American Health Care Act Of 2017
Mr. Speaker, I've been here a while and it's hard for me to recall a time when we've voted on something so obviously and willfully harmful to children, seniors and working Americans. This bill strips healthcare from 24 million people. It…
Mr. Speaker, I've been here a while and it's hard for me to recall a time when we've voted on something so obviously and willfully harmful to children, seniors and working Americans.
This bill strips healthcare from 24 million people.
It requires some seniors to pay 100 percent or more of their income in premiums.
This legislation dramatically cuts Medicaid, directly contradicting President Trump's claim not to.
In Michigan, HALF of all children rely on Medicaid.
In my district alone, 56,000 people will lose coverage, including 16,000 children.
Let's be clear: if we pass this bill, children, seniors, and working people will suffer and some will die, so that the wealthy can get a tax cut.
Healthcare is a right, not a privilege. That's why I support a single-payer, Medicare-for-All plan, and why I will be voting ``no'' on this mean spirited legislation.
Mr. Speaker, as Ranking Member on the House Judiciary Committee, I include in the Record a legal analysis prepared by committee staff that concludes that the provision of H.R. 1628 that requires New York State to change how its counties fund the State's portion of Medicaid expenses is not related to a legitimate Federal interest, that no rational Federal purpose has been proffered for the provision, and that it would severely intrude on traditional state prerogatives. As such, this provision would violate Constitutional limits on the Federal Spending Power, the Due Process and Equal Protection Clauses and the Tenth Amendment (reserving all undelegated powers to the States) and would likely be held unconstitutional if challenged in court.
Memorandum
To: Interested Members.
From: House Judiciary Committee Democratic Staff.
Re: Constitutionality of Faso-Collins Amendment.
Date: March 24, 2017.
The Faso-Collins amendment, incorporated into the Manager's
amendment, would violate Constitutional limits on the Federal
Spending Power, the Due Process and Equal Protection Clauses
and the Tenth Amendment (reserving all undelegated powers to
the States). Requiring New York State to change how its
counties Fund its portion of Medicaid expenses is not related
to a legitimate Federal interest, no rational Federal purpose
has been proffered for the provision, and it would severely
intrude on traditional state prerogatives.
If the Faso-Collins amendment were ever enacted, it quickly
would be invalidated by the Federal courts. The irony of this
``buyout'' is that the ``payment'' supposedly being delivered
in exchange for votes--the unconstitutional provision--is the
legislative equivalent of a check on a closed bank account,
which will never deliver the promised benefits.
For the last 51 years, New York State has chosen to fund a
portion of its share of the Medicaid Program by using funds
from county property taxes. Fifteen other States structure
Medicaid funding through a similar legally authorized system.
The Faso-Collins amendment specifies that any State that
had an allotment of Disproportionate Share Hospital (DSH)
funds that was more than 6 times the national average, and
that requires subdivisions with populations of less than
5,000,000 to contribute toward Medicaid costs, shall have its
reimbursement reduced by the amount of contributions by such
subdivisions. (This effectively limits the application to New
York State, and carves out New York City.) Under the
amendment, New York State is at risk of losing $2.3 billion
of its $32 billion in Federal Medicaid funds.
This provision is unconstitutional, and could be struck
down for several reasons:
Violation of Limits on Spending Power--Article I of the
Constitution grants Congress spending power to ``provide for
the . . . general Welfare.'' In South Dakota v. Dole, 483
U.S. 203 (1987), the Supreme Court held that any spending
condition imposed on the States must be related to the
Federal interest in that particular project or program and
that Congress cannot coerce the States into compliance with
the Federal government's objectives. In NFIB v. Sebelius, 132
S. Ct. 2566 (2012), the Supreme Court found provisions of the
Affordable Care Act which required all States to comply with
the law's Medicaid expansion violated this spending
authority, noting the ``Constitution has never been
understood to confer upon Congress the ability to require the
States to govern according to Congress' instructions.'' The
Faso-Collins language does not appear to be related to any
Federal interest in the use or allocation of Federal Medicaid
funds: it does not further Medicaid's purposes and has
nothing to do with ensuring the proper disbursement of
Federal funds. Indeed, because the provision applies to
counties in a single State--and leaves the very same system
undisturbed in 15 other States--it could not possibly be
justified by any legitimate Federal interest.
An additional line of Supreme Court cases, including New
York v. United States, 505 U.S. 144, 167, 172 (1992), has
held that conditions on Federal grants must be ``reasonably
related to the purpose of the [Federal] expenditure'' because
otherwise ``the spending power could render academic the
Constitution's other grants and limits of Federal
authority.'' Likewise, in Massachusetts v. United States, 435
U.S. 444, 461 (1978), the Supreme Court noted that it has
``repeatedly held that the Federal Government may impose
appropriate conditions on the use of Federal property or
privileges and may require that State instrumentalities
comply with conditions that are reasonably related to the
Federal interest in particular national projects or
programs.'' Under these precedents, the Faso-Collins language
would be held to be an arbitrary exercise of Federal power
which intrudes on only one particular State's sovereign tax
powers, and is unrelated to any Federal interest or purpose
in the Medicaid Program.
As Yale Law School Professor Abbe Gluck wrote in a post on
the Balkinzation blog today, the Faso-Collins ``amendment is
likely unconstitutional. The protection from federal
interference of the internal functions of a state government
is one of the bedrocks of state sovereignty protected by the
limitations on Congress's powers in Article I of the
Constitution and the reservation of power to the states in
the Tenth Amendment.'' She further reasoned that ``Even if
one could argue that this is an exercise of the federal
spending power under Article I, for Congress to legally use
that power, the conditions on a state's use of federal
funding have to be tied to a reasonable federal propose . . .
It is hard to see a reasonable federal purpose here other
than garnering more GOP votes for the struggling repeal
bill.'' (available at https://ballkin.blogspot.com/2017/03/ is-gop-aca-repealer-unconstitutional-on.html?m=1)
Violation of Due Process and Equal Protection--Under the
Fifth Amendment, the Federal government is not permitted to
deprive its citizens of equal protection or due process of
law. Those clauses have been interpreted on numerous
occasions to prevent the government from discriminating
between the treatment of the sovereign States absent a
rational basis. For example, in Helvering v. David, 301 U.S.
619, 640 (1937), the Supreme Court warned that Congress does
not possess the right to demonstrate a ``display of arbitrary
power'' in its treatment of the various States. In this
regard, in 2009, when an earlier Senate version of the
Affordable Care Act sought to provide special treatment for
Nebraska with respect to Medicaid reimbursements, 13
Republican State attorneys general wrote to Congress
(available at http://www.law.columbia.edu/sites/default/ files/microsites/career-servicesifiles/Letter%20to%
20the%20 Honorable%20Nancy %20Pelosi%20 and%20the
%20Honorable%20Harry %20Reid.pdf) asserting the provision was
unconstitutional (the provision was ultimately dropped). In
the case of the Faso-Collins language, there is no legitimate
policy justification for developing a special rule limiting
Medicaid funds for New York as compared to all other States,
including 15 States which have sharing agreements with their
counties. Nor has a justification been offered for why New
York City should be excluded from the application of the
special rule. As such, it is clear that the provision is
discriminatory, ``arbitrary'' and has no rational basis.
Abrogation of Tenth Amendment Principles--The Tenth
Amendment provides in relevant part that powers not delegated
to the Federal government or prohibited to the States are
reserved for the States. This has been read to prevent the
federal government from ``commandeering'' the states to serve
its own purposes. In Printz v. United States, 521 U.S. 898
(1997), the Supreme Court held that Congress cannot
commandeer State officers to implement Federal policy--in
that case requiring criminal background checks for handgun
purchases pursuant to the Brady Handgun Violence Prevention
Act. The Faso-Collins language commandeers New York State
government to facilitate the partisan political ends of a
faction in the U.S. Congress, which would seem well outside
the proscriptions of Printz. In fact, by essentially ordering
New York to reorganize its internal affairs, the Faso-Collins
amendment may run even further afoul of Tenth Amendment
principles than was the case in Printz given the lack of a
Federal purpose and the interference with the core sovereign
function of how a State chooses to use its taxing power.
It is of particular constitutional concern that the Faso-
Collins provision directly interferes with New York's
internal decisions about how to structure its own tax and
spending policies, and how to allocate those responsibilities
between the State and its subdivisions--which is a core
function of a sovereign entity protected by the Tenth
Amendment (and potentially Article IV Sec. 4 of the
Constitution, which provides that the ``United States shall
guarantee to every State in this Union a Republican Form of
Government.''). This is constitutionally significant because
in Reynolds v. Sims, 377 U.S. 533, 575 (1964), the Supreme
Court held that political subdivisions such as counties and
cities ``have been traditionally regarded as subordinate
governmental instrumentalities created by the State to assist
in the carrying
out of State governmental functions.'' In Hunter v. City of
Pittsburgh, 207 U.S. 161, 178 (1907), the Court noted that
these subdivisions are ``created as convenient agencies for
exercising such of the governmental powers of the state, as
may be entrusted to them'' and that the ``number, nature, and
duration of powers conferred upon these [entities] and the
territory over which they shall be exercised rests in the
absolute discretion of the state.'' The Faso-Collins
amendment purports to invoke Federal power to displace New
York's sovereign exercise of this ``absolute discretion''
and, for that reason, violates the Constitution. As Chief
Justice John Marshall long ago explained in Gibbons v. Ogden,
22 U.S. 1, 198-200 (1824), the States' ``power of taxation is
indispensable to their existence. . . . In imposing taxes for
State purposes, [States] are not doing what Congress is
empowered to do. Congress is not empowered to tax for those
purposes which are within the exclusive province of the
States.''