Academic journal article Vanderbilt Law Review

Two Wrongs Don't Make a Right: Medicaid, Section 1983 and the Cost of an Enforceable Right to Health Care

Academic journal article Vanderbilt Law Review

Two Wrongs Don't Make a Right: Medicaid, Section 1983 and the Cost of an Enforceable Right to Health Care

Article excerpt


More than a trillion dollars annually is spent on the health care system . . . . Despite increases in medical care spending that are greater than the rate of inflation, population growth, and Gross Domestic Product growth, there has not been a commensurate improvement in our health status as a nation. . . . Despite our Nation's wealth, the health care system does not provide coverage to all Americans who want it.1

These words capture both the essence of America's public health care dilemma and the frustration felt by many of the lawmakers charged with the duty to solve it. The battle to lower costs and expand access to health care is not limited to the chambers of Congress, however. Recently, the fighting has spilled over into the federal courts as States battle Medicaid beneficiaries over the scope of the cooperative federal-state Medicaid program.2 For example, in Westside Mothers v. Haveman, Michigan recently defended its Medicaid program against the charge that the State was not doing enough to ensure that Medicaid-eligible children were taking advantage of the medical services required under the program.3 The plaintiffs, representing Medicaid-eligible children in Michigan, sought to force the State to take steps to promote increased utilization and provision of such services.4

The language of the Medicaid Act ("the Act") does not expressly provide beneficiaries with a private cause of action against the State.5 Accordingly, the district court dismissed the case, concluding that the court did not have jurisdiction and that the plaintiffs did not have standing to sue.6 The United States Court of Appeals for the Sixth Circuit ("Sixth Circuit"), following the Supreme Court's admittedly confusing precedent in this area,7 reversed, allowing the plaintiffs to proceed under 42 U.S.C. Section 1983.8 Section 1983 supplies a cause of action for an individual when anyone, acting under color of State law, deprives that individual of "rights, privileges, or immunities secured by the Constitution and laws" of the United States.9

The Sixth Circuit held that the Medicaid Act was within the term "laws" for the purposes of section 1983 because it "was intended to benefit the putative plaintiff," because it placed "a binding [rather than precatory] obligation on a government unit," and because the plaintiffs' asserted interests were not so "'vague and amorphous' that their enforcement would strain judicial competence."10 One month later, however, in Gonzaga University v. Doe, the United States Supreme Court announced that section 1983 provided a cause of action only for violations of "unambiguously conferred rights," specifically precluding actions seeking to secure mere "benefits" or "interests" created by federal law.11

Since the Supreme Court later denied certiorari in both the Westside Mothers case12 and a similar case from North Carolina,13 it has not ultimately settled the question of whether private plaintiffs may sue under section 1983 to force a State to comply with specific Medicaid provisions. A State "must comply with certain requirements imposed by the [Medicaid] Act and regulations imposed by the Secretary of Health and Human Services" as long as the State continues to participate in the Medicaid program.14 The unanswered question is whether Medicaid creates a right to certain enumerated health care services, enforceable by private individuals against participating States.

This Note concludes that the Act does not (and should not) confer an enforceable private right to such services. It further concludes that the federal courts have distorted the important political and financial relationship between Congress and the States by enforcing Medicaid provisions as if a right to such care existed, substantially hindering attempts to ensure some adequate level of health care for all Americans.

Part II briefly discusses the history of Medicaid, describes the financial and political attractiveness of the Medicaid program to both the States and Congress, and explains how the federal courts contribute to the States' present financial crises by imposing precatory federal health care priorities on the States with a vigor that Congress never intended. …

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