’s historic health care reform law. The court should dismiss this lawsuit, not just because Congress had the constitutional authority to pass much-needed health care reform legislation, but also because the Affordable Care Act is good for federalism, for states, and for Americans. While the plaintiffs in the Florida lawsuit claim that the Act violates constitutional principles of federalism and state sovereignty, the law actually preserves the states’ longstanding role in protecting the health and welfare of their residents and reflects the partnership between the federal government and the states at its best.

The pending challenge to the constitutionality of the Act has been brought by several state governors and Attorneys General purporting to represent the people of their respective states and the interests of the states in general, but state legislators from across the country–including from the states the plaintiffs claim to represent–do not agree with the lawsuit’s legal approach or political position. Last year, over 1,000 state legislators from all 50 states joined together and signed letters urging the Obama Administration and Congress to pass comprehensive health care reform legislation. Now, these legislators are working hard in their states to implement reform efficiently and effectively, working in partnership with the federal government.

Talk of “states’ rights” or national power tends to drown out more nuanced visions of our federalism, but the Constitution does not set up a zero-sum game between the states and the federal government. Our Constitution creates a vibrant system of federalism that gives broad power to the federal government to act in circumstances where a national approach is necessary or preferable, while reserving a significant role for the States to craft innovative policy solutions that showcase the diversity of America’s people, places, and ideas. The Affordable Care Act maintains the careful balance of this constitutional design.

Health care reform was imperative for Americans, as well as their state and local governments. The ever-rising costs of and limited access to insurance coverage and health care have severely stressed the budgets of state governments and American families, and literally cause tens of thousands of deaths each year. The health care reform legislation that President Obama signed into law expands coverage, cuts costs, ensures health insurance security for millions of Americans, and sets up a federal-state partnership that sets a minimum national floor of coverage and protection while allowing states significant options–including whether to continue in the Medicaid program, whether and in what manner a state insurance exchange should be established, and even whether to seek a waiver from the federal program to try to build a better health reform system of their own.

This significant amount of choice for the states belies the claims made by the plaintiffs in the Florida lawsuit that the Act, especially the law’s provisions for expanding Medicaid coverage to an additional 16 million people, intrudes on state sovereignty. If the governors and Attorneys General suing the federal government do not think it is in their states’ best interests to provide more of their citizens with Medicaid coverage, they don’t have to–their states can simply opt out of Medicaid altogether. The plaintiffs admit in their lawsuit they do not want to end their states’ participation in the voluntary federal-State Medicaid program, because to do so “would desert millions of their residents, leaving them without access to the healthcare services they have depended on for decades under Medicaid.” This is absolutely true–many state residents have come to appreciate and rely upon Medicaid. But the Constitution allows the federal government to structure or condition federal funds and programs in a certain way, allowing states to choose whether to participate and accept those conditions, or not. The plaintiffs’ Medicaid and other federalism claims in the Florida lawsuit appear to seek a judicial “do-over” on the Act, trying to get the court to craft a health care reform bill that is more to the plaintiffs’ liking. That is an effort that belongs in the political arena, not the courts.

State leaders and legislators should be able to carry on with their work protecting the health and security of their respective state’s citizens without the cloud of the legally meritless, politically charged Florida lawsuit hanging over their efforts. The Florida district court should dismiss the lawsuit, and allow the real work of health care reform to go forward in the states.

Cross-posted at Huffington Post.

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