Because it does not allow for states’ consent, the proposed Medicaid Patient CARE Act block-grant program likely will be considered unconstitutional, say two public policy authorities.

In a recent New England Journal of Medicine article, legal scholars Sara Rosenbaum and Timothy Westmoreland contend that the Patient Choice, Affordability, Responsibility and Empowerment Act, proposed by leading Republican members of Congress, appears to be a violation of the Tenth Amendment because Medicaid is a state-run program.

The Patient CARE Act would repeal the Affordable Care Act’s insurance reforms and significantly scale back premium subsidies. 

It would eliminate all federal funding for the ACA’s new adult expansion population; end Medicaid’s comprehensive coverage for low-income children, pregnant women, and families with dependent children; and end long-term care services and supports for elderly Medicaid beneficiaries as well as Medicaid beneficiaries with disabilities.

Rosenbaum and Westmoreland argue that the block grant would be unconstitutional based on the 2012 Supreme Court decision in National Federation of Independent Businesses v. Sebelius.

Block grants are limited chunks of money that local authorities can use for general services.