skip navigation
Support KUOW

Supreme Court Ruling Puts Medicaid in Washington Legislature's Hands

Ruby de Luna

The US Supreme Court's ruling on the Affordable Care Act means the law remains intact — except for one provision. The justices said the law requiring states to expand Medicaid went too far. KUOW's Ruby de Luna explains what the ruling means for Washington state.


The court ruling means states could choose to expand Medicaid to cover single, low–income adults. Medicaid is a federal–state program created in 1965 for specific groups of low–income people.

Sanford: "People over 65, people who are on Medicare, but people who are low income, pregnant women, children, and some disabled people."

Sallie Sanford is a law professor at the University of Washington. Medicaid is voluntary and all states offer it. The Affordable Care Act required states to open up Medicaid to include single low–income adults in 2014.

Sanford: "For the first few years, the federal government picks up 100 percent of the cost of covering these newly eligible people. And that ratchets down to 90 percent of the cost."

But some states balked at the plan. They argued that even if the federal government picked up most of the tab, Medicaid would still be a financial burden. And if the states declined to cover the newly eligible people, they would've lost their entire Medicaid funding. That's part of the reason why 26 states sued the federal government over the plan. On Thursday the high court agreed that states were given no choice in the matter.

Sanford: "What the court said is that the threat of losing all of your coverage is too much. So effectively, as I'm reading from the opinion of the chief justice, he writes, as a practical matter, states may now choose to reject the expansion. They may choose not to cover these additional people."

In the coming months, states will have to make decisions on how to cover the poorest Americans.

Doug Porter is Washington's Medicaid director. He says the state Legislature had assumed that Medicaid was a federal mandate. So during the last session, lawmakers passed bills to set the stage for that expansion.

Porter: "And now that Supreme Court has made through its ruling that it's a voluntary step, I would expect the next Legislature would weigh in on that and either elect to participate or not; you'll never know what the Legislature will do in the future."

Porter estimates that about 500,000 Washington residents may qualify under the expanded Medicaid program.

State lawmakers will meet next month in a bi–partisan summit. They'll plan their next steps in response to the Supreme Court ruling.

I'm Ruby de Luna, KUOW News.

© Copyright 2012, KUOW