BUFFALO, N.Y. -- The long-awaited Supreme Court ruling on
President Obama's signature health care law upholds much of the
act's intentions to expand coverage, with one major exception, says
a University at Buffalo Law School professor who is an expert on
"That exception has to do with the expansion of the Medicaid
program," says Anthony H. Szczygiel, founder and director of the
William and Mary Foster Elder Law Clinic at UB's Law School. "The
president's health care act encouraged states to expand Medicaid,
but the president's plan also went further and gave the secretary
of Health and Human Services the authority to withhold all Medicaid
funding -- not just that related to the expansion -- if states fail
to expand the Medicaid programs."
Szczygiel says the bottom line is that the Supreme Court ruling
will accomplish much of what the act intended, in terms of
expanding health insurance.
"But the expansion of Medicaid coverage will be a matter of
state choice," he says. "And thus in some states, the added
coverage will be more limited.
"Everything stays in effect, but the intention of the act to
expand coverage is somewhat tempered by the ruling of the court
because of Medicaid expansion."
Szczygiel said the Affordable Care Act fundamentally changes the
Medicaid program, making it much more like private insurance.
"The Court held that each state needed to be able to say 'yes'
or 'no' to that fundamental change," he says, "without the coercion
posed by the threat of losing all federal funding for their current
Szczygiel also said the majority decision was "very respectful
of the government's separation of powers." Congress sets the
policy, whether that be good or bad.
"If the people don't like it, they can vote against the policy
makers," he says. "The Court only decides whether Congress acted
within the authority of the Constitution, and the Court should give
Congress the benefit of the doubt when considering that
Anthony H. Szczygiel
Professor, UB Law School