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IN THE UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF FLORIDA
PENSACOLA DIVISION
STATE OF FLORIDA, by and through ) BILL McCOLLUM, ATTORNEY GENERAL ) OF THE STATE OF FLORIDA, et al., ) ) Plaintiffs, ) ) v. ) Case No.: 3:10-CV-91-RV/EMT ) ) UNITED STATES DEPARTMENT OF ) HEALTH AND HUMAN SERVICES, et al., ) ) Defendants. ) __________________________________________)
BRIEF OF GOVERNORS TIM PAWLENTY AND DONALD L. CARCIERI AS AMICI CURIAE IN SUPPORT OF PLAINTIFFS’
MOTION FOR SUMMARY JUDGMENT
Hans F. Bader (D.C. Bar # 466545) Counsel of Record Sam Kazman Competitive Enterprise Institute 1899 L Street, NW, 12th Floor Washington, DC 20036 Telephone: (202) 331-2278 Facsimile: (202) 331-0640 Counsel for Amici Curiae Governors Tim Pawlenty and Donald L. Carcieri
i
TABLE OF CONTENTS
I. INTEREST OF AMICI ...................................................................................1
II. ARGUMENT ....................................................................................................2
The Affordable Care Act is Unconstitutionally Vague and Indefinite ..............2
A. The ACA’s Ambiguity Renders It Illegitimate Under Spending-Clause Jurisprudence, Which Requires That Federal Conditions Be Clear and Definite Enough to Be Contractually Valid and Enforceable .......................... 2
B. The ACA’s Complexity Accentuates Its Vagueness .......................................... 4
C. The ACA’s Vagueness Is Aggravated by the Vast Discretion and Virtual Blank Check It Gives to the Federal Officials Who Implement It ...............6
D. The Law’s Expansive Reach Makes Its Nebulousness More Grave ............. 10
E. By Leaving the Federal Government With Unbridled Power to Expand States’ Medicaid Obligations, the ACA Violates Principles Forbidding Illusory and Indeterminate Contracts.................................................................. 13
ii
TABLE OF AUTHORITIES Cases
Arlington Cent. Sch. Dist. Bd. of Educ. v. Murphy, 548 U.S. 291 (2006) .............................. 3, 4, 6 Association Ben. Services, Inc. v. Caremark RX, Inc., 493 F.3d 841 (7th Cir. 2007) ..................... 3 Barnes v. Gorman, 536 U.S. 181 (2002) .................................................................................. 3, 4 Botts v. State, 604 S.E.2d 512 (Ga. 2004) .................................................................................. 10 Cheek v. U.S., 498 U.S. 192 (1991) ............................................................................................. 6 Livermore v. Heckler, 743 F.2d 1396, 1403 (9th Cir. 1984) .......................................................... 4 Matter of T & B General Contracting, 833 F.2d 1455 (11th Cir. 1987) ........................................ 3 Nebraska v. E.P.A., 331 F.3d 995 (D.C. Cir. 2003) ...................................................................... 4 New York v. United States, 505 U.S. 144 (1992) .......................................................................... 2 Pennhurst State School & Hosp. v. Halderman, 451 U.S. 1 (1981) ........................................ 3, 14 Purgess v. Sharrock, 33 F.3d 134 (2d Cir. 1994) ....................................................................... 13 Reno v. ACLU, 521 U.S. 844 (1997) .......................................................................................... 12 South Dakota v. Dole, 483 U.S. 203 (1987) ......................................................................... 1, 3, 6 Virginia v. Riley, 106 F.3d 559 (4th Cir. 1997) ........................................................................... 12 Young & Vann Supply Co. v. Gulf F. & A. Ry. Co., 5 F.2d 421 (5th Cir.1925) ............................ 13
Constitutional Provisions
Minn. Const., Art. IV, § 23 .......................................................................................................... 1 Minn. Const., Art. XIII, § 1 ......................................................................................................... 1 Rhode Island Const., Art. IX, § 15 ............................................................................................... 1 Rhode Island Const., Art. XII ...................................................................................................... 1 Spending Clause................................................................................................................ 1, 3, 15 Tenth Amendment....................................................................................................................... 2
Treatises
Restatement (Second) Contracts ............................................................................................ 3, 14 Williston on Contracts (4th ed. Updated 2010) .......................................................................... 14
Other Authorities
Abelson, Health Rules Are Waived More Often, New York Times, Nov. 10, 2010, at B2 ............. 7 Abelson, Waivers Aim at Talk of Dropping Health Coverage, New York Times, Oct. 7, 2010, at
B1 ........................................................................................................................................... 8 Chen, How Obamacare Burdens Already Strained State Budgets, Heritage Foundation, Nov. 10,
2010 (Backgrounder #2489) .................................................................................................. 12 Congressional Research Service, Deadlines for the Secretary of Health and Human Services in
the Patient Protection and Affordable Care Act, Oct. 1, 2010, at 1 ........................................... 8 Congressional Research Service, Summary of Potential Employer Penalties Under PPACA (P.L.
111-148), Apr. 5, 2010 .......................................................................................................... 11
iii
Department of Health and Human Services, Approved Applications for Waiver of the Annual Limits Requirements of the PHS Act Section 2711 As of Nov. 1, 2010 ...................................... 7
Freire, Dems Admit CEO’s Were Right to Report Losses from Obamacare, Washington Examiner, April 27, 2010 ........................................................................................................ 8
Georgetown Health Policy Institute Center for Children and Families, Medicaid and State Budgets: Looking at the Facts (2008) .................................................................................... 12
Hacker, Health Reform 2.0, American Prospect, Sept. 1, 2010, at A25 ....................................... 14 Haislmaier & Blase, Obamacare: Impact on States, Heritage Foundation, July 1, 2010
(Backgrounder #2433) ..................................................................................................... 10, 11 Joint Economic Committee Republicans, America’s New Health Care System Revealed: Updated
Chart Shows Obamacare's Bewildering Complexity, Committee News, Aug. 2, 2010 .............. 4 Joint Economic Committee, Republican Staff, Your New Health Care System, ............................ 4 Malkin, Creators Syndicate, Repeal Is the Ultimate Obamacare Waiver, Washington Examiner,
Nov. 18, 2010, at 43 ............................................................................................................ 7, 8 Sen. Tom Coburn, HHS Administrative Failure: HHS Failed to Meet a Third of Mandated
Deadlines Under New Federal Health Care Law, Oct. 4, 2010 ................................................ 9 Senator Tom Harkin, Health Legislation A Solid Foundation to Build Upon, Wilmington News-
Journal, Dec. 30, 2009 ........................................................................................................... 13 Siegel, Obamacare Will Clog America’s Medical System, USA Today, Oct. 19, 2010, at 9A ....... 8 Surber, Obamacare Leads to 47% Premium Hike, Charleston Daily Mail, Oct. 16, 2010 ............. 8
1
I.
INTEREST OF AMICI
As the Governors of Minnesota and Rhode Island, respectively, amici Tim
Pawlenty and Donald L. Carcieri have a direct interest in this case. The Patient
Protection and Affordable Care Act of 2010 (“ACA”) fundamentally transforms
Medicaid and will effectively co-opt control over the States’ budgetary processes
and legislative agendas, crowding out spending on other state priorities, including
duties that are mandated by state constitutions.1 Given their role in shaping and
overseeing state budgets, the Governors have a vital stake in ensuring that basic
limits on the federal government’s spending power are maintained.2 One of those
limits is that any conditions imposed by federal law must be clear, so that States
may exercise their choice to accept or reject federal funds “knowingly, cognizant
of the consequences of their participation.”3
On November 12, this Court granted
the Governors leave to file their amicus brief (Docket # 108).
1 See, e.g., Minn. Const., Art. XIII, § 1 (state has “duty” to “establish a general and uniform system of public schools” that is “thorough and efficient”); Rhode Island Const., Art. XII (state has “duty” to “promote public schools and public libraries” to foster “diffusion of knowledge,” and to not “divert” education funds). 2 See, e.g., Rhode Island Const., Art. IX, § 15 (Governor “shall prepare and present” the state budget “to the general assembly”); Minn. Const., Art. IV, § 23 (line-item veto). 3 South Dakota v. Dole, 483 U.S. 203, 207 (1987).
2
II.
ARGUMENT
The Affordable Care Act is Unconstitutionally Vague and Indefinite
A. The ACA’s Ambiguity Renders It Illegitimate Under Spending-Clause Jurisprudence, Which Requires That Federal Conditions Be Clear and Definite Enough to Be Contractually Valid and Enforceable
As plaintiffs rightly note, the ACA “violates the principle that conditions on
federal funds must be unambiguous, so as to ‘enable the states to exercise their
choice knowingly, cognizant of the consequences of their participation.’”4 This is
both because the ACA includes “vast potential liabilities that cannot even be
projected as of now,” and because “the ACA’s sweeping changes could not
reasonably have been foreseen by the states when they started their Medicaid
programs.”5
Even looking at the ACA purely from the vantage point of the present,
rather than when States began participating in Medicaid, the ACA is so ambiguous
and indefinite that it is facially unconstitutional, as we explain below. This
vagueness undermines political accountability and thus aggravates the ACA’s
unduly coercive aspects, in violation of the Tenth Amendment.
As a result, the States could not have voluntarily and knowingly
assumed the burdens and liabilities now imposed on them by the ACA.
6
4 Memorandum In Support of Plaintiffs’ Motion for Summary Judgment at 36.
5 Id.. at 42, 45. 6 See New York v. United States, 505 U.S. 144, 168 (1992) (Spending Clause legislation’s legitimacy is rooted in the fact that “where Congress encourages state regulation rather than compelling it, state governments remain responsive to the local electorate's preferences; state officials remain accountable to the people.”; “Accountability is thus
3
The Supreme Court has repeatedly characterized legislation enacted
pursuant to the spending power as “much in the nature of a contract: in return for
federal funds, the States agree to comply with federally imposed conditions.”7
But even if States could choose to stop participating in the Medicaid
program, the ACA is so vague that it does not – and cannot – allow the States “to
exercise their choice knowingly, cognizant of the consequences of their
participation.” Dole, 483 U.S. at 207 (quoting Pennhurst). The ACA fails to
speak “unambiguously,” Pennhurst, 451 U.S. at 17, about how a State can opt out
of Medicaid’s expansion, and what State compliance may mean if it opts in.
“The legitimacy of Congress’ power to legislate under the spending power thus
rests on whether the State voluntarily and knowingly accepts the terms of the
contract.” Pennhurst State School & Hosp. v. Halderman, 451 U.S. 1, 17 (1981).
Because the States are not given a clear and informed choice between
participation and non-participation, the Act lacks the hallmarks of contractual
enforceability. See, e.g., Matter of T & B General Contracting, 833 F.2d 1455,
1459 (11th Cir. 1987) (“Without a meeting of the minds on all essential terms, no
enforceable contract arises.”).8
diminished when, due to federal coercion, elected state officials cannot regulate in accordance with the views of the local electorate.”).
The Act is indefinite in other key respects as well,
so “we cannot fairly say that [a] State could make an informed choice.” Pennhurst,
7 Pennhurst, 451 U.S. 1, 17 (1981); see also Barnes v. Gorman, 536 U.S. 181, 186 (2002); Arlington Cent. Sch. Dist. Bd. of Educ. v. Murphy, 548 U.S. 291, 296 (2006). 8 See also Association Ben. Services, Inc. v. Caremark RX, Inc., 493 F.3d 841, 850 (7th Cir. 2007); Restatement (Second) Contracts, § 33; see Pennhurst, 451 U.S. at 17 (must show states’ acceptance of “the terms of the contract’”).
4
451 U.S. at 25. “There can, of course, be no knowing acceptance if a State is
unaware of the conditions or is unable to ascertain what is expected of it.”9
B. The ACA’s Complexity Accentuates Its Vagueness
The ACA is so mammoth, its provisions are so complex, and its passage
was so irregular that the federal attorneys who have spent the past eight months
defending it cannot even clearly identify its length. (See Tr. at 8, Docket # 77).
Its sheer complexity is aptly, but only partially, captured by the chart provided by
minority staff of the Joint Economic Committee, which is found on the next
page.10 (While that “chart displays a bewildering array of new government
agencies, regulations and mandates,” the reality is even more complicated, since
“committee analysts could not fit the entire health care bill on one chart. ‘This
portrays only about one-third of the complexity of the final bill. It’s actually worse
than this.’”11
9 Id. at 17-18; see Arlington Cent. Sch. Dist., 548 U.S. at 296; Barnes, 536 U.S. at 186. 10 See Joint Economic Committee, Republican Staff, Your New Health Care System, available at http://jec.senate.gov/republicans/public/?a=Files.Serve&File_id=5ee16e0f-6ee6-4643-980e-b4d5f1d7759a (visited Nov. 18, 2010); Nebraska v. E.P.A., 331 F.3d 995, 998 n.3 (D.C. Cir. 2003) (taking judicial notice of agency materials on web); Air Transport Ass’n v. U.S. Dep’t of Transp., 613 F.3d 206, 208 (D.C. Cir. 2010) (citing JEC report); Livermore v. Heckler, 743 F.2d 1396, 1403 (9th Cir. 1984) (report by JEC staff). 11 See Joint Economic Committee Republicans, America’s New Health Care System Revealed: Updated Chart Shows Obamacare's Bewildering Complexity, Committee News, Aug. 2, 2010 (quoting Rep. Brady), available at http://jec.senate.gov/republicans/public/index.cfm?p=CommitteeNews&ContentRecord_id=bb302d88-3d0d-4424-8e33-3c5d2578c2b0 (visited Nov. 18, 2010).
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Prep
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by:
Join
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an S
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an K
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Bra
dy,
Sen
ior
Hou
se R
epub
lican
Sena
tor
Sam
Bro
wnb
ack,
Ran
king
Mem
ber
Pat
ien
t Pro
tect
ion
& A
ffor
dab
le C
are
Act
, P.L
. 111
-148
;H
ealt
h C
are
& E
du
cati
on R
econ
cili
atio
n A
ct, P
.L. 1
11-1
52
§300
4
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5
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§10407
§10407
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§§3022, 10307
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§§13
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§§1341, 10104
§§12
01, 1
301,
130
4
§§12
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301,
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4
§1342
§130
1
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§§12
01, 1
301,
130
2
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§§1311, 10104
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1
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4
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1
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1
§134
2
§3012
§4004
§400
4
§4004
§4002
§104
09
§131
1
§670
3
§6703
§301
2
§400
1
§1512
§1511
§340
3, 1
0320
§4003
§800
2
§8002
§800
2
§800
2
§§90
01, 1
0901
; HC
ER
A §
1401
§§90
01, 1
0901
; HC
ER
A §
1401
§§1001, 10101
§9004
§9003
§§9009, 10904
§900
8; H
CE
RA
§14
04
§§90
10, 1
0905
; HC
ER
A §
1406
§9002
§§90
05, 1
0902
; HC
ER
A §
1403
§1501
§§13
11, 1
0104
§§3103, 10320
§1334, 10104
§§13
22, 1
0104
§133
3, 1
0104§1
312
§630
1
§3005
§301
1
§§3021, 10305, 10306
§302
6
§4001
§§30
06, 1
0301
§141
1
§4305
§1001
§§1201, 1301, 1302
§133
1, 1
0104
§1341, 10104
§8002
§1513, 10106
§660
5
§§2001-2004
§§90
17, 1
0907
§§15
01, 1
0106
; HC
ER
A §
§100
2, 1
004
§§90
15, 1
0906
; HC
ER
A §
1402
§901
3
§1511
§1511
§§1201, 1301
§1312
Titl
e II
I
§§32
01, 1
0318
; HC
ER
A §
1102
§8002
§§30
01, 1
0335
§6301
§§13
11
§§15
14, 1
0106
§132
1
§2703
§5605
§§1311, 10104
§630
1
§400
1
§9002
§800
2
§141
4
§1411
§2701
§340
3, 1
0320
§670
3
§1331, 10104
§2602
§3403, 10320
§1512
§§1514, 10106
§141
1
§141
1
§§30
01, 1
0335
§300
4§3
004
§3011
§302
1
§302
2, 1
0307
§3026
§270
1
§2701
§2701
§270
3
§400
1
§430
2
§3013
§141
1
§4004
§630
1
§630
1
§670
3
§301
1
§4305
§104
09
§331
1
§331
1
§302
1
§301
1
§3012
§800
2
§331
1
§§1311, 1413
§3005
§300
4
§141
1
§131
3, 1
0104
§§1001, 10101
§560
5
§1512
§560
5
Qua
lifie
d
Hea
lth
Plan
s§§
1301
, 130
2,13
11, 1
0104
Hea
lth
Car
e C
hoic
e C
omp
acts
§§13
33, 1
0104
Rei
nsur
ance
Pr
ogra
m§§
1341
, 101
04V
alue
-Bas
ed
Insu
ranc
e D
esig
n &
Cov
erag
e of
Pr
even
tive
Hea
lth
Serv
ices
§100
1
Op
tion
al
Basi
c H
ealt
h Pr
ogra
m§§
1331
, 101
04
GA
O§§
1401
, 300
1, 3
403,
630
1,10
105,
103
20
Com
ptr
olle
r G
ener
al§§
1313
, 132
2M
edPA
C§2
602
Stat
es§§
1311
,133
1,
1333
,134
1, 1
0104
, 10
407
Stat
e Su
rvey
ors
§670
3
Vit
al
Stat
isti
cs
Ag
enci
es§1
0407
US
Terr
itor
ies
§132
3; H
CE
RA
§12
04
Key
Nat
iona
l In
dic
ator
Sys
tem
Im
ple
men
tati
on
Inst
itut
e§5
605
Com
mis
sion
on
Key
In
dic
ator
s§5
605
Nat
iona
l Aca
dem
y of
Sci
ence
s§5
605
Con
gre
ssM
emb
ers
& P
erso
nal
Sta
ff
Man
dat
e:
Onl
y E
xcha
nge
Cov
erag
e§1
312
Nat
iona
lTr
aini
ng In
stit
ute
for
Fed
eral
and
St
ate
Surv
eyor
s§6
703
AH
RQ
§301
2, 3
013,
603
1
Ess
enti
alH
ealt
h B
enef
its
Pac
kag
e§§
1001
,120
1, 1
301,
130
2Pl
atin
umBr
onze
Silv
erG
old
Gov
ern
men
t H
ealt
h B
enef
it
Exc
han
ges
§§12
01, 1
301,
1302
, 131
1, 1
312,
131
3,
1321
, 132
3, 1
334,
141
1, 1
413,
101
04;
HC
ER
A §
1204
Inte
rnet
Po
rtal
§131
1
Dat
a C
olle
ctio
n§1
311
HH
S In
spec
tor
Gen
eral
§131
3, 8
002,
1010
4
Elig
ibili
ty
Det
erm
inat
ions
§141
1
Priv
acy
Stud
y§1
411
Secr
etar
yH
ealt
h &
Hu
man
Se
rvic
es
Hea
lth
Insu
ran
ceC
O-O
P§§
1322
, 101
04
CO
-OP
Ad
viso
ry
Boar
d§1
322,
101
04
Priv
ate
Purc
hasi
ng
Cou
ncil
§132
2
US
Prev
enti
ve
Serv
ices
Ta
sk F
orce
§100
1
Hea
lth
Savi
ngs
Acc
ount
s§§
9003
, 900
4
Med
icar
e Be
nefic
iari
es§3
311
Hea
lth
Insu
ranc
e Po
licy
Hol
der
§§10
01, 1
0101
Smal
l Em
plo
yers
§§13
04, 1
311,
142
1, 1
512,
10
105
Larg
e E
mp
loye
rs§§
1304
, 151
1, 1
512,
151
3,
1514
, 101
06
Med
icar
ePa
rt C
& P
art D
In
sure
rs§3
311
Larg
e G
roup
M
arke
t§§
1201
, 130
1, 1
511
Prem
ium
Tax
Cre
dit
Su
bsi
die
s§§
1401
, 141
2, 1
0105
; H
CE
RA
§§1
001,
10
04
Ann
ual F
ee§§
9010
, 109
05;
HC
ER
A §
1406
3.8%
In
vest
men
t In
com
e Ta
xH
CE
RA
§14
02
HSA
Use
Res
tric
tion
§900
3
Mis
use
ofH
SA F
und
s§9
004
“Cad
illac
Plan
s” T
ax§§
9001
, 109
01;
HC
ER
A §
1401
Sub
sid
ies:
Out
-of-
Pock
et
Exp
ense
s§§
1402
, 141
2;H
CE
RA
§100
1
Ind
ivid
uals
Man
dat
es, R
egul
atio
ns,
& T
axes
§§13
11, 1
411,
150
1, 9
003-
9005
, 901
3,
9015
, 901
7, 1
0106
, 109
02, 1
0906
, 109
07;
HC
ER
A §
§100
2, 1
004,
140
2, 1
403
“Exc
essi
ve
Prof
its”
§§10
01, 1
0101
Pat
ien
ts
Med
icar
ePa
yrol
l Tax
Incr
ease
: 0.9
%§§
9015
, 109
06;
HC
ER
A §
1402
Flex
ible
Sp
end
ing
A
rran
gem
ent
§900
5, 1
0902
; HC
ER
A §
1403
Onl
y M
edic
al E
xpen
ses
Ab
ove
10%
of I
ncom
e (A
GI)
are
Tax
D
educ
tib
le§9
013
FSA
C
ontr
ibut
ion
Lim
it: $
2,50
0§§
9005
, 109
02;
HC
ER
A§1
403
Ris
kC
orri
dor
s§1
342
Larg
e Bu
sine
ss
Em
plo
yees
§151
1, 1
512
Smal
l Bus
ines
s E
mp
loye
es§1
512
ME
WA
Hea
lth
Plan
s§§
1301
, 660
5
Self-
Insu
red
H
ealt
h Pl
ans
§130
1
Smal
l Gro
up
Mar
ket
§130
1, 1
304,
134
2In
div
idua
l Mar
ket
§120
1, 1
301,
130
4, 1
342
10%
Ta
x O
n In
doo
r Ta
nnin
g
Serv
ices
:§§
9017
, 10
907W
2 H
ealt
h In
sura
nce
Dis
clos
ure
§900
2
Ind
ivid
ual
M
and
ate:
Bu
y H
ealt
h In
sura
nce
§§15
01, 1
0106
;H
CE
RA
§§1
002,
100
4
Em
plo
yer
Man
dat
e:
Pro
vid
e H
ealt
h In
sura
nce
§§15
13, 1
0106
; H
CE
RA
§10
03
Man
dat
ory
Wor
ker
Aut
o-E
nrol
lmen
t§1
511
Smal
l Bu
sine
ssH
ealt
h In
sura
nce
Tax
Cre
dit
§§14
21,
1010
5
Insu
ran
ce
Man
dat
es
§§
1001
, 110
1,
120
1, 1
251,
1
0101
,
101
03;
HC
ER
A
§
2301
17
Hea
lth
Insu
ranc
e C
omp
anie
sM
and
ates
, Reg
ulat
ions
, R
equi
red
Ben
efit
s, &
Ta
xes
§§10
01, 1
201,
125
2, 1
301,
133
4, 1
341,
33
11, 9
001,
901
0, 1
0101
, 101
04, 1
0901
, 10
905;
HC
ER
A §
§140
1, 1
406
Em
plo
yers
Man
dat
es, R
egul
atio
ns,
& T
axes
§§15
11, 1
512,
151
3, 9
001,
900
2,
1010
6, 1
0901
; HC
ER
A §
§100
3, 1
401
Dem
onst
ra-
tion
Pro
gra
m§3
001
Pub
lic D
ata
Dis
clos
ure
Syst
em§3
006,
10
301
FFS
Acc
ount
able
C
are
Org
aniz
atio
ns
Prog
ram
§§30
22, 1
0307
Com
mun
ity-
Base
d C
are
Tran
siti
ons
Prog
ram
§302
6
Hos
pit
al
Qua
lity
Rep
orti
ng
Prog
ram
§300
4, 3
005
Med
icai
d
Hea
lth
Hom
e Pr
ogra
m§2
703
Fed
eral
C
oord
inat
ed
Hea
lth
Car
e O
ffice
§260
2
Med
icai
d
Qua
lity
Mea
sure
men
t Pr
ogra
m§2
701
Stat
e-Sp
ecifi
c A
dul
t H
ealt
h Q
ualit
y M
easu
res
§270
1
Med
icai
d
Exp
ansi
on:
+16
mill
ion
§§20
01-2
004
CBO
Cos
t Est
imat
e,3/
20/1
0
Stat
e M
edic
aid
A
gen
cies
§§26
02, 2
701,
270
3,
3011
Med
icar
eC
uts:
$52
8.9b
n(i
nclu
des
MA
cut
s)Ti
tle
III;
C
BO C
ost E
stim
ate,
3/2
0/10
Med
icar
e A
dva
ntag
e C
uts:
$20
5.9b
n§§
3201
, 103
18; H
CE
RA
§1
102;
CBO
Cos
t E
stim
ate,
3/
20/1
0
Sub
sid
y:
Med
icar
e Pa
rt D
D
rug
Pro
gra
m
“Don
ut H
ole”
§330
1; H
CE
RA
§1
101
Hos
pit
al
Com
par
e W
ebsi
te§3
001
Hos
pit
alV
alue
-Bas
ed
Purc
hasi
ng
Prog
ram
§§30
01, 1
0335
Cen
ter
for
Med
icar
e&
Med
icai
d
Inno
vati
on§§
3021
, 103
05,
1030
6 Phys
icia
n V
alue
-Bas
ed
Paym
ent
Mod
ifier
§§30
07
Ann
ual F
ee§9
008;
HC
ER
A
§140
4
Hos
pit
als
§§13
11, 3
001,
103
35
Skill
ed N
ursi
ng
Faci
litie
s§§
3006
, 103
10
§§30
06, 1
0301
Am
bul
ator
y Su
rgic
al C
ente
rs§§
3006
, 103
01
Hom
e H
ealt
h A
gen
cies
§300
6
Med
ical
Dev
ice
Man
ufac
ture
rs§§
9009
, 109
04;
HC
ER
A §
1405 Ph
arm
aceu
tica
l C
omp
anie
s§9
008;
HC
ER
A §
1404
Inp
atie
nt
Reh
abili
tati
on
Faci
litie
s§3
004
Hos
pic
e Pr
ogra
ms
§300
4
PPS-
Exe
mp
t C
ance
r H
osp
ital
s§3
005
Med
icar
e A
dm
inis
trat
ive
Con
trac
tors
§331
1
Hea
lth
Ind
ustr
y
Man
dat
es, R
egul
atio
ns,
Taxe
s, &
Pay
men
t Cut
s§§
1311
, 300
1-30
06, 3
311,
900
8, 9
009,
10
327,
103
31, 1
0335
, 109
04; H
CE
RA
§§
1404
, 140
5
Long
-Ter
mC
are
Hos
pit
als
§300
4
Med
ical
D
evic
eE
xcis
e Ta
x§§
9009
, 109
04;
HC
ER
A
§140
5IPA
B§3
403,
103
20
IPA
B C
onsu
mer
A
dvi
sory
C
ounc
il§§
3403
, 103
20Med
icar
e Pa
rt A
Tru
st
Fund
§302
6, 3
403,
63
01,9
015
Med
icar
e Pa
rt B
Tru
st
Fund
§302
6, 6
301
Pub
licH
ealt
h Q
ualit
y &
E
ffici
ency
Mea
sure
s D
evel
opm
ent
Prog
ram
§§30
13, 1
0304
Hou
rs o
f Ser
vice
D
eter
min
atio
n fo
r C
alcu
lati
ng
Em
plo
yer
Man
dat
e Pe
nalt
y§§
1513
, 101
06
Rul
es fo
r In
sura
nce
Cla
ims
Ap
pea
ls§1
001,
101
01
Hea
lth
IT P
olic
y C
omm
itte
e§1
561
Offi
ce o
f Pe
rson
nel
Man
agem
ent
§§13
34, 1
0104
Pres
iden
t§§
301
2, 3
024,
340
3, 4
001,
800
2, 1
0320
Cur
es
Acc
eler
atio
n N
etw
ork
Rev
iew
Boa
rd§1
0409
Nat
iona
l D
iab
etes
R
epor
t Car
d
Prog
ram
§104
07
CLA
SS
Ind
epen
den
ce
Bene
fit P
lan
§800
2
CD
C§§
1001
, 400
3, 4
004,
41
02, 1
0407
NIH
§§43
05, 6
301,
10
409
Nat
iona
l Pa
rtne
rshi
p o
n Pr
even
tion
&
Hea
lth
Prom
otio
n§4
004
Nat
iona
l Pu
blic
Ed
ucat
ion
Cam
pai
gn
on
Prev
enti
on &
Hea
lth
Prom
otio
n§4
004
Com
mun
ity
Prev
enti
ve
Serv
ices
Tas
k Fo
rce
§400
3
Nat
iona
l Ora
l H
ealt
h Pu
blic
E
duc
atio
n C
amp
aig
n§4
102
Cur
es
Acc
eler
atio
n N
etw
ork
§104
09
CLA
SS
Ind
epen
den
ce
Fund
Boa
rd o
f Tr
uste
es§8
002
Life
In
dep
end
ence
A
ccou
nts
§800
2
Nat
iona
l D
iab
etes
Mor
talit
y St
atis
tics
Ed
ucat
ion
Trai
ning
Pro
gra
m§1
0407
Elig
ibili
ty
Ass
essm
ent
Syst
em§8
002
Pers
onal
Car
e A
tten
dan
ts
Wor
kfor
ce
Ad
viso
ry P
anel
§800
2
CLA
SS
Ind
epen
den
ce
Fund
§800
2
CLA
SS
Ind
epen
den
ce
Ad
viso
ry
Cou
ncil
§800
2
Blac
k Lu
ng
Bene
fits
Act
§155
6
Offi
ce o
f M
ulti
-Sta
te Q
ualif
ied
H
ealt
h Pl
ans
§133
4, 1
0104
Pub
licH
ealt
h Se
rvic
e§§
3011
, 400
2, 4
302
Surg
eon
Gen
eral
§400
1
Ad
viso
ryG
roup
on
Prev
enti
on, H
ealt
h Pr
omot
ion,
and
In
teg
rati
ve a
nd
Pub
lic H
ealt
h§4
001
PCO
RI
Exp
ert
Ad
viso
ry
Pane
ls§6
301
PCO
RI
Met
hod
olog
y C
omm
itte
e§6
301
PCO
RI B
oard
of
Gov
erno
rs§6
301
PCO
RI
Web
site
§630
1
Stat
e Pr
otec
tion
&
Ad
voca
cy
Syst
ems
§800
2
Just
ice
Dep
artm
ent
§670
3
Nat
iona
l Pr
even
tion
, H
ealt
h Pr
omot
ion,
&
Pub
lic H
ealt
h C
ounc
il§4
001
Prev
enti
on
Web
site
§400
4
Web
site
“Tra
nsp
aren
cy
in G
over
nmen
tӤ1
552
Prev
enti
on&
Pub
lic
Hea
lth
Fund
§400
2
Inte
rag
ency
W
orki
ng G
roup
on
Hea
lth
Car
e Q
ualit
y§3
012
PCO
RI
Trus
t Fun
d§6
301
PC
OR
I§§
6301
, 106
02
Soci
alSe
curi
ty
Ad
min
istr
atio
n§1
411
Hom
elan
d
Secu
rity
D
epar
tmen
t§1
411
Lab
or
Dep
artm
ent
§§10
01, 1
302,
131
1, 1
511,
151
2,
1513
, 660
5, 1
0101
, 101
06
CLA
SS
Prog
ram
§800
2
Offi
ceof
Tax
A
naly
sis
§§13
31, 1
0104
Eld
er
Just
ice
Coo
rdin
atin
g
Cou
ncil
§670
3
Ad
viso
ryBo
ard
on
Eld
er
Ab
use,
Neg
lect
, &
Exp
loit
atio
n§6
703
Mul
ti-
Dis
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6
This enormous complexity accentuates its vagueness,12
Thus, the Plaintiff States cannot be expected to “exercise their choice knowingly,
cognizant of the consequences of their participation.” Dole, 483 U.S. at 207.
and makes it all but
impossible to comprehend “from the perspective of a state official who is engaged
in the process of deciding whether the State should accept [federal] funds and the
obligations that go with those funds.” Arlington Cent. Sch. Dist., 548 U.S. at 291.
C. The ACA’s Vagueness Is Aggravated by the Vast Discretion and Virtual Blank Check It Gives to the Federal Officials Who Implement It
Even if the ACA’s text were fully understood, many of its requirements would
ultimately be unknowable due to the unprecedented discretion granted to federal
officials to implement key provisions. States, for example, will be required to
“develop service systems” to provide long-term care that “allocate resources for
services in a manner that is responsible to the changing needs and choices of
beneficiaries . . . .” ACA § 2404(a). The substance of this vague mandate is
delegated to the discretion of the Secretary of Health and Human Services. Id.
Similarly, states must provide individuals who are “newly eligible” for
Medicaid with “benchmark” coverage. ACA § 2001(a)(2)(A). The substance of
this mandate too is expressly delegated to the discretion of the Secretary. ACA §§
2001(c)(3), 1302(a), (b). The Secretary is also empowered to determine, inter
alia, state enrollment programs for Medicaid and CHIP, ACA § 1413(a), obstetric
12 Cheek v. U.S., 498 U.S. 192, 199-200 (1991)(“complexity” of statutes can make “it difficult for the average citizen to know and comprehend” their requirements); Hope Clinic v. Ryan, 195 F.3d 857, 866-67 (7th Cir. 1999), vacated, 530 U.S. 1271 (2000) (“complex” provisions can result in “unfair surprise”).
7
and smoking cessation services that must be provided by the states, ACA §§ 2301,
4107, and myriad data collection, evaluation, and reporting requirements that must
be carried out by the states, see, e.g., ACA §§ 2001(d)(1)(C), 2701, 2951.
The Secretary’s vast discretion in implementing the ACA is illustrated by
the more than 111 waivers that she has granted to employers whose health care
plans were unable to satisfy the ACA’s costly mandates.13 1.2 million employees
participate in the health plans that have already received waivers, and far more
may be affected in the future.14 These waivers are not permanent, but last for only
one year, adding further uncertainty.15 Moreover, there is no telling whether these
ad hoc waivers, some of which were granted to politically-influential unions or
businesses that supported the Administration and the ACA’s passage,16 will
granted in the future to anyone else.17
13 E.g., Reed Abelson, Health Rules Are Waived More Often, New York Times, Nov. 10, 2010, at B2 (available at
If not, States may face enormous additional
www.nytimes.com/2010/11/10/health/policy/10waiver.html); Department of Health and Human Services, Approved Applications for Waiver of the Annual Limits Requirements of the PHS Act Section 2711 As of Nov. 1, 2010, available at http://www.hhs.gov/ociio/regulations/approved_applications_for_waiver.html. 14 Abelson, Health Rules Are Waived More Often, N.Y. Times, Nov. 10, 2010, at B2. 15 Department of Health and Human Services, Approved Applications for Waiver of the Annual Limits Requirements of the PHS Act Section 2711 As of Nov. 1, 2010, available at http://www.hhs.gov/ociio/regulations/approved_applications_for_waiver.html; see Abelson, Health Rules Are Waived More Often, N.Y. Times, Nov. 10, 2010, at B2. 16 See Michelle Malkin, Creators Syndicate, Repeal Is the Ultimate Obamacare Waiver, Washington Examiner, Nov. 18, 2010, at 43 (www.washingtonexaminer.com/opinion/ columns/Repeal-is-the-ultimate-Obamacare-waiver-1595832-108685514.html). 17 See Michelle Malkin, Waiver-Mania! The Ever-Expanding Obamacare Escapee List, Nov. 14, 2010, at 10:26 a.m. (http://michellemalkin.com/2010/11/14/waiver-mania-the-ever-expanding-obamacare-escapee-list/) (arguing that Obama Administration is granting these “temporary” waivers not out of “compassion” or for consistent policy reasons, “but out of a panicked urgency to avoid a public relations disaster” of employers dumping large numbers of employees from health insurance shortly after passage of a law that the
8
costs, both from people who lose their employer-provided health insurance18 and
end up on state-subsidized Medicaid programs, and, to a lesser extent, from the
burdens it imposes on state employers (such as increased premium costs,19 and
assessments imposed on employers for failure to offer the level of insurance
mandated under ACA rules.) The Secretary’s vast discretion in writing and
waiving ACA rules makes predicting these costs simply impossible, and makes it
impossible for States to ascertain “the consequences of their participation,” Dole,
483 U.S. at 207. (Many rules that HHS is supposed to issue to implement the
ACA’s vague requirements have not been issued yet, and either have no statutory
deadline at all,20 or have deadlines that have been flouted.21
President promised would allow employees to keep their healthcare plan if they liked it); Reed Abelson, Waivers Aim at Talk of Dropping Health Coverage, New York Times, Oct. 7, 2010, at B1 (Obama Administration “tried to defuse stiffening resistance” to ACA through waivers, “as part of a broader strategic effort” to mollify critics “at a time when the midterm elections are looming”; White House official “acknowledged that the concessions given to companies and insurers reflected attempts to avoid having people lose their current coverage before the full law goes into effect”; “politics from state to state” cited as factor in debate over how stringently to enforce ACA mandates) (http://www.nytimes.com/2010/10/07/business/07insure.html)
).
18 In the absence of waivers, many employers will drop their health care plans. See, e.g., Michelle Malkin, Repeal Is the Ultimate Obamacare Waiver, Washington Examiner, Nov. 18, 2010, at 43 (Fowler Packing Company “pursued an HHS waiver because their low-wage agricultural workers would have lost the[ir] basic coverage” absent a waiver, stripping “large numbers of workers” of “access to affordable coverage.’”) 19 See Dr. Marc Siegel, Obamacare Will Clog America’s Medical System, USA Today, Oct. 19, 2010, at 9A (ACA pointlessly drives “up costs and premiums”) (available at www.usatoday.com/news/opinion/forum/2010-10-19-column19_ST_N.htm); J. P. Freire, Dems Admit CEOs Were Right to Report Losses from Obamacare, Wash. Examiner, April 27, 2010, at 1:24 p.m. (www.washingtonexaminer.com/opinion/blogs/beltway-confidential/dems-admit-ceos-were-right-to-report-losses-from-obamacare-92199744.html); cf. Don Surber, Obamacare Leads to 47% Premium Hike, Charleston Daily Mail, Oct. 16, 2010, 9 a.m. (http://blogs.dailymail.com/donsurber/archives/22999). 20 See Congressional Research Service, Deadlines for the Secretary of Health and Human Services in the Patient Protection and Affordable Care Act, Oct. 1, 2010, at 1 (ACA rules
9
It also remains unclear whether many state employers will be able to
benefit from the Act’s “grandfather clause” provision protecting existing health
plans from some of the ACA’s costly mandates, as even the government’s own
estimates suggest.22
As the Congressional Research Service notes, “Given the complexity of the
health care system prior to PPACA, and the many changes generated by the new
law, the impact on states will vary and will be difficult to estimate, even with the
HHS has adopted regulations construing that provision so
narrowly so that it arguably does not apply to the majority of employers. George
Pantos, Manage Rising Health Care Costs, Atlanta Journal-Constitution, Sept. 20,
2010, at A21 (“The Obama administration has released its rules governing
‘grandfathered’ insurance plans. Those that qualify will remain legal . . .Those that
don't will have to comply with costly new mandates. Throughout his campaign
for health reform, the president vowed that he wouldn't disrupt Americans'
existing policies. These rules are . . . .so onerous, though, that most employers will
find it impossible to follow them.”) (found in Westlaw at 2010 WLNR 19387643).
“generally” have “flexible deadlines or no deadline at all”) (available at http://coburn.senate.gov/public/index.cfm?a=Files.Serve&File_id=54103bf6-ae3a-47be-916e-72548ba34b5b). 21 See id. at 3-5 (“no public information found” for many rules that were due to be issued by now); Sen. Tom Coburn, HHS Administrative Failure: HHS Failed to Meet a Third of Mandated Deadlines Under New Federal Health Care Law, Oct. 4, 2010, available at http://coburn.senate.gov/public/index.cfm/rightnow?ContentRecord_id=f6efe11e-39bc-4532-a586-d1ad0b608e80. 22 See Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act, 75 Fed. Reg. 34538, 34552 (June 17, 2010) (employers relinquishing grandfather status estimated at between 33% to 69% for all employers, with large employers ranging between 29% and 64%).
10
best modeling.”23
“State impacts will vary based on current coverage levels across states, generosity of the state’s Medicaid/CHIP eligibility rules and other state-financed coverage programs, existing private insurance regulatory authority, standards, and resources, current state fiscal health, and other factors. Such variation creates difficulties in accurately estimating costs across states. There are substantial differences among states in terms of the percentages of the states’ populations that would meet the definition of “newly eligible” under the mandatory Medicaid expansion as compared to previously eligible individuals. Federal matching rates to share in the cost of Medicaid/CHIP coverage for these individuals under health reform will vary by state, by year, and by eligibility status.”
Moreover, the ACA’s Medicaid costs will vary widely among
States:
24
Moreover, “Beyond the extra Medicaid costs that states are certain to incur, there
are some other state Medicaid cost increases that are probable, but not definite,”
such as “payments to so-called Disproportionate Share Hospitals (DSH) and
payments to specialist physicians.”
25
D. The Law’s Expansive Reach Makes Its Nebulousness More Grave
These uncertainties and variations matter enormously because of the
massive scope of the ACA’s expansion of state Medicaid obligations and the
ACA’s vast delegation of policymaking to federal officials.26
23 Congressional Research Service, Memorandum re: Variation in Analyses of PPACA’s Fiscal Impact on States, Sept. 8, 2010, at 1 (Pl. App. Ex. 36).
“Obamacare’s
24 Id. at 7. 25 Edmund Haislmaier & Brian Blase, Obamacare: Impact on States, Heritage Foundation, July 1, 2010 (Backgrounder #2433), available at http://www.heritage.org/Research/Reports/2010/07/Obamacare-Impact-on-States. 26 See Botts v. State, 604 S.E.2d 512, 515 (Ga. 2004) (“broad language” of statute made its imprecise contours “too vague” to be constitutional, even though those words had a “dictionary definition,” especially since their broad reach had the effect of delegating “basic policy matters” to government officials on “an ad hoc” basis).
11
unfunded mandates are a fiscal time bomb set to explode state balance sheets
across the country starting in 2014,” creating a fiscal “crisis,” notes the Heritage
Foundation.27 The ACA will force States to “massively expand their already
burdensome Medicaid rolls” to include “all non-elderly individuals with family
incomes below 138 percent of the federal poverty line.”28 “But that is just the
benefit costs. Obamacare does not pay for any of the costs necessary to administer
the expansion of the Medicaid rolls, rolls that are expected to increase by
approximately 50 percent in states like Nevada, Oregon, and Texas”; indeed, “just
the administrative costs of the Obamacare Medicaid expansion will cost almost
$12 billion by 2020.” 29
27 Heritage Foundation, Morning Bell: The Obamacare Burden To Your State Budget, November 12th, 2010 at 9:22am (
While the ACA’s precise costs are unknown, preliminary
estimates suggest staggering increases. In Texas alone, “the Medicaid expansion
may add more than 2 million people to the program and cost the state up to $27
billion in a decade,” while Florida faces “an additional $5.2 billion in spending
between 2013 and 2019 and more than $1 billion a year beginning in 2017,” and
California faces billions in “annual costs”; “The seven-year cost of the Medicaid
expansion in Indiana is estimated to be between $2.59 billion and $3.11 billion,
with 388,000 to 522,000 people joining the state’s Medicaid rolls,” while
http://blog.heritage.org/2010/11/12/morning-bell-the-obamacare-burden-to-your-state-budget/). 28 Id. The 138 percent figure reflects “the 133 percent FPL [federal poverty level] plus extra 5% FPL that is to be disregarded from individuals’ income when determining Medicaid eligibility.” See Congressional Research Service, Summary of Potential Employer Penalties Under PPACA (P.L. 111-148), Apr. 5, 2010, at pg. 2 (available at http://www.ltgov.ri.gov/smallbusiness/employerprovisions.pdf). 29Heritage Foundation, The Obamacare Burden To Your State Budget, supra note 27, citing Haislmaier & Blase, supra note 25.
12
“Obamacare will result in nearly one of five Nebraskans being covered by
Medicaid.30 (While increasing the States’ costs, the ACA apparently reduces
some of their revenues, such as pharmacy rebate revenue.31
The indefinite nature of the States’ long-run financial commitments to
Medicaid make the ACA on its face contractually infirm and hence
unconstitutional. It also undermines political accountability and aggravates the
coerciveness and unduly burdensome nature of the Act.
)
32
Although the Act indicates that the federal government will initially pay for
some Medicaid expansions, the States are advised that they will pay for 10 percent
of some unspecified costs in four years, and there is no indication that the States
will not pay more in succeeding periods. In the initial, spare introduction of
Medicaid in 1965, there was no hint that the States 45 years later would be coerced
to spend a substantial proportion of their budgets on Medicaid under the ACA.
33
30 Lanhee Chen, How Obamacare Burdens Already Strained State Budgets, Heritage Foundation, Nov. 10, 2010 (Backgrounder #2489) (available at
http://www.heritage.org/Research/Reports/2010/11/How-Obamacare-Burdens-Already-Strained-State-Budgets), citing estimates by the Florida Agency for Health Care Administration and the California Legislative Analyst’s Office, and a study by the Milliman econometrics experts hired by Nebraska and Indiana). 31 See Milliman Explains Assumptions and Methodology Used in Nebraska Medicaid Budget Exposure Analysis, Daily Pak Banker, Sept. 19, 2010 (2010 WLNR 18614676). 32 Virginia v. Riley, 106 F.3d 559, 571 (4th Cir. 1997) (spending-clause legislation must speak “affirmatively and unambiguously, so that its design is known and the States may marshal their political will in opposition” to expropriations of sovereign rights); cf. Reno v. ACLU, 521 U.S. 844, 864 (1997) (“vagueness” relevant to “overbreadth inquiry”). 33 On average states spend 16.8 percent of their general-fund budgets on Medicaid, with Rhode Island spending 23.5 percent and Minnesota 16.8 percent. See Georgetown Health Policy Institute Center for Children and Families, Medicaid and State Budgets: Looking at the Facts (2008), available at http://ccf.georgetown.edu/index/cms-filesystem-action?file=ccf%20publications/about%20medicaid/nasbo%20final%205-1-08.pdf (last
13
States also face great uncertainty as to the Medicaid cost-share ratio for a large
new population of single adults without children that the ACA adds to Medicaid.34
E. By Leaving the Federal Government With Unbridled Power to Expand States’ Medicaid Obligations, the ACA Violates Principles Forbidding Illusory and Indeterminate Contracts
Even if there were some guarantee of a limitation on State obligations
under the ACA’s expansions of Medicaid, such a promise would be functionally
meaningless. As the Defendants admit, any such promise could be changed at the
Defendants’ whims, without any limitations or any consent by the States. See
Defs. Mem. Dis. at 16 (arguing that Congress has “full and complete power” under
42 U.S.C. § 1304 to make any alteration or amendments); id. at 15 n.7 (“Here,
Congress changed a core element of Medicaid”).35 Indeed, backers of the Act
have called it a mere “starter home” to be expanded and fleshed out through future
legislation and administrative action,36 which will make Medicare a “model of
simplicity compared with the current law.”37
visited Nov. 10, 2010). Plaintiff States overall spend similar percentages. Id. Those percentages will rise under the ACA’s expansion of Medicaid.
34 It is not clear whether the ratios will be drawn from the ACA itself, or other legislation, like the enhanced Federal Medical Assistance Percentages under the Health Care and Education Reconciliation Act of 2010, Pub L. No. 111-152 35 See Purgess v. Sharrock, 33 F.3d 134, 144 (2d Cir. 1994) (“A court can appropriately treat statements in briefs as binding judicial admissions of fact”), citing Young & Vann Supply Co. v. Gulf F. & A. Ry. Co., 5 F.2d 421, 423 (5th Cir.1925). 36 Senator Tom Harkin, Health Legislation A Solid Foundation to Build Upon, Wilmington News-Journal, Dec. 30, 2009 (calling passage of the ACA “the opening act in health reform, not the final act. . .I think of the current health reform bill as something of a ‘starter home’” that “has plenty of room for additions and improvements”)(available in Westlaw news database at 2009 WLNR 26128708); Harkin Statement on the Social Security and Medicare Board of Trustees Annual Report to Congress, Aug. 6, 2010 (2010 WLNR 156788171) (again calling ACA “starter home”); Health Care: Just A Start,
14
It cannot be the case that the federal government has unbridled authority to
make any amendments to Medicaid, no matter how coercive or arbitrary, or how
fundamentally they change the contractual bargain between the federal
government and the States. See 1 Williston on Contracts § 4:21 (4th ed., updated
May 2010) (“a reservation in either party of a future unbridled right to determine
the nature of the performance” renders contract “too indefinite for enforcement”).
In contract law, such unbridled power vested in one party makes the
contract illusory and non-enforceable. See Restatement (Second) Contracts, § 2
cmt. e (“Words of promise which by their terms make performance entirely
optional with the ‘promisor’ whatever may happen, or whatever course of conduct
in other respects he may pursue, do not constitute a promise.”); § 77 cmt. a
(“Words of promise which by their terms make performance entirely optional with
the ‘promisor’ do not constitute a promise.”). For this reason too, as well as for
obvious reasons of duress and contractual adhesion, the ACA does not qualify as a
contractually enforceable deal with the States, and violates Pennhurst’s now-well-
Richmond Times-Dispatch, Jan. 5, 2010 (Harkin called ACA “starter home” with “great foundation” with “room for expansions and additions”) (2010 WLNR 197651); Jacob Hacker, Health Reform 2.0, American Prospect, Sept. 1, 2010, at A25 (“Sen. Tom Harkin put the point well when he described the health bill as a “starter home.” What Harkin neglected to mention is that the home isn't built yet”) (2010 WLNR 17483695). 37 Jacob Hacker, Health Reform 2.0, American Prospect, Sept. 1, 2010, at A25 (backer of ACA observes that “Medicare was a model of simplicity compared with the current law”; ACA “eschewed the simple approach to expanding coverage embodied in Medicare”).
15
accepted contractual conceptualization of Spending Clause conditions.
Dated: November 19, 2010
Respectfully submitted, /s/ Hans F. Bader___________ HANS F. BADER (D.C. Bar. No. 466545) N.D. Florida Bar Member, Counsel of Record SAM KAZMAN Competitive Enterprise Institute 1899 L Street, NW, 12th Floor Washington, DC 20036 Telephone: (202) 331-2278 Facsimile: (202) 331-0640 E-mail: [email protected] Attorneys for Amici Curiae Governors Tim Pawlenty and Donald L. Carcieri
CERTIFICATE OF SERVICE
Undersigned counsel certifies that on November 19, 2010, a true and correct copy
of the foregoing Brief of Governors Tim Pawlenty and Donald L. Carcieri As Amici
Curiae In Support of Plaintiffs’ Motion for Summary Judgment was filed electronically
with this Court through the CM/ECF filing system. Notice of this filing will be sent to all
parties for whom counsel has entered an appearance by operation of the Court’s CM/ECF
system.
The following counsel for the parties, among others, will receive notice of this
filing through the Court’s CM/ECF system:
David Boris Rivkin, Jr. [email protected] Lee Alfred Casey [email protected] Blaine H. Winship [email protected] Katherine Jean Spohn [email protected] William James Cobb, III [email protected] Carlos Ramos-Mrosovsky [email protected] Brian G. Kennedy [email protected] Eric B. Beckenhauer [email protected]
/s/ Hans F. Bader D.C. Bar No. 466545 N.D. Florida Bar Member 1899 L Street, NW, 12th Floor Washington, D.C. 20036 Phone: 202-331-2278 Fax: 202-331-0640 Email: [email protected] Counsel for Amici Curiae Governors Tim Pawlenty and Donald L. Carcieri