by Nick Estes
Aug. 12, 2011

Politics can make for strange bedfellows. In an unusual break with the Obama administration, several prominent Democrats in Congress have filed an amicus (“friend of the court”) brief in the Supreme Court, urging that private citizens be allowed to sue states that are not fulfilling their obligation to provide health care to eligible Medicaid recipients if they accept federal Medicaid funds (which all the states do).

The strange bedfellow in this case – the U.S. Chamber of Commerce, which rarely agrees with congressional Democrats – also filed an amicus brief taking the same position. The Obama Administration is on the other side, arguing that compliance with Medicaid rules should be strictly up to the states, without the threat of citizen lawsuits.

The case was brought by Medicaid beneficiaries after California cut its payment rates to providers. California already had one of the lowest reimbursement rates in the nation and plaintiffs claim more cuts have made it nearly impossible to find providers who will take Medicaid patients. The Dem’s amicus brief reads, in part, “California has been accepting more than $20 billion in federal Medicaid funds per year in exchange for its promise, among other things, to ensure that needy patients had access to health care.” But, it argues, the state is failing to fulfill that promise.

Citizen advocates take the position that the federal government is much too overloaded to effectively supervise whether states are complying with federal Medicaid law so citizen lawsuits are essential in enforcing the rules. New Mexico Voices for Children agrees.

But back to the strange bedfellows. Why would a conservative-leaning, free-market-loving group like the U.S. Chamber, which is generally against tax-payer funded social services such as Medicaid, be on the same side as Democrats in Congress? Likely for the same reason that many “small government” conservatives don’t want to cut defense spending: these government programs create jobs. Good private-sector jobs.

Health care services are delivered by the private sector even when they are paid for by Medicaid. This federal spending supports jobs for doctors and other health care providers as well as their administrative staffs, custodial services, and much more. Like the American Medical Association, which is also siding with the plaintiffs, the U.S. Chamber is just looking out for the best interests of its members – hospital administrators, doctors, and other medical professionals – who rely on reasonable reimbursement rates in order to pay their bills. Congressional Democrats, on the other hand, are looking out for the best interest of those Americans who do not have access to employer-sponsored health insurance and cannot afford to purchase it privately. Still, these seemingly disparate outcomes – health care for the poor and good reimbursement rates for doctors – can be achieved by working toward the same end. It goes to show that those on both sides of the ideological spectrum could probably work much better together if they kept their eyes on the end objective instead of finding fault in how the “other guys” are trying to get there.

Nick Estes is NM Voices Deputy Policy Director