The Affordable Care Act provides for a substantial expansion of the population that states “must cover” under Medicaid. However, if a state fails to participate in this expansion of Medicaid, the state could lose all of its federal Medicaid funding – ie., not just its funding for the expansion. Several states therefore have objected that the Affordable Care Act “coerces” them into compliance with a federal objective and violates the “coercion doctrine.” The final session of oral arguments before the Supreme Court on the constitutionality of the Affordable Care Act therefore focused on whether the expansion of Medicaid in the Affordable Care Act violates State Sovereignty.
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