WASHINGTON D.C.—What was originally a case about California’s reductions to Medicaid funding, has turned into a possibly national precedent that could deny patients and doctors the right to sue the government.
Especially patients with low-income and/or disabilities.
California’s Medicaid system is called Medi-Cal. It serves lower-income people, senior citizens, as well as people considered to be disabled.
On 3 October 2011, the U.S. Supreme Court brought in its new term, hearing oral arguments on three cases regarding decisions made in California district courts in 2008 and 2009. Those decisions blocked cuts to Medi-Cal provider rates.
Provider rates reflect how much a health care provider, like doctor’s offices, receives from Medi-Cal funding. If provider rates are cut, providers cannot offer as much funding for services to their patients.
In such a scenario, patients can either go without services, or be asked to pay out-of-pocket for services.
The Supreme Court’s first case, Douglas v. Independent Living Center of Southern California, focused on whether or not people receiving Medi-Cal, their providers, and their advocates can sue California and stop its cuts to Medi-Cal provider rates.
Plaintiffs in the case see the cuts as violations to federal Medicaid laws.
Garden Grove, California Pharmacist Thu-Hằng Trần was a plaintiff in the case and traveled to Washington D.C. to offer her presence as support.
“If you don’t have the right to sue, the court will not accept your case,” Pharmacist Trần told the Viễn Đông, adding that this case will affect decisions regarding similar lawsuits in the future.
She continued, saying that if the plaintiffs win the case, there will be similar lawsuits against states throughout the country.
However, if the plaintiffs lose, doctors and patients may never be able to sue the government again.
Build up to Supreme Court arguments
In 2008, the U.S. District Court in Los Angeles (LA) blocked a 10 percent cut to provider rates, originally passed in the 2007-2008 California State budget.
California appealed the decision with the U.S. Supreme Court in 2009 and again in 2010, losing both times.
Although unsuccessful in the past, California is now backed by 31 other states.
As Medicaid is an optional joint federal-state program, states must comply with certain requirements, like maintaining sufficient provider rates, in order to participate in the Medicaid program.
With the rising costs of health care, largely due to the national deficit, more states are in support of opting out of Medicaid as they are unable or unwilling to comply with such requirements.
Though not in support of California’s reduction to Medi-Cal provider rates, the Obama Administration supported California on Monday, urging the Supreme Court justices to not hear the Independent Living Center case.
If the lawsuit proceeds and the plaintiffs are unsuccessful, it will be a victory for the Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare, Pharmacist Trần told the Viễn Đông.
One provision within the ACA requires people not covered under Medicaid or Medicare to purchase health insurance or receive federal subsidies for such insurance. If the plaintiffs are unsuccessful in the lawsuit, not only will a precedent be set against doctors and patients suing the government, but other states participating in Medicaid would feel free to not comply with federal Medicaid laws.
These states might not be paying attention to the fact that noncompliance with Medicaid means states can lose funding for the program. With Medicaid inadequately funded in such states, people covered under Medicaid in those states would then have to be covered under the ACA.
Adversity to the ACA has been a common Republican theme, heavily targeted by candidates in recent 2012 GOP Presidential debates.
Pharmacist Trần added that plaintiffs in the case are largely supported by Republicans.
What happens next?
Pharmacist Trần told the Viễn Đông that the Supreme Court will probably not make a decision on the case until at least the beginning of 2012, while other reports estimate a date even later in the year.
Either way, the decision will be made as the 2012 elections approach.
While awaiting the court’s decision, it is important to ponder the possible outcomes of this case.
Under the Constitutional Supremacy Clause, federal law is supreme over state laws. That means states can be punished for acting contrary to federal laws.
The Supreme Court usually allows businesses to use the Supremacy Clause to challenge state environmental or consumer protection laws. Yet, plaintiffs in the Independent Living Center case have been asked to prove that they are protected under the Supremacy Clause.
Overall, Pharmacist Trần is optimistic.
“I believe in the judges, the system,” she told the Viễn Đông.