Cents and sensitivity - Teaching physicians to think about costs

摘要

Third, in a surprising alignment, Breyer and Kagan joined Roberts and the four justices on the joint opinion to rule that Congress could not condition the federal Medicaid funds that states currently receive on their agreement to participate in the ACA's Medicaid expansion. Despite the principle that under its power to spend for the "general welfare" Congress may attach conditions to federal funds provided to the states, the seven justices concluded that by tying not only new money but also existing Medicaid payments to participation in the expansion, the policy crossed the line from encouragement to coercion, violating the 10th Amendment. Roberts further argued that the expansion made Medicaid "no longer a program to meet the health care needs of the neediest among us but an element of a national plan to provide universal health insurance coverage."