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Nancy Smith

Rick Scott Files Motion for Injunction Over 'Unconstitutional' Health-Care Threats

May 6, 2015 - 6:00pm

It took Rick Scott less than 24 hours since coming away empty from a meeting with U.S. Secretary of Health and Human Services Sylvia Burwell to take legal action against the federal government. The Florida governor filed a motion for preliminary injunction Thursday to immediately prohibit the Obama administration from using "the same coercive threats that the Supreme Court has already held unconstitutional."

The 35-page motion, filed in U.S. District Court in Pensacola by plaintiffs Scott, Florida Attorney General Pam Bondi and the state Agency for Health Care Administration, regales a story of coercion by an administration exceeding its authority and disregarding the law of the land.

It quotes the landmark 2012 U.S. Supreme Court decision in National Federation of Independent Business v. Sebelius (NFIB), stating, "The Supreme Court held that the federal government may not threaten to withhold preexisting Medicaid funding to coerce States to expand their Medicaid programs in the manner that the Affordable Care Act (ACA) envisions. Yet, not three years later, the federal government is at it again."

The motion continues, "Just before the Florida Legislatures constitutionally mandated responsibility to pass a balanced budget was due, the federal government informed the State that it would be withholding more than $1 billion in federal funding for a critical, longstanding Medicaid waiver program unless Florida agrees to participate in the ACAs Medicaid expansion.

"To make matters worse, the federal government imposed this condition even though the State voluntarily agreed to tailor its waiver program to eliminate any potential overlap with the ACAs Medicaid expansion. Accordingly, once again, the federal government is knowingly and deliberately attempting to coerce Florida into participating in Medicaid expansion by withholding massive amounts of preexisting Medicaid funding if it refuses. Just like last time, the federal governments actions are unconstitutional."

Scott and Bondi's motion continues by laying out the consequences of allowing the Obama administration "coercion" to stand:

"Unless this unconstitutional coercion is redressed, it will have immediate and devastating consequences for Florida, its healthcare providers, and its residents. The $2.2 billion in total healthcare funding made possible by the waiver program is critical to ensuring that the States healthcare providers are able to continue providing care for individuals and services that are not otherwise provided by Medicaid, even as expanded by the ACA.

"The program also provides vital funding to offset the cost of care provided by medical schools, community health clinics, and county health departments -- funding that once again is not otherwise available under Medicaid or the ACA.

"As a practical matter, the loss of more than $1 billion in federal funding will spell the end of this program, all because Florida has exercised its constitutional prerogative not to participate in Medicaid expansion.

"The impending June 30 expiration date for existing federal funding leaves the State and its healthcare providers with little choice but to start taking irreversible actions now to cope with the loss of federal funds that are being withheld for impermissible reasons.

The motion informs the court that Florida needs judicial relief now, and therefore, it should grant the state's motion for a preliminary injunction -- or, second to that, grant a writ of mandamus.

Either would prohibit the federal government "from again leveling the same coercive threats that the Supreme Court has already held unconstitutional."

The motion acknowledges the federal government is entitled to its opinion, to try to persuade states to reach the same conclusion, including offering new funding for opting into Medicaid expansion.

"But," argues the motion, quoting from the 2012 NFIB case, "the federal government decidedly may not engage in 'economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.'"

Scott and Bondi point out that what the federal government is doing this time is worse than in 2012.

"Indeed, the manner in which the federal government has effected this coercion is even more constitutionally offensive than in NFIB. At least NFIB involved an unambiguous statutory command with a four-year phase-in period, leaving States time to consider and pursue various options, including seeking judicial relief. Here, the federal government waited until mere weeks before Floridas budget was due, and mere months before federal funding would expire, to spring its new unconstitutional condition. ..."

Likely, the motion is precisely what Secretary Burwell was expecting today. Her hour-long, private conversation with the governor in Washington Wednesday covered the same ground. Scott was hoping to persuade the Obama administration to continue the Low Income Pool, or LIP program, that sends more than $1 billion in federal funds to Florida each year to help reimburse hospitals for the costs of caring for the state's poor.

Burwell's office issued a written statement after the talk, saying Florida's request "falls short of the key principles HHS will use in considering proposals regarding uncompensated care pool programs."

Burwell also argues that Florida was alerted a year ago that federal funding of the program to reimburse hospitals would end June 30, 2015.

Scott, meanwhile, contended that a letter HHS sent to Florida last month linked the expiration of LIP with Florida's refusal to exercise its option to expand health insurance coverage through Medicaid.

Reach Nancy Smith at or at 228-282-2423. Twitter: @NancyLBSmith

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