What does the Medicaid part of the ACA decision mean for various civil rights statutes that rely on similar constitutional logic?:
In the health care decision, the Court held that Congress exceeded its Spending Clause authority by forcing states into an all-or-nothing choice by threatening to revoke all of their Medicaid funding if they did not participate in the Medicaid expansion. A decade or so ago, several states made similar challenges to a number of important civil rights statutes that condition receipt of federal funds on the state’s agreement to abide by non-discrimination principles in the federally funded programs. These statutes include Title IX (sex discrimination in federally funded education programs), Title IV (race discrimination in any federally funded program), and the Rehabilitation Act (disability discrimination in federally funded programs). States argued that by threatening to take away all of a program’s funds if the State’s didn’t agree to abide by these statutes, Congress was engaging in unconstitutional coercion.
Mostly, the states were arguing not so much that the anti-discrimination mandate was unconstitutional, but that the states were unconstitutionally coerced into agreeing to waive their sovereign immunity and submit to private lawsuits by individuals alleging discrimination in violation of the federal statutes. But the coercion claim would have applied equally to the requirement to refrain from discrimination in the first place.
All of these challenges failed. But it seems likely that many will now be revived. States can now point to the Supreme Court’s striking down of the Medicaid Expansion for support for the proposition that the coercion doctrine — which had been mentioned but never enforced by the Supreme Court in prior decisions — is real and has teeth. And they can look to the majority and dissenting decisions for guidance on what counts as unconstitutionally coercive.
This does not mean they will succeed. To be honest, I find the opinions to be remarkable thin on doctrinal guidance. The Justices mostly adopted a “we know it when we see it” theory of coercion in this case. The lower courts are going to have to spend a lot of time trying to turn the Court’s gut reaction into a set of legal principles.