In a case the U.S. Supreme Court is likely to hear this fall, the Obama administration has taken a wrong turn by claiming that Medicaid beneficiaries are without legal recourse if states cut Medicaid payments to providers. Without the threat of a lawsuit, more states may try to balance their budgets by taking an ax to Medicaid rates and reducing access to care, and with a different administration in the White House, they might well get away with it.
Federal law guarantees that rates paid to doctors, pharmacists and nursing homes will be sufficient to give Medicaid recipients — who are among the poorest Americans — about the same access to care as the area's general population. But the administration claims there is no right to enforce this provision through legal action because compliance is policed by the secretary of the Department of Health and Human Services.
Meanwhile, Medicaid beneficiaries across the country already have difficulty finding doctors and other health professionals willing to accept them as patients because the provider payment rates are low. In California, Medicaid recipients and providers fought back and filed lawsuits after the state reduced Medicaid payment rates in consecutive years.
While there is no explicit provision in the Medicaid law allowing people to sue to enforce the "equal access to care" standards, the 9th U.S. Circuit Court of Appeals in San Francisco allowed the suits to advance under the U.S. Constitution's Supremacy Clause, which says federal law trumps that of the states.
But the administration is keen to defeat the suits and bar access to the courts for others. It filed a "friend of the court" brief this spring with the high court, which will hear the issue next term, declaring that federal health officials are better positioned than the courts to balance the interests of access and cost. Moreover, the administration claims that federal law does not allow such suits by private individuals.
This stand will hurt the country's poorest citizens in cash-strapped states. Medicaid's equal-access provision was an effort to prevent states from hollowing out the entitlement over time. But without a means of direct enforcement by private individuals, equal access will be little more than a paper promise and dependent upon the whims of whoever occupies the White House.