The Daily Beast and Talking Points Memo both have stories up suggesting that the Medicaid portion of Chief Justice John Roberts Obamacare decision makes it possible for states to lower their drinking age below the federally mandated age 21. But if you are in the affected age group, don’t get your hopes up.
Instead, take a couple of minutes to read the Court’s opinion. The Medicaid portion is just over ten pages, stretching from page 45 to page 55. If that is still too long, the relevant passages are below:
In South Dakota v. Dole, we considered a challenge to a federal law that threatened to withhold five percent of a State’s federal highway funds if the State did not raise its drinking age to 21. … We accordingly asked whether “the financial inducement offered by Congress” was “so coercive as to pass the point at which ‘pressure turns into compulsion.’” Id., at 211 (quoting Steward Machine, supra, at 590). By “financial inducement” the Court meant the threat of losing five percent of highway funds; no new money was offered to the States to raise their drinking ages. We found that the inducement was not impermissibly coercive, because Congress was offering only “relatively mild encouragement to the States.”
In fact, the federal funds at stake constituted less than half of one percent of South Dakota’s budget at the time. … Medicaid spending accounts for over 20 percent of the average State’s total budget, with federal funds covering 50 to 83 percent of those costs. … It is easy to see how the Dole Court could conclude that the threatened loss of less than half of one percent of South Dakota’s budget left that State with a “prerogative” to reject Congress’s desired policy, “not merely in theory but in fact.”
The threatened loss of over 10 percent of a State’s overall budget, in contrast, is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.
In plain English, not only does the Court not threaten to overturn South Dakota v Dole, it explicitly uses the case as the foundation of its new rule striking down parts of Obamacare’s Medicaid expansion. Basically the Court held that if the federal funding that Congress uses to coerce state behavior is large enough, 10 percent of a state’s overall budget, then threatening to withhold that funding is unconstitutional coercion. But if the funding is only a tiny part of a state’s, like the Highway Trust Fund is, then Congress can make them do whatever they want (as long as it is related to the overall purpose of the original funding).
In fact, Medicaid spending is such a uniquely large portion of federal grants to states ($258 billion spent on Medicaid in 2012 compared to just $$ billion on highways), it is highly doubtful that Roberts’ Medicaid analysis will ever be applied to a program other than Medicaid.