This week, the U.S. Supreme Court heard oral argument in Armstrong v. Exceptional Child Center, Inc., a little noticed case that raises a big question about the Constitution’s Supremacy Clause and access to the courts.  The issue in Armstrong is whether Medicaid providers, who allege that in setting artificially low reimbursement rates the state is flouting the requirements of Medicaid’s equal access provision, can invoke the Supremacy Clause in order to seek an injunction blocking the state’s rate setting.

Consistently closing courthouse doors on aggrieved individuals has been a key part of Chief Justice Roberts’ first decade on the Court, as recounted in our latest Roberts at 10 snapshot, and he emerged in Armstrong as the leading voice for denying Medicaid providers the right to sue under the Supremacy Clause.   During the argument, Roberts argued that “there’s no way to allow [providers] to seek . . . relief under an implied right of action under the Supremacy Clause without opening the courthouse door to everybody who says that the Federal law was not followed.”  That, Roberts suggested, would be “a prescription for budget-busting across the board.”  Justice Stephen Breyer, too, expressed concerns about cost, looking for solutions to the problem raised by the Chief Justice.   

Justice Sonia Sotomayor pushed back, putting her finger on what she called “the essence of the Supremacy Clause question”: the right of individuals to “ensure that State governments are complying with Federal law.”  “Who’s going to go around when the Federal government doesn’t care to ensure that State are, in fact, doing what they promised to do?”  In a similar vein, Justice Elena Kagan argued that preemption claims seeking higher reimbursement rates under Medicaid would likely succeed only in narrowly confined circumstances, such as, in the case before the Justices, where the state refused to follow its own rate-setting methods and procedures.

These are powerful answers, but perhaps the most effective rejoinder to the Chief Justice is even simpler: we don’t close the court house door on plaintiffs because a remedy may be costly. 

Indeed, in numerous areas of constitutional law, courts vindicate the Constitution and supremacy of federal law by imposing injunctions and other kinds of equitable remedies that require states to expend additional funds.  That’s not budget busting; it reflects the proper role of courts in ensuring the supremacy of federal law. 

In school desegregation cases, courts have long ordered states to expend money to maintain and operate public schools on the basis of equality and live up to the dictates of the Fourteenth Amendment as spelled out in Brown v. Board of Education.  Likewise, in prison cases, courts have ensured that states spend the money needed to ensure basic human dignity for prisoners, often actively supervising the management of state prisons to ensure compliance with the Constitution. 

For example, in 2011, Brown v. Plata, the Supreme Court by a 5-4 vote affirmed a court order requiring California to remedy massive overcrowding in its state prisons.  In dissent, Justice Samuel Alito argued that “the Constitution does not give federal judges the authority to run state penal systems. Decisions regarding state prisons have profound public safety and financial implications, and the States are generally free to make these decisions as they choose.”  But the majority rejected that view.  As Justice Anthony Kennedy explained, “Courts . . . must not shrink from their obligation to enforce the constitutional rights of ‘all persons,’ including prisoners. Courts may not allow constitutional violations to continue simply because a remedy would involve intrusion into the realm of prison administration.” 

Rather than closing the courthouse doors on plaintiffs, the Supreme Court has developed a number of doctrines designed to limit the scope of federal equitable remedies.  As Justice Kennedy made the point in a 1992 desegregation case, “[t]he essence of a court’s equity power lies in its inherent capacity to adjust remedies in a feasible and practical way to eliminate the conditions or redress the injuries caused by unlawful action. Equitable remedies must be flexible if these underlying principles are to be enforced with fairness and precision.” Courts must ensure that the scope of relief ordered is properly tailored to violation of federal law and they must approach the remedial task with appropriate sensitivity, paying due regard for the proper role of state authorities in running a prison, a school system, or as in Armstrong, a Medicaid program.  Indeed, during the Armstrong argument, Justice Sotomayor took note of these basic principles, suggesting that perhaps the district court’s injunction should have been framed more narrowly.      

In short, while concerns that a remedy may be costly are certainly legitimate, they don’t serve as the basis for closing the courthouse doors on aggrieved individuals who are harmed when states flout federal law.  There are ways to limit the scope of equitable remedies without stripping the courts of the constitutional obligation to maintain the federal-state balance and prevent states from enforcing preempted state law. 

Armstrong may have attracted little attention so far, but the far-reaching question it poses makes the case one to watch.  A decision is expected by June.