In its review of Obamacare’s constitutionality, the Supreme Court will examine two substantive parts of the law: the “individual mandate” that compels private citizens to purchase health insurance, and the statute’s massive expansion of Medicaid rolls. While the mandate question holds great constitutional interest, the outcome won’t greatly affect Obamacare’s operation one way or the other. The Medicaid question, in contrast, is crucial. The expanded program is expected to provide health coverage for an additional 16 million poor and near-poor, heretofore-uninsured individuals, at a cost of upwards of $500 billion between 2014 and 2019. In a brief filed earlier this week, the litigating states claim that the statute unduly “coerces” them into participating in the program, in violation of the constitutional federalism balance. Should they prevail, all of Obamacare will have to be renegotiated.
That renegotiation, of course, is the holy grail of conservative agitation. However, the states won’t prevail on their Medicaid claim. Nor should they. Conservatives’ vocal support for the states’ opportunistic position is incoherent as a matter of both policy and federalism theory.
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