Over at the Atlantic, constitutional scholar Garrett Epps hypothesizes that the expansion of Medicaid could be the real undoing of health care reform. States opposing the ACA will argue that they have become so dependent on federal Medicaid funding that it must comply with any new conditions attached to the funding (like the expansion of Medicaid to single adults living in poverty), no matter how sweeping or burdensome, or risk losing the funding entirely. According to the states, this amounts to an unconstitutional abuse of Congress’s spending powers. It’s a bit like the ungrateful trust fund kid objecting to his rich uncle’s recent edict that he must maintain a 3.0 GPA or the trust fund spigot gets turned off. And Epps seems to think there’s at least a chance that the conservative Court could buy the argument.
It’s an interesting theory, but I’m skeptical. I’m not aware of any precedent that questions Congress’s ability to attach conditions to the funding it doles out. To rule otherwise would cast doubt on nearly every other program that distributes money to states, whether it’s related to education, food safety, or just about any other realm of public concern. The Court would also have to set forth some fairly specific criteria defining reasonable and unreasonable exercises of Congressional spending powers. Such wading into the legislative weeds might give even the most right-leaning justices pause. My own guess (and it’s only a guess) is that the Medicaid expansion will stand regardless of how the Court rules on the individual mandate.
