I posed a question earlier today about the Medicaid (not Medicare as I wrote earlier) portion of the Supreme Court decision on the Affordable Care Act that came down this morning. My question, essentially, was how is the decision to compel states to cover certain groups under Medicaid by threatening complete loss of funding different than when the drinking age was raised in the US to 21 by threatening to take away state highway funding? In addition, by holding that part of the law unconstitutional, how is the Supreme Court not denying Congress the ability to change legislation? It seems to me very confusing that the Supreme Court could come along and say you actually cannot change the law. I mean, it’s Congress, right? They make laws, they change laws, they get rid of laws?
I either didn’t express my question very well or no one wanted to answer me, but luckily, I talked to my go-to-lawyer friend tonight who actually read the brief and explained the decision to me. I still don’t totally buy that the reasoning in the brief, but at least I got an explanation.
In short (and correct me if I’m totally mashing your words on this), is that federal highway funding constituted a very small portion of a state’s overall finances. So denying federal highway funding would have constituted a very small burden for any given state. In contrast, because Medicaid represents a much larger proportion of a state’s budget, 20% (or so?) and because the vast majority of that is federally funded, requiring the state to cover more people (and increase its own outlay) amounts to coercion because a state wouldn’t be able to cover those people without federal funds.
The answer to the second part of my question, which I think makes even less sense, is that Congress still has the ability to make laws and distribute funds, but this law represented a radical departure from the formerly existing law, not merely an amendment, which places an undue burden on the states who don’t want to expand access.
Thank goodness for lawyer friends.
ERIN K. FLETCHER 
Actually, ACA subsidizes the Medicaid *expansion* by 90% in 2020 and beyond, and at higher rates before that. So, this expansion should not have a major effect on state budgets. Quite frankly, any state would be foolish not to take it. Which means states with GOP Governors will not.
http://www.kff.org/healthreform/upload/8061.pdf (PDF)
Like I said, I don’t buy the argument, that’s just the one that was explained to me.