this expansion of medicaid is uniquely not onerous compared to past expansions of medicaid. the average share of state medicaid spending now is 59%, which i didn't know before but i'll take it for granted. for this expansion of medicaid, the federal government is undertaking to pay $100% of what it will cost to pay for newly eligible people through 2016 and after that the percentage drops to 90% until 2020 and it is made permanent at 90%. so the federal government is covering much more of the shared costs of funding medicaid for this expansion than it has for any of the past expansions. so the argument that this is uniquely onerous as a constitutional matter is completely nonsense. three minutes left. the rest of the arguments. next argument -- they have actually said this over and over again. never before has the federal government done this when it's expanded medicaid. never before has it said if you don't accept the new requirements, then you can only do that by withdrawing from medicaid altogether and losing all your existing funding. that's simply completely not true. a

lose rather than what you stand to gain, it seems to me that it does not matter whether the medicaid expansion is substantial or whether it is modest or if there is any -- expansion of. the government could decide that under the current system, too much money has a and employing to nursing home care and that would be better in serving the general welfare if it were directed at infants and children but if the government said we will redirect the spending priorities of the money we're offering, they could say we do not like that and we would like to keep spending money and we have no choice because this program has gotten too big for us to exit. it seems to me standing here -- >> the smaller it is the bigger the coercion. the more you stand to lose. >> before you leave. >> i -- just before you leave that, i'd -- i'd appreciate it if you would expand a little bit on the answer to justice kagan's question for the reason, when i read the cutoff statute, which as i said has been there since 1965 unchanged, it does refer to the secretary's discretion to keep the funding, insofar as the funding has no

that brief details why the medicaid expansion in the nca and nca itself is enormously ben fs official to states. i think we should bear that in mind. this is a very serious and genuine philosophical policy, political debate, but it is really not a debate between the states or state interests and the feds. as i said, i have to disagree with a great deal of how these, use were characterized by my friend here. as you might expect. but i do agree -- about the way in which roger and i think tim stated that, the basic simple issue. medicaid expansion in the aca has a number of aspects, but the main thing is very simple. it expands eligibility to all adults up to 138% of the federal poverty line from where it was before and roger and tim both appropriately described the

the issue below of whether the medicaid expansion of both the scope of coverage and the actual substantive coverage of medicaid would be constitutional under congress's taxing power was argued below and the courts, both the district court and the appellate court found against the plaintiffs in that case, against the states. but the supreme court thought the issue was important enough that it reached out su esponte on its own to consider this question. and it's no surprise considering a suit brought by 26 states that to them at least it's a very burning question. and it raises the question of whether the federal government, the congress through its power to tax can do indirectly what it is prohibited from doing directly. in other words, the federal government cannot directly order states to set up programs for their indigent citizens to help provide for their health care. but if through the taxing power, the court can compel states to enter into these nominal relationships, these federal/state partnerships, is the question that is before the court. and it raises the question under south dak

rather than what you stand to gain, then it seems to me that it doesn't matter whether the medicaid expansion is substantial or whether it's modest, or whether there's any expansion at all. the states, for example -- the federal government, for example, could decide that under -- under the current system too much money has ended up flowing to nursing home care and that money would be better serving the general welfare if it were directed at infants and children. but if the federal government said we're going to redirect the spending priorities of the federal money that we're offering to you, the states could say, well, geez, we don't like that, we'd like to keep spending the money the way we were, and we have no choice, because this has gotten too big for us to exit. and so -- and in fact, it seems to me, standing here today before these expansions take place, under their theory, the provision is coercive. >> the smaller it, is the bigger the coercion. >> well - >> the smaller what you're demanding of them, the bigger the coercion to go along. >> the more they stand to lose. and -- and so --

we don't think that would have effect. >> so the government's position is if medicaid expansion is shut down the rest can operate? >> in the past congress has expanded medicaid coverage without there being a minimum coverage provision. >> i don't understand where you

rather than what you stand to gain, then it seems to me that it doesn't matter whether the medicaid expansion is substantial or whether it'ss expansion at all. the states, for example, could decide that unthstem too much m up flowing to nursing home care and that money will be better serving the general welfare if it were directed at infants and children, but if the federal government said we're going to redirect the spending priorities of the federal money that we're offering to you, the states could say, well, geez, we don't to keep spending the money the way we were and we have no choice because this program has gotten too big for us to exit. it seems to me standing here today before these expansions take place under their theory, the provisions -- >> the smaller it is, the bigger the coercion. smaller what you're demanding, the bigger -- >> the more they stand to lose. i'm sorry. >> just before you leave that, i'd appreciate it if you would expand a little bit on the answer to justice kagan's question for the reason that i read the cutoff statute, which as i said has been there since 1965

this provision, the medicaid expansion that we're talking about this afternoon and the provisions we talked about yesterday, we've been talking about them in terms of their effect as that solve problems, problems in the economic marketplace that have resulted in millions of people not having health care because . there is an important connection, a profound connection, between that probles importth of that. that in this population of medicaid eligible people who will receive health care that they cannot now afford under this medicaid expansion, there will be millions of people with chronic conditions like diabetes and heart disease, and as a result of the health care that they will get, they will be unshackled from the disabilities that those diseases put on them and have the opportunity to enjoy the blessings of liberty, and the same thing will be true for a husband whose wife is diagnosed with breast cancer and who won't face the prospect of being forced into bankruptcy to try to get care for his wife and face the risk of having to raise his children alone and i could multiple exam

justice, with respect to the medicaid expansion, the states' argument is as they have said it in their briefs, they articulated it a little bit different this morning. it's not what you stand to gain, but what you stand to lose. but the important thing to evaluate in this on the kex is fully 60% of medicaid expenses in this country are based on optional choices. but states are given choices to expand the beneficiaries beyond the federal minimum and to expangd services beyond the federal minimum. does this act not require states to keep at the present legal their existing medicaid example? so some states may have been more generous than others in medicaid. so they can't go back. >> there is something called the maintenance of effort provision which lasts until 2014, until such time as the medicaid expansion takes place. that applies to the population, says with respect to the ybody out, it does not apply be the states still have flexibility. they can still reduce optional benefits that they're now providing if they want to control costs. they can also work on provider rates with respect

companies are involved in that, they are going to be reimbursed. >> what if there isn't medicaid expansion. we talked about the individual mandate. does the government have a position on what should happen if the medicaid exspan slun is struck down? >> we don't think that would have any effect. that could be addressed in the next argument. we don't think that would have any effect on the rest of the -- >> so the government's position is that if medicaid expansion is struck down the rest of the ookt can operate. >> yes. in the past congress has expanded medicaid coverage without there being -- it's done it many times without there being a minimum coverage provision. >> i don't understand where you are with the answer to justice alito's question. assume that there is a substantial probability that the 350 billion plus 350 billion equals 7 s going to be cut in half if the individual mandate is stricken. assume there is a significant possibility of that. is it within the proper exercise of this court's function to impose that kind of risk? can we say that the congress would have intended that

that's the case of medicaid and the part of the health care law that calls on the expansion of medicaid in the states. next up is russell from houston. how are you? >> caller: i would like to see this removed from the abuse that it's going to force on the united states let me qualify that by saying i'm a lifelong democrat. and having been in the trenches, so to speak,5 years, i know that the average working person when caught up in the daily grind of making a liveing that they missed a lot of what was going on. they missed the subtle tricks that we as union organizers were taught. and i see that playing out now. and, of course, i have regrets. >> when you say, russell, you see that playing out. you've seen it playing out in demonstrations before the court? >> caller: not so much now. my mind was made up having time to follow this very closely. i just know know what is attempted to alter our law r our constitution forever. i recognize are tactic rules for radicals. and i just see that a lot of it is smoke and mirrors. and most of the people don't realize what's going on. i'm glad to lear

looking at severability andondrd of oral arguments when the court looks at medicaid and whether the affordable care act's expansion of the medicaid program violates the constitution. let's go now to charlene. take us through what the affordable care act does to medicaid. >> so i know it sounds very complicated to a lot of people, but put very simply, the let reform really juan cover more people under the medicaid program. so there's a federal poverty limit now, and states cover people up to level. what this does, it expands that and requires that under the medicaid program than they currently have to cover. here are the numbers to calm. republicans -- and independent callers, 202- 628-0205. d issue here today. what are the states concerned about? >> it's all about money. the health care law is estimated to cover 16 million people who did not before qualify for medicaid, and that costs money. now what's interesting is that at the beginni, years of the health care law starting in 2014, the federal government picks up 100% of the cost for these newbies, but after that two years, they gradually start to cover a little

i'd also say that the legal attack on the affordable care act medicaid expansion provisions much more than the individual mandate side of their case is an overt, overt not sneaky, but an overt drive to effect a revolutionary change in constitutional law and in governmental practice. the legal briefs on filed by the republican officials in the 26 states challenging the law are very much closer to the libertarian philosophical and somewhat radical briefs filed by a number of you all. then perhaps is the case with respect to the commerce clause, the relatively more mundane commerce clause arguments being made against the mandate on that side of the case. i'd like to make one other point. just to begin and that is this is not a state versus federal issue. this is a partisan democrat

they can legislate for it in medicaid, and congress can legislate some expansions and medicaid? >> i think there's a difference, but if i am wrong about that and the consequence is that congress has to break medicaid down into the remotely manageable pieces as opposed to $3.3 trillion over ten years before the expansion, i don't think there would be the end of the world but i would ask you to focus on specifically what is going on which is they take these newly eligible people and it's a massive change in the way the program works, these are people that are healthy adults who are not covered in many states they say okay we are going to need to cover those and have a separate program for how you get reimbursed. you get reimbursed differently from the other eligible individuals but if you want to get our money we are going to take away your participation of the program for the visually impaired and the disabled. >> is because they feel comfortable cmac if they don't want to do it the better way. so i just don't understand the logic of saying that you are not entitled to our money.

chief justice, and may it please the court -- the constitutionality of the act's massive expansion of medicaid depends on the answer to two related questions. first, is the expansion coercive? and, second, does that coercion matter? >> mr. clement, can i ask you just a matter of clarification? would you be making the same argument if, instead of the federal government picking up 90% of the cost, the federal government picked up 100% of the cost? >> justice kagan, if everything else in the statute remained the same, i would be making the exact same argument. >> the exact same argument. so that really reduces to the question of why is a big gift from the federal government a matter of coercion? in other words, the federal government is here saying, we are giving you a boatload of money. there are no -- there's no matching funds requirement, there are no extraneous conditions attached to it, it's just a boatload of federal money for you to take and spend on poor people's healthcare. it doesn't sound coercive to me, i have to tell you. >> well, justice kagan, let me --i mean, i eventually want to

the medicaid expansion issue is the sleeper issue.he state's argument has the opportunity to open pandora's box. the consequences of their arguments are more extreme. one of the positions. charlie is a republican cholera in texas. good morning. -- caller in texas. caller: i was wondering, if the court finds that they could sever out the mandate, and they leave the balance of this law intact, does that mean it that a whole other bevy of lawsuits will be filed to take out, for instance, this proposed panel of bureaucrats that are going to decide whether we should receive health care as a matter of budget? host: charlene frizzera? guest: that is a great question. if you separate a lot -- there are provisions in the law and legislators can change anything in the lobby wants to. the board that was referred to -- there is a lot of discussion about repealing that board. legislatively, that might happen. they might agree to change the law to give the of the board. there are two ways that could happen. if that does not happen because of legisl

. >> that would be true if this medicaid expansion happened or not. >> but you have been emphasizing that the federal government is going to pay 90% of this. the knox fiscal year they can decide that they're going to pay a lot less and you states are still on the hook. you just have to pay more because we're going to pay less. less. >> i agree that it could be a difficult choice in some circumstances, but that is not to say it's coercion as a legal matter or even as a practical matter and i think it would depend on what the circumstances were. >> i'm trying to go back to that because justice kennedy asked you whether there's, i think he said, it's coercion if no one can be politically accountable. i'm not sure how that could be practically political attemptable. because almost every gift, if the terms are attractive, it would be an unattractive political alternative to turn it down. >> i guess my point is this has two -- if somebody really likes something like medicaid, they're not going to let you drop it, is that correct? >> the capacity of the citizens of the state, and that's wha

the states that i was talking about, the democratic states who support the medicaid expansion, argue that there should be a coercion doctrine. they're much more prostate interests in their orientation than the justice department is but they argue that it doesn't apply here so we'll find that out. >> sir, right here. >> my name is craig olson, i'm retired from the state department mostly. the preamble to the constitution states that one of the reasons that the constitution was created was to promote the general welfare, welfare. article 1, section 8, says one of the reasons that you raise taxes is to provide for the general welfare. why isn't that in and of itself sufficient to make the affordable care act -- >> there's an easy answer. tim, what is it? >> well, i don't know if it's an easy answer. >> i'll give it if you don't. >> roger is my teacher. i would say the general welfare clause refers for one thing to the general welfare and not to the specific welfare and that a great many of the schemes that the federal government engages in through the spending clauses for the specific w

medicaid expansion under this bill is dramatic. 31% of the people in south carolina will be medicaidll wreck our state budget. wrach f watch for the court to strike down the medicaid expansion as an overstep. they could say the fine is actually a tax and we're going to wait to see how that happens -- >> they might keep the individual mandate. >> they might say it's too early to judge the fine because it hasn't gone into effect yet, it's really a tax. they could say this medicaid expansion is a federal government takeover of state budgets. i don't know what the court is going to do but the public doesn't like obama care they don't like the way it was passed and they don't like the substantial and it would be a signature item for the republican party. >> somewhat of a split issue at this point. let me move you on to a couple of overseas issues. one of them is afghanistan. we heard two of the republican candidates out there, santorum and gingrich, saying it might be time to just get out of there. this was after the massacre. >> and i shot back very hard at newt. i like newt. he's a smar

the medicaid expansion for 16 million low income americans as well as the success of the private healthinsurance expansion through the individual mandate. i think ultimately, far less important decision of the supreme court will be the decision of the voters in november, on november 6. really, the future of this law will be decided by who controls the white house and who controls congress next year. the supreme court is really secondary. >> dr. stephanie woolhandler? >> we did not take a position when the solvent -- with the supreme court deliberations. some of the members did weigh in in an amicus brief. some are more ambivalent and felt there was some good in the bill. what we all agree on, however, is the bill is not a solution. it will leave 27 million americans uninsured when it is fully implemented. it will leave tens of millions of americans woefully under insured with gaps in their coverage like copayments and deductibles, so they will still be bankrupt by illness. it is not going to control cost. we still need single payer national health insurance regardless of what happens at

it would be the largest medicaid expansion since medicaid came about, so let's take a look at how it would expand made kad. it does it a couple different ways. first of all, what it does is it changes the income requirement. so let's take a look at the foster family. these are my imaginary friends, i bring them along every so often. these are the fast food fosters. now, in order for the parents to get on medicaid, their income has to be below about $23,000. after health care reform, if it goes through, which is looking i guess more and more doubtful, they would have to make less than $31,000. so that's a big difference. the big difference between making $31,000 and making $23,000. so you can see that would add on many, many more families if health care reform comes to pass. >> those are the changes for income. what about other changes? >> it's interesting. a lot of people don't know when you're single, you cannot automatically get on medicaid, even if you're very low income. if you're single, you can't just get on it. let's take a look at seamstress sally. she earns $154.15. that's l

the expansion is really breathtaking. medicaid served in 1984. the federal spending was a spade over $21 billion. right now it's $250 billion. and that's before the expansion on the statute. >> well, if you're right, doesn't that mean that medicaid is unconstitutional now? >> not necessarily, justice kagan. we're not here with a one trick pony. we point to three statures. one is the size of the program. and if you want a gauge on the size of the program, the best place to look is the government's own number. footnote six. >> so when does a become too big? give me a dollar number. >> $3.3 trillion over the next ten years. >> the amount approximately if you look into it as a percentage of gdp, it's big. but it was about 2.0% of gdp. it will go up to 3% of gdp. now look at the kovrp rabble numbers, which i did look at, with the expansion that we're talking about before. or even from 0 to 6. and while you can argue those numbers, it's pretty hard to arg argue. if i'm right on those numbers, or even roughly right, i don't guarantee them. then would you

will spend an additional $526 million to $766 million over the next ten years, on its medicaid program. the expansion could add up to 145,000 -- could add up to 145,000 nebraskans to the medicaid program over the next decade. currently, one in nine nebraskans are enrolled in medicaid. the new provisions of the law will expand eligibility to one in five nebraskans, 20%. governor hien aman addressed this issue and said this unfunded and unparalleled expansion of medicaid is an unfair and unsustainable mandate on nebraska and other states. the federal health care law is an extraordinarily large and excessive unfunded mandate for states. it is potentially devastating to our state budget. now, today with me on the floor i am joined by two former governors. all three of us have had to deal with balancing budgets, and we have no choice but to make sure that at the end of our legislative sessions, our budgets are in fact balanced. senator alexander, you were vocal in speaking out against this policy during the health care debate. you've got a rather unique perspective because not only are you a former govern

they also looked at the expansion of medicaid. once again tonight, "newshour" health correspondent betty ann bowser begins our coverage. >> reporter: the morning arguments focused on whether parts of the law could survive without the mandate, the so- called severability issue. justice ruth bader ginsburg questioned attorney paul clement about the logic of revoking the entire law. clement represents 26 states opposed to it. >> i mean, it's a question of whether we say everything you do is no good, now start from scratch, or to say, yes, there are many things in here that have nothing to do frankly with the affordable healthcare and there are some that we think it's better to let congress to decide whether it wants them in or out. so why should we say it's a choice between a wrecking operation, which is what you are requesting, or a salvage job. and the more conservative approach would be salvage rather than throwing out everything. >> what makes this different is that the provisions that have constitutional difficulties or are tied

in their brief to the supreme court the states suing over the medicaid expansion said it best. quote, when congress mandates that medicaid-eligible individuals maintain insurance but provides no means for them to obtain it, it is impossible to label the state's participation in medicaid voluntary" -- end of quote. the only way you can get it, it's not voluntary. well, obamacare as a whole cannot survive without these unconstitutional provisions and these are the reasons why i believe that it will and in fact should be struck down as unconstitutional. mr. president, the last thing that i'd like to comment on is an unrelated subject. it has to do with comments that the president was overheard making in a meeting that he was holding with russian president dmitri leb deaf -- in south korea. he had a hot mike which, in other words, captured comments he was making privately to president medudev and he requested a little space in negotiations over missile defense until after the election when he said we have more flexibility. well, obviously this presents a problem that is going to hav

otherwise would not be able to support their own insurance, would be covered because of the medicaid expansion. that's something which would be lost if that was ruled against or if the mandate went away? >> here's the thing. i actually thought that the provision that was argued on wednesday afternoon testing the expansion of medicaid, the state federal program for the poor, that would mean more people would be eligible for medicaid and that the states are protesting because they feel like they'd pick up more of a burden even though they're voluntarily in it and the federal government pays for most of it. i think that there was not a to strike down that provision. >> i think, again, it's close. i think it's stunning that it even was close because the government, i think, was especially gobsmacked about it because the government's position is, you know, so new, this is the way medicaid's been working for decades. we've put new conditions on it and the states can take it or leave it and the states are saying it's not a real choice but i think the fact that the court was even entertaining the thou

i want you to speak about medicaid expansion in just a moment. the supreme court created the coercion doctrine. as far as i can tell, it is still viable lot. it is on the books. every circuit save one, the fourth circuit, the rest of the circuits seem to ignore the cores and doctored. it is a pretty powerful argument that you have on this medicaid expansion. >> a couple of things, a chief justice. i think it is true. there are a lot of circuits to seem to deem coercion -- despite what the court has said. if you want to look at those cases and the pathology of how the circuits got to the wrong answer, i think it is because a lot of them started with the d.c. circuit case that was decided before dole. the court picked up that language and the ninth circuit picked up on that even though it was after dole. of course there is no limits on spending power. under garcia, there are no limits on the -- >> accepting with you that the doctrine of coercion is alive and well, it is abundantly clear that it is, there is holding that applies and rejects the doct

the medicaid expansion in particular provides that kind of care. >> reporter: the states argue the federal government has no right to force them to spend millions of dollars to expand medicaid but admits it was not the strongest part of their case. >> even if the courts did nothing more than strike down the individual mandate, it would be a very significant victory. >> reporter: a spokesman for the president is confident the justices will rule in the administration's favor. >> there's no contingency plan in place. we're focused on implementing the law. and we are confident that the law is coming. >> reporter: justices are expected to issue their ruling in june. danielle nottingham, cbs news, the supreme court. >>> the american soldier charged with killing 17 afghan civilians suffered a traumatic incident while sevening in iraq, according to his lawyer. sergeant robert bales served three tours in iraq before being shipped to afghanistan. attorney john henry browne wouldn't say what the traumatic incident was but said it triggered tremendous depression. >>> we are learning more about the mid

and tomorrow afternoon, is the law's expansion of medicaid coverage an unconstitutional intrusion on states? and c-span has commissioned a poll on the supreme court's consideration of the health care law. among the findings, 95% have expressed interest in the case. while 54% indicated they'll listen to the argument. 86% think this week's case should be televised. and 74% think all supreme court arguments should be televised. and don't forget we've been following the health care debate from the beginning at c-span.org. you'll find video of hearings, speeches and rallies and related documents and links to other web pages. again, that's at in march of 1979, c-span began televising the u.s. house of

tomorrow we will hear two days -- another day of argument on the severability issue as well as the medicaid expanse but what we can tell you today, we felt very comfortable with the questions asked and firmly believe this is unconstitutional and as justices said, this would be such an overreach if the federal government can do this, they can force us to do anything.that's this with everything we've got. i'd now like to introduce my colleague, attorney general john bruni from south dakota and the next united states senator. >> thank you. >> well, first of all, i want to say, thank you to my colleague, pam of florida and greg of texas and alan wilson, south carolina. we have a managing committee of litigation. we started as 13 states. across the country law professorers said -- >> later on c-span you'll be nt conference live. that was being held on the capitol grounds right across the street from the supreme court. you can see some ofaving, and b first street to the supreme court. i want to show you some of the sights and sounds that are happening there as well. as we continue to take your calls. now

equally difficult is the medicaid expansion issue.o, we would ask you to direct your argument there. i would ask counsel but when you first get up, speak to us briefly about standing. i know that at one point in this case you challenge standing as well as some of the other challenges to standing. it seems to us that there is clearly standing in the case as to the individuals as far as the individual mandate issue and there is clearly standing as to the states in regard to the issue of medicaid expansion. with that, we will hear from you first. >> thank you, chief judge. i would like to claim the meritless used first and then get to your question about standing. after years of study and debate, congress passed the affordable care act. first that the m including the minimal coverage division, which " regulating activity the this economic in nature about how and when health care is paid for that substantially affects interstate commerce with a substantial part of this economic activity. the absence of which would undercut the health-care

they're also going to focus on the medicaid expansion. right now, qualifying for medicaid is different in every state. the states here today will argue they should not be forced, as they put it, to expand that program. also, more today on that requirement to buy health insurance. today, the supreme court considers whether the new health law can survive without requiring everyone to buy health insurance. on tuesday, justices debated how far the government can go making you spend your own money. can uncle sam force you to buy healthier food, too? >> everybody's in the market. therefore, you can make people buy broccoli. >> it seems pretty clear that if there are substantial effects on interstate commerce, congress can act. >> reporter: liberals argued there's a ripple effect. >> people who don't participate in this market are making it much more expensive for the people who do. >> reporter: justice kennedy, the swing vote, suggested a unique solution may be warranted, if the government can justify it. >> the reason this is concerning is beca

on the issue of medicaid expansi expansion, medicaid is for poor citizens, medicare is for older citizens. on the issue of medicaid expansion, i thought donald verilli had a much better day today than he did yesterday. and i thought the obama administration had a fighting chance for pulling together five votes on that issue. but, you know, that's not the main part of this law it's very, very important but it's not the main part of this law. and on the main part of the law, i just think they're in a lot of trouble. >> okay, jeff toobin, we shall see. thank you. you just saw jeff. want to see what he said yesterday that definitely drew attention. >> this was a train wreck for the obama administration. this law looks like it's going to be struck down. i'm telling you, all the predictions including mine that the justices would not have a problem with this law were wrong. >> i wouldn't bet on this, but i'll bet on the court a lot more than jeffrey toobin. i've had arguments, federal circuit, supreme court and hundreds of times before trial courts, and the questions you get from the judges does