Health Law and Policy at George Washington University School of Public Health and Health Services, Washington, DC, USA.
Health Aff (Millwood). 2012 Aug;31(8):1663-72. doi: 10.1377/hlthaff.2012.0766.
In National Federation of Independent Business v. Sebelius, the US Supreme Court upheld the constitutionality of the requirement that all Americans have affordable health insurance coverage. But in an unprecedented move, seven justices first declared the mandatory Medicaid eligibility expansion unconstitutional. Then five justices, led by Chief Justice John Roberts, prevented the outright elimination of the expansion by fashioning a remedy that simply limited the federal government's enforcement powers over its provisions and allowed states not to proceed with expanding Medicaid without losing all of their federal Medicaid funding. The Court's approach raises two fundamental issues: First, does the Court's holding also affect the existing Medicaid program or numerous other Affordable Care Act Medicaid amendments establishing minimum Medicaid program requirements? And second, does the health and human services secretary have the flexibility to modify the pace or scope of the expansion as a negotiating strategy with the states? The answers to these questions are key because of the foundational role played by Medicaid in health reform.
在“全国独立企业联合会诉西贝柳斯案”中，美国最高法院维持了要求所有美国人都拥有负担得起的医疗保险的规定的合宪性。但在一项史无前例的举措中，七位大法官首先宣布强制性医疗补助资格扩大规定违宪。然后，由首席大法官约翰·罗伯茨（John Roberts）领导的五位大法官通过设计一种补救措施，简单地限制了联邦政府对其规定的执行权力，并允许各州在不失去所有联邦医疗补助资金的情况下不扩大医疗补助，从而防止了对该扩大规定的彻底取消。法院的做法提出了两个基本问题：第一，法院的裁决是否也影响现有的医疗补助计划或《平价医疗法案》中为数众多的其他医疗补助修正案，这些修正案确立了医疗补助计划的最低要求？第二，卫生与公众服务部长是否有灵活性来修改扩大范围或扩大范围的步伐，作为与各州的谈判策略？这些问题的答案至关重要，因为医疗补助在医疗改革中起着基础性的作用。
