Supreme Court weighs Medicaid expansion

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Ending three days of hearings in the Florida-led challenge to the 2010 Affordable Care Act, the U.S. Supreme Court on Wednesday considered part of the law that would lead to a major expansion of Medicaid eligibility, reports the News Service of Florida.

Florida and other opponents contend the expansion is unconstitutional because states would be coerced to take part. That argument stems from the possibility states could lose all of their federal Medicaid funding if they don’t carry out the expansion. The court’s more-liberal justices appeared to reject the coercion argument, in part because the federal government would cover almost all of the expansion’s costs in the coming years. “In other words, the federal government is here saying, we are giving you a boatload of money,” Justice Elena Kagan said, according to a transcript. “… there’s no matching funds requirement, there are no extraneous conditions attached to it, it’s just a boatload of federal money for you to take and spend on poor people’s health care. It doesn’t sound coercive to me, I have to tell you.” But conservative justices appeared to side more with the states’ arguments. Justice Antonin Scalia likened the situation to Congress making an offer that states “can’t refuse,” because of the possibility of jeopardizing billions of dollars in Medicaid funding. “Can you conceive of a state saying no?” Scalia asked. “And if you can’t, that sounds like coercion to me.” The Medicaid expansion is part of the law’s broader goal of making sure almost all Americans have health coverage starting in 2014.

Florida, joined by 25 other states and the National Federation of Independent Business, has fought the Affordable Care Act in court for the past two years. Justices heard arguments Tuesday on the most-controversial part of the law, which would require almost everybody to have health coverage or pay penalties — a requirement that has become known as the “individual mandate.”

Earlier Wednesday, they heard arguments about whether the entire law would need to be tossed out if the individual mandate in unconstitutional. Justices are expected to rule by the end of June.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including,,, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.