Health Care Reform: The Tea Party Goes To Court

The first federal complaint against the Patient Protection and Affordable Care Act filed by 13 state attorneys general is stunning not just for the remedies it seeks from the federal government but for the stark picture it paints of the current gulf between federal and state interests. The pleading reads more like a bold declaration of war, by overburdened local officials against an overbearing and remote federal power, than it does the latest sorry episode of a particularly hysteric time in American history. The Tea Party, in other words, is alive and well and now in federal court.

You thought that state and federal government are supposed to work together for the common good, right? Sorry. It's lions and hyenas here. Right off the bat, from the complaint: "The Act represents an unprecedented encroachment on the liberty of individuals living in the Plaintiffs' respective states, by mandating that all citizens and legal residents of the United States have qualifying healthcare coverage or pay a tax penalty. The Constitution nowhere authorizes the United States to mandate, either directly or under threat of perjury, that all citizens and legal residents have qualifying healthcare coverage." 

But the states are okay with Medicaid, right? Wrong. The current Medicaid scheme itself is under fire because of its role in implementing many of the new requirements of the Act. For example, the complaint reads: None of the states involved "agreed to become a Medicaid partner of the federal government with an expectation that the federal government would exploit its control over Medicaid terms and eligibility as part of a coercive scheme to force all citizens and residents to have healthcare coverage."

Worse, the states complain, if they are forced to "participate in the Act" they will "have to expand their Medicaid coverage to include all individuals under age 65 with incomes up to 133 percent of the federal poverty level." If we had wanted to provide health insurance for the poorest Americans we would have done so already, goes this argument. A logical one to make to the otherwise well-off, until you consider the raw data. Based upon 2008 statistics, Florida alleges, it has 3,641,933 "uninsured persons living in the state. Of those persons, 1,259,378 are below 133 percent of the federal poverty line, and therefore must be added to Florida's Medicaid rolls under the Act."

Let's leave aside for the moment the sheer size of those numbers--and the fact that the shame they represent has been thrown back in the faces of the very people now authorized to help. What argument on behalf of the states does this really represent? We have done such a horrible job in getting our own citizens health insurance over the years that now its too late for you feds to come in and help? The problem has become too great for us to handle but we aren't going to let you try, either? If you send us a bag man we'll drop the lawsuit and talk?

Its only a few paragraphs later in the complaint where we are all reminded that the federal government already is massively subsidizing Medicaid in Florida (and elsewhere). It's a matter of dollars, in other words, not state soverignty or federalism. The grand constitutional offense evidently only comes when the steeper price tag does. From the complaint: "In sum, while the Act infringes on Florida's constitutional status as a soveign, entitled to cooperate with but not to be controlled by the federal government under the Medicaid program, the Act also will force Florida to cover more than one million additional persons and, in doing so, to spend billions of additional dollars, a price it simply cannot afford to pay."

There are no great surprises here. The complaint touches upon all of the grand, eternal constitutional questions--the Commerce Clause, the Taxing and Spending Clause, the 10th Amendment, etc--that legal analysts and law professors have been discussing for weeks. There are lots of references to state sovereignty, and to the "right to a republican form of government," and to the doctrine of federalism, which is to say all the hallmarks of a fight between the competing jurisdictions in our multi-layered legal confederation.

What's different is the language of the complaint. It is a powerful blend of law and politics, with different messages being sent in different places in the document to different conservative constituencies. The last time we saw this in federal court may have also been in northern Florida, nearly ten years ago now, when case ultimately titled Bush v. Gore decided a presidential election and condemned us all to at least another ten years of this sort of partisan nastiness in Washington.