The principal issue addressed in Federal District Court Judge Roger Vinson’s ruling Monday on the case of Florida vs. U.S. Department of Health and Human Services is the application of the Constitution’s “interstate commerce” clause with respect to Obamacare’s individual mandate. But two other parts of his ruling send an important judicial “tough love” message to state and federal lawmakers that the courts cannot—and should not attempt to—solve their political and policy problems for them.
In the case of state lawmakers, Judge Vinson dismissed the states’ argument that the federal government was unconstitutionally “commandeering” state resources when Congress included in Obamacare provisions that will have the effect of increasing state costs for Medicaid. He pointed out that participation in the Medicaid program is an entirely voluntary choice by a state, under which the state agrees to accept federal funding in exchange for abiding by federal rules for how those funds are spent. Any time a state decides that the requirements attached by Congress to federal Medicaid funds are too onerous, the state is free to terminate its participation in the program. Simply put, once a state no longer takes federal Medicaid funding, it no longer has to abide by federal Medicaid rules, and there is nothing the federal government can do about it.
Indeed, we previously noted that one effect of Obamacare’s Medicaid provisions might be to push some states past the “tipping point,” causing them to terminate their Medicaid programs.
The fact that either option—continuing to participate, or terminating participation, in Medicaid—entails significant political costs and difficulties does not create grounds for asking the courts to relieve state lawmakers of their obligation to make difficult decisions. Governors and state legislators are elected by their constituents to make decisions, and they can’t just pass off to courts, or someone else, decisions within the scope of their authority that happen to be difficult or unpalatable.
Judge Vinson also sent the same message to Congress in ruling on the severability of the individual mandate from the rest of Obamacare. Citing the defense’s own arguments, he noted that numerous other provisions of Obamacare will clearly not have the effects intended by the authors of the legislation in the absence of the individual mandate provision. Having determined that Congress does not have the authority under the Constitution to impose an individual mandate to buy health insurance, Judge Vinson further determined that the only way to preserve the rest of the legislation would be to rewrite large parts of it to accommodate removal of the mandate—an exercise that inherently entails making numerous policy decisions.
He correctly concluded that it is the job of Congress, not the courts, to make such policy decisions and that therefore any rewriting of Obamacare to ensure it passes constitutional muster is a job for Congress. As with state lawmakers, the judge’s message to federal lawmakers is that they cannot pass off to the courts decisions within their scope of their authority simply because those decisions are difficult or politically contentious. Consequently, Judge Vinson ruled that because the individual mandate provisions could not, as a practical or legal matter, be severed from the rest of Obamacare, the entire legislation is voided by its constitutional defect and that it is up to Congress to decide whether or not it will enact replacement legislation that is within the scope of its constitutional authority.
Judge Vinson’s ruling puts the issue of health care reform squarely back where it belongs—in the hands of Congress and state lawmakers. As the judge correctly noted, there are many constitutionally acceptable ways for state and federal lawmakers to improve the health system—many of which Heritage health policy experts have described in great detail over the years.
The fight over Obamacare, both before and since enactment, has triggered an important rethinking of America’s health care system. The issue was never just the status quo versus Obamacare. It was always the status quo versus Obamacare’s government central-planning approach versus alternative reform approaches based on creating better market incentives for increasing coverage, controlling costs, and identifying and rewarding value in health insurance and medical care.
Now is the time for federal and state lawmakers to look to those other approaches that the advocates of Obamacare systematically worked to exclude from the health care debate over the last two years. It is among those alternative ideas that lawmakers will find the right policy solutions for America’s health system.