Yes, the Supreme Court’s Medicaid Decision Was Terrible

Kevin Drum argues, in response to Yglesias, that we shouldn’t blame the Roberts Court for its decision striking down the ACA’s Medicaid funding mechanism.  Not because the decision isn’t responsible for awful consequences, but because it was right.

I…do not find Drum’s defense persuasive:

There’s an even bigger problem with Drum’s argument, which can be summed up in two words: Shelby County. What made the Supreme Court decision eviscerating the Voting Rights Act so outrageous was that one hand Congress was explicitly authorized by the 15th Amendment to address racial discrimination in voting, and on the other hand the Voting Rights Act did not violate any other explicit provision of the Constitution. Well, the argument that the Medicaid expansion violates the Constitution had the same problem. While I think that the argument that the ACA’s individual mandate exceeded Congress’s power is extremely weak, it is at least based on a real constitutional limitation: it is clearly implicit in Article I and made explicit by the 10th Amendment that any Congress must act within its enumerated powers, so it did have to be shown that the mandate was a regulation of interstate commerce, necessary and proper to Congress’ commerce power, or a valid exercise of its taxing powers. With respect to the Medicaid expansion, conversely, Congress is unambiguously given the authority to tax and spend to “provide for the . . . general Welfare of the United States,” and nobody argues that the Medicaid expansion violates any explicit provision of the Constitution.

As with Shelby County, I think this should settle the question. If we’re going to strike down major legislation based not on a fundamental individual liberty interest protected by the Constitution, but in order to uphold some free-floating concept of “state sovereignty” not tethered to any explicit provision, there had better be a very good argument that some clearly positive consequences will flow from the decision or that the “sovereignty” being protected is of major importance to the functioning of state governments. Here, the argument against the Medicaid expansion fails massively. As Waldman shows in detail, the policy consequences of the Supreme Court’s intervention were not only bad but perverse: the states where the poor have the least access to healthcare are also generally the states least likely to take the money. (The way Congress structured the program, in other words, has been very much retroactively justified.) Nor am I able to see why being required to accept the federal government’s current requirements to accept Medicaid funding represents some kind of existential threat to the Sovereign Dignity of the states but being offered deals that create a de facto national drinking age and speed limit don’t. Having read two Supreme Court opinions trying to make the case several times I remain entirely unclear why the authority to deny medical care to large numbers of poor people, in particular, is an essential component of state sovereignty.

Read the whole etc. if you’re so inclined.