Do No Harm in Medicaid Act

SI-generated grade · five published checks · not individually reviewed by a person · methodology

HR 498 raises significant constitutional concerns under the Spending Clause and the Tenth Amendment, as it conditions federal Medicaid funds on state compliance with a policy that restricts medical decision-making for minors. While the federal government has broad authority to attach conditions to spending, this bill may infringe on state police powers and parental rights, creating a tension with the Ninth and Tenth Amendments. The bill passes checks on enumerated powers and due process but fails on individual sovereignty and decentralization due to its potential to override state and family autonomy in medical care.

• ✓ Passes · Enumerated powers
  The federal government has authority under the Spending Clause (Article I, Section 8, Clause 1) to set conditions on Medicaid funds, as long as conditions are unambiguous and related to the federal interest in the program. This bill conditions payment on a specific medical policy, which is a permissible exercise of spending power under South Dakota v. Dole.
• ✓ Passes · Bill of Rights
  The bill does not directly infringe on any enumerated right in the Bill of Rights. It does not restrict speech, religion, assembly, press, petition, arms, quartering, search and seizure, self-incrimination, due process, fair trial, jury, cruel and unusual punishment, or unenumerated rights under the Ninth Amendment. The Ninth Amendment protects unenumerated rights, but the bill's restriction on fe…
• ✗ Concern · Individual sovereignty
  The bill restricts access to certain medical procedures for minors, which implicates the right of parents to direct the upbringing and medical care of their children, a fundamental liberty interest protected by the Due Process Clause of the Fourteenth Amendment (Pierce v. Society of Sisters, Meyer v. Nebraska). While the government has a compelling interest in protecting minors from potentially ha…
• ✗ Concern · Decentralization
  The bill fails the decentralization test. (1) Individual families can handle medical decisions for their children with state and local oversight, so the federal government's involvement is not necessary. (2) Local communities and states can regulate medical procedures for minors under their police powers. (3) States can handle this without federal involvement, as they traditionally regulate medica…
• ✓ Passes · Due process and takings
  The bill does not bypass due process or take property without just compensation. It does not impose criminal penalties or seize property; it merely conditions federal funding on compliance. States and individuals retain the ability to challenge the conditions through the political process or courts, and the bill includes exceptions for medical emergencies and other conditions, providing procedural…

Sources: Congress.gov: HR 498 summary