Real bill currently in Congress  c/o  HR/119/8650

To amend title XIX of the Social Security Act to increase payments to States with respect to outreach and enrollment under the Medicaid program.

Latest action (2026-05-04): Referred to the House Committee on Energy and Commerce.

The Framers

“Founders’ Verdict”

CONSTITUTIONAL

Confidence 0.50

Synthesis

2-2 split: Hamilton and Marshall deem CONSTITUTIONAL under taxing/spending for general welfare and necessary and proper clause; Madison and Jefferson deem UNCONSTITUTIONAL as exceeding enumerated powers and violating state sovereignty.

Hamilton YES

The proposed amendment falls within the enumerated power of Congress to tax and spend for the general welfare, as it authorizes increased payments to States for outreach and enrollment under an existing federal program. Such expenditures promote the general welfare by facilitating the administration of relief to the needy, a proper object of federal spending. This action is a necessary and proper means to execute the spending power, amending prior legislation without encroaching upon state sovereignty, as States may accept or decline the funds. Federal supremacy ensures the validity of such co…

Article I, Section 8, Clause 1 Article I, Section 8, Clause 18 Federalist No. 33
Jefferson NO

The proposed amendment to title XIX of the Social Security Act seeks to expand federal payments to States for outreach and enrollment in the Medicaid program, a form of public welfare provision. The Constitution grants Congress no enumerated power to engage in such internal matters of health, charity, or assistance to individuals, which are reserved to the States or the people. The taxing and spending authority is limited to the common defense and general welfare within the scope of other enumerated powers, not a broad license for federal welfare schemes. This action invades the reserved power…

Tenth Amendment Article I, Section 8, Clause 1
Madison NO

This proposed amendment to title XIX of the Social Security Act seeks to increase federal payments to States for outreach and enrollment in a program of medical assistance to particular classes of citizens. Such expenditures fall outside the enumerated powers of Congress, as the power to tax and spend is not an unlimited commission for the 'general welfare' but is qualified by the specific objects listed in Article I, Section 8. In Federalist No. 41, it is observed that the phrase 'common defense and general welfare' does not convey plenary authority but is explained by the particulars that fo…

Article I, Section 8, Clause 1 Tenth Amendment Federalist No. 41 Federalist No. 45
Marshall YES

The proposed amendment to title XIX of the Social Security Act, increasing payments to States for outreach and enrollment under the Medicaid program, falls within the enumerated powers of Congress. The power to lay and collect taxes to provide for the general welfare is expressly granted, and the provision of funds to States for the assistance of their inhabitants in matters of health and welfare is a legitimate end within that scope. Such payments are plainly adapted as a means to execute this power, consistent with the necessary and proper clause, as they enable the promotion of the general …

Article I, Section 8, Clause 1 Article I, Section 8, Clause 18 McCulloch v. Maryland (1819)

What should pass

“AI Consensus Solution”

Read full document →

Medicaid Outreach Performance Grants Act

Increase federal payments to states to support outreach and enrollment efforts in the Medicaid program, aiming to boost enrollment among eligible individuals.

Bipartisan rationale: Honors Democratic priorities of expanding healthcare access for vulnerable populations through higher enrollment; honors Republican priorities of fiscal restraint via hard caps, performance metrics, state flexibility in program design, and automatic sunset to prevent open-ended spending.

Funding: General Fund of the Treasury, via annual a $1 billion total cap over 5 ye Sunset 5y Oversight: HHS Office of Inspector Genera Enforcement: Annual performance audits; clawback

Vote-count path: ~235 House votes: 210 D access advocates + 25 R fiscal hawks with caps; ~58 Senate votes: 49 D + 9 R from rural health caucus.

→ Article I, Section 8, Clause 1 (power to tax and spend for general welfare) → Tenth Amendment (respects state sovereignty via voluntary, performance-based grants without mandates)

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