The issue to be addressed is whether the Patient Protection and Affordable Care Act’s (ACA or “Obamacare”) manifest goal of promoting the general welfare of the nation by encouraging states to expand their existing Medicaid plans is a coercive use of Congress’ power under the Spending Clause if the federal government permanently picks up at least 90 percent of the cost of the expansion. The Spending Clause grants Congress the power “to pay the Debts and provide for the . . . general Welfare of the United States.” To make certain that federal money given to the States is used to promote the general welfare of the people in a manner consistent with the intent of Congress, it is necessary for Congress to have the power to place restrictions on the States’ expenditure of federal dollars.
L. Darnell Weeden,
Medicaid Expansion, the Patient Protection and Affordable Care Act, and the Supreme Court's Flawed Spending Clause Coercion Reasoning in National Federation of Independent Business v. Sebelius,
61 Clev. St. L. Rev.
available at https://engagedscholarship.csuohio.edu/clevstlrev/vol61/iss4/8