* In upholding the federal health care reform program, the US Supreme Court also ruled that part of the law was unconstitutional. Congress could not withhold all Medicaid funding from states if they refused to participate in the law’s huge Medicaid expansion, the court ruled, calling it unconstitutional coercion. From Chief Justice John Roberts’ majority opinion…

In this case, the financial ‘inducement’ Congress has chosen is much more than ‘relatively mild encouragement’ — it is a gun to the head

* The federal government is constantly putting strings on money it doles out to the states, so this ruling has made people wonder what might happen to current and future federal “inducements,” and if states might now be emboldened to take other federal requirements to court. NPR looks into the matter…

“It is true that this is the first time that the court has invalidated an expansion based upon restraint on federal power,” says James Blumstein, a law professor at Vanderbilt University who wrote an amicus brief in the Medicaid case that anticipated Roberts’ ruling.

“But they’ve always said for years, decades, that this [limit] existed,” Blumstein says. “If this [Medicaid rule] had not crossed the line, the line wouldn’t have existed.”

So where exactly is the line now? No one is certain.

In his health care opinion, Roberts cited a 1987 decision, South Dakota v. Dole, in which the court found that it wasn’t “impermissively coercive,” as the chief justice put it, to require states to raise the minimum drinking age to 21 or lose 5 percent of their federal highway funds.

The sum at stake amounted to less than one-half of 1 percent of South Dakota’s budget at the time — a lot less than the share of federal Medicaid money that makes up every state’s budget, which is about 15 percent, according to the National Association of State Budget Officers.

But because there’s such a big gap between the amount of money the court has said is permissible and the amount it has ruled is unconstitutional, no one has a clear sense of how much leverage Congress can wield over the states.

It’s possible that the Medicaid ruling will remain an outlier. Medicaid is far and away the largest federal-state program, and it was an unusual move for Congress to put the entirety of existing Medicaid dollars at risk, as opposed to a small percentage of program funding. […]

On the other hand, nothing in the court’s opinion suggested that it views Medicaid as unique because of its size.

Go read the whole thing.

…Adding… So far, six Republican governors have said they won’t participate in Obamacare’s Medicaid expansion program. The Washington Post looks at the history of the program…

Medicaid got a chilly reception when it launched in January 1966. It was up to the states to decide whether to participate and only six initially signed up: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma and Pennsylvania. Twenty-seven followed suit later that year. Across the country, governors weighed the boon of new federal dollars — Washington would foot half of Medicaid’s bill — against the drawback of putting state money into a new program.

Nascent Medicaid programs quickly faced threats: Republican legislators in the New York introduced a bill in 1967 calling for the state to “live within its means” and repeal its Medicaid program.

Doctors, meanwhile, lamented the program’s bureaucracy and griped that payments often arrived late. “Doctors’ complaints tie up our telephone lines all day, every day,” Frederick W. Richmond, chairman of the Citizen’s Committee for Medicaid, told the New York Times in 1967. Some pharmacists voted to boycott the program altogether.