Florida v. Department of Health and Human Services

Whether the Patient Protection and Affordable Care Act's expansion of the Medicaid law exceeds Congress's power under the Spending Clause of Article I.

(In its review of the healthcare law, the Supreme Court granted certiorari to each issue independently. This is a summary of the first question presented by petitioners. One hour of argument time allotted on this question.)

The Patient Protection and Affordable Care Act (“Act”), as amended by the Healthcare and Education Reconciliation Act of 2010, seeks in part to expand Medicaid coverage by extending eligibility for Medicaid to individuals under 65 with incomes up to 133 percent of the federal poverty level. The Act provides that the federal government will pay 100 percent of the expenditures required to cover these newly eligible Medicaid recipients through 2016. Thereafter, the Act imposes on the states an obligation to pay up to 10 percent of the cost to fund the expansion of coverage. Twenty-six states brought suit against the federal Health and Human Services, Treasury, and Labor Departments and their Secretaries arguing that the Act is unconstitutional under South Dakota v. Dole as unduly coercive on the states

The District court granted summary judgment in favor of the Government holding that Congress had the power to expand Medicaid coverage. On appeal, the 11th Circuit affirmed, holding that the Act's Medicaid expansion is constitutional because, while the Act puts pressure on the states to comply, the states still have a real choice to participate, and the Act is not so coercive as to violate the Tenth Amendment's restriction on the use of the spending power to encourage state legislation. The Supreme Court granted certiorari because of a circuit split.