Attorney General Kamala D. Harris Files U.S. Supreme Court Brief in Support of Medicaid Expansion

Friday, February 17, 2012
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SAN FRANCISCO -- Attorney General Kamala D. Harris has filed a friend-of-the-court brief in the U.S. Supreme Court urging the court to uphold the constitutionality of the landmark federal healthcare reform law’s Medicaid expansion which has helped millions of Americans obtain insurance.

The Patient Protection and Affordable Care Act of 2010 (ACA) increases health care coverage in a variety of ways, including expanding Medicaid eligibility to nearly all non-elderly adults who earn up to 133 percent of the federal poverty line. This is expected to expand health insurance coverage to 11.2 million people nationwide, including 1.9 million Californians. California was one of the first states to begin covering low-income adults, ages 19 to 64, who would not have otherwise qualified for Medi-Cal. As of October 2011, more than 220,000 Californians were covered through the program, which also provides funds for hospital care and public health initiatives.

“Millions of previously uninsured Californians now have access to quality health care due to federal law,” said Attorney General Harris. “Extending Medicaid to all low-income adults is vital to ensuring that every individual has access to affordable and reliable health insurance. Every individual deserves to be treated with dignity and to receive the care they need.”

Attorney General Harris, joined by 11 other attorneys general, argued in the brief filed today in the U.S. Supreme Court that the ACA does not coerce states into action, but maintains the fundamental Medicaid arrangement of a federal-state cooperative program.

The amicus brief argues that Congress has the authority to define the central requirements of the program according to federal objectives and to provide financial incentives for states to comply with these basic requirements. Since Medicaid’s enactment over 45 years ago, Congress has frequently extended coverage to new populations in response to changing policy concerns. The ACA’s Medicaid expansion is no different.

“The Medicaid expansion significantly changes who is eligible for Medicaid, but the ACA does not change the basic structure of the program or how the program is implemented. Medicaid has always been a cooperative partnership between the federal government and the States, and the ACA does not change that. The Act continues the tradition of State flexibility and experimentation that has been the hallmark of cooperative federalism, by allowing the States to apply for federal grants, seek waivers, operate demonstration projects, and otherwise exercise discretion in implementing Medicaid. The ACA thus strikes an appropriate, and constitutional, balance between national requirements that will expand access to affordable healthcare and State flexibility to design programs that achieve that goal,” the amicus brief states.

The federal government is covering the lion’s share of the costs for this expansion, paying 100 percent of the costs until 2016 and 90 percent or more thereafter.

Other states joining California in this brief are Connecticut, Delaware, Hawaii, Illinois, Iowa, Maryland, Massachusetts, New Mexico, New York, Oregon and Vermont. The brief is also joined by the Governor of Washington.

Attorney General Harris has vigorously defended the constitutionality of federal health care reform. Joined by other attorneys general, she has filed three briefs in the U.S. Supreme Court and five briefs in the federal appellate courts urging the courts to uphold the Patient Protection and Affordable Care Act.

A copy of the amicus is attached to the online version of this release at

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