Dylan Scot Young
84 Geo. Wash. L. Rev. 511
The effect of the decision in National Federation of Independent Business v. Sebelius (“NFIB”), can be felt most directly in the eighteen states that refused to expand their Medicaid programs under the Patient Protection and Affordable Care Act. The pertinent legal ramifications of NFIB can be summarized as the establishment of an “Anti-Leveraging Principle” that provides a limit on the power of the Spending Clause. The real-world consequences, however, are much more important. The fact that states can now opt out of expanding Medicaid has left a gap in coverage for about three million citizens—those who are neither covered by their state’s Medicaid program, nor qualify for subsidies in the state or federally run Health Insurance Marketplaces. This gap can only be filled through a judicial solution that circumvents the inability of the federal government to force the Medicaid expansion itself. Roberts’s opinion in NFIB left intact the mandatory language of the act creating a new eligibility category covering all nonelderly low-income persons. This is the kind of strong language that, in providing a right directly to individuals and families, survives the recent restrictions on private enforcement of Spending Clause statutes under the Gonzaga-Blessing paradigm. Therefore, potential beneficiaries should be able to utilize 42 USC § 1983 to enforce this right-creating language. This Note explores how this predicament developed, explains the § 1983 claim in relation to the Medicaid Act, and elucidates how the language added by the Affordable Care Act can be enforced just as previous Medicaid provisions have been—by class actions seeking injunctions.
*Dylan Scot Young was awarded The Howard J. Rudge Best Note Award for authoring the best student note being published in Volume 84 of The George Washington Law Review.
