Texas isn’t alone in refusing to take the bait that is Medicaid expansion.
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Twenty-six states challenged this threat. Previously and most famously in the case South Dakota v. Dole, the Supreme Court ruled that a point existed where Congress’ funding threats would become so large as to be coercive. With the PPACA ruling, the Court found a spending program from Congress to be coercive for the first time in modern American jurisprudence. Under the original act, the states had no functional choice but to follow the federal government’s wishes. Losing billions in federal funding would force any state to participate, and thus the Chief Justice’s opinion described the situation as a “gun to the head” of states forcing compliance. The federal government, according to the Court, cannot condition previous Medicaid funding on expansion. As a result, states now have an option whether to expand. The Supreme Court’s ruling on the constitutionality of PPACA recognizes that a limit to Congress’ spending power does exist. The ruling gives states the option to expand their Medicaid population in 2014 without being punished by losing all Medicaid funding. States must now decide whether to cooperate with the federal government in expanding a broken, costly system.