Today’s Supreme Court ruling has upheld the central piece of the Affordable Care Act, the individual mandate, but has deemed part of that act unconstitutional when it comes to another major piece, the Medicaid expansion.

Under the Act, Medicaid will expand to cover all persons under 133% of the poverty line. Under the original Medicaid rules, only certain “covered groups” were eligible; namely the aged, blind, disabled, children, or parents with dependent children.  No provision was made for poor childless adults.  The Affordable Care Act sought to change that, and conditioned all future Medicaid funding on states’ compliance with the new coverage rules.

Chief Justice John Roberts, in his majority opinion, deemed that the federal government forcing the states to comply with the expansion, lest they lose all Medicaid funding, was unconstitutional, stating, “In this case, the financial ‘inducement’ Congress has chosen is much more than ‘relatively mild encouragement’ — it is a gun to the head.”  Therefore, the Medicaid expansion under health reform is now optional; states can choose to accept or refuse the conditions for the Medicaid expansion without fear of losing current Medicaid funding. Continue reading »