IE 11 is not supported. For an optimal experience visit our site on another browser.

Beyond the mandate: Court's ruling on another ACA provision could threaten Congress's spending power

All eyes are on the Supreme Court's ruling that the Affordable Care Act's individual mandate is a constitutionally permissible tax. But legal scholars suspect that another portion of the Court's opinion may have even broader implications—both for Obamacare itself, and for other laws.

The Court's ruling contains a very narrow reading of the Affordable Care Act's planned Medicaid expansion. As SCOTUSblog's Kevin Russell reported, the justices ruled that the federal government can offer states more funding on the condition that they'll use that money to implement an expansion of Medicaid. However, if states refuse to comply, the federal government does not have the power to entirely withhold Medicaid funding; it only has the legal authority to withhold the additional funding that would have gone towards a Medicaid expansion.

As Lean Forward reported earlier, George Washington University law professor Jonathan Turley believes that the Medicaid decision could spell disaster for health care reform:

"This creates a ripple effect," Turley said on MSNBC. "A majority of states oppose this law. If they had an ability to opt out, they would. I don't see how the health care law could survive if the pool is reduced by that amount. You need to force young people to buy health insurance since they're not going to get sick as often and (having them in the pool) makes it more affordable."

But not everyone agrees. Gillian Metzger, the vice dean of Columbia Law School, cautions that the implications for the law will be "hard to gauge, as many states may opt to go forward with the expansion."

Even harder to gauge will be the ruling's effect on other laws. In a post at the conservative National Review Online titled, "Lose Battle, Win War?" Jonathan H. Adler, a law professor at Case Western Reserve University, suggests that the Court's ruling on Medicaid "would mark the firmest limit on use of the spending power in decades, and could constrain lots of future mischief." In a separate post at the legal blog The Volokh Conspiracy, Adler argues that even some existing laws (or mischief, as he might view them) might now be threatened. "I can think of some federal laws, including portions of the Clean Air Act, that are likely to be challenged on these grounds," he writes.

Richard Garnett of the University of Notre Dame seems to concur. "For people like me, interested in Federalism and judicial review of federal power, the decision had a lot of emphasis of how the Commerce Clause does have limits," he said. "The Medicaid expansion decision puts teeth into the notion that the federal government can't coerce states."

However, it remains to be seen whether those teeth can bite. Adler concedes that the Court's reading of the Medicaid expansion "may not go beyond the limits articulated in South Dakota v. Dole." And Indiana University's Gerard Magliocca, while admitting that he could be "underestimating the importance of the Medicaid issue," writes: "The Chief Justice gave a pretty speech about federalism, but ultimately he did nothing about it."

So here's the takeaway: it is possible that the Court's narrow reading of the Medicaid provision could make other provisions of the Affordable Care Act unsustainable in the long term. It is also possible that conservatives could use the precedent from this ruling to successfully challenge other federal legislation that mandates the states to use existing funding for specific purposes. But we won't know the implications of the ruling for health care until we see how many states opt out of the Medicaid expansion. And we won't know how this ruling affects other federal legislation until we see the first lawsuit claiming it as precedent.