Question

The conflict between federal and state jurisdiction in healthcare matters is not always clear.

what is the authority for federal regulation of healthcare?

Answer 1

• Congress has enacted numerous statutes, such as Medicare, Medicaid, and the Children’s Health
  Insurance Program, that establish and define specific statutory rights of individuals to receive health care services from the government. As a major component of many health care entitlement statutes, Congress has provided funding to pay for the health services provided under law.
• Most of these statutes have been enacted pursuant to Congress’s authority to “make all Laws which shall be necessary and proper” to carry out its mandate “to … provide for the … general
  Welfare.”
• Congress has also used other constitutional powers, such as its power to regulate
  interstate commerce and its power to levy taxes, to enact legislation relating to health insurance and health care.
• In 2010, Congress enacted the Affordable Care Act, a comprehensive health care reform law which includes a requirement, effective in 2014, that most individuals purchase health insurance, and which significantly expands the Medicaid program.
• A number of lawsuits were filed
  challenging various provisions of this legislation, and, on June 28, 2012, the Supreme Court upheld the majority of ACA’s provisions.
• Significantly, the Court upheld the requirement that individuals purchase health insurance as a valid exercise of Congress’ taxing power, but the Court limited Congress’ power to spend for the general welfare by holding that Congress cannot
  threaten the states with the loss of all federal Medicaid funds if the states decline to expand Medicaid coverage as mandated by ACA.
• In addition, several states have passed laws, amended their state constitutions, or entered into interstate compacts to attempt to “nullify” or “opt out” of the federal individual health insurance
  mandate and other federal health care provisions.
• Direct conflicts between federal laws and state nullification statutes or state constitutional amendments would raise constitutional issues which are likely to be resolved in favor of federal law under the Supremacy Clause of the United States Constitution.
• A number of state constitutions contain provisions relating to health and the provision of health care services.
• State constitutions may provide constitutional rights that are more expansive than those found under the federal Constitution since federal rights set the minimum standards for.