The Supreme Court’s decision in NFIB v. Sebelius upheld most major provisions of the Affordable Care Act, but not all. Stunning most close observers, the Court ruled that the ACA’s efforts to expand Medicaid coverage unconstitutionally “coerced” state recipients of federal Medicaid subsidies -- in the process upending seventy-five years of “conditional spending” doctrine. While seven justices agreed in that outcome, no rationale for it commanded more than four votes. And each of the competing rationales is itself complex, leaving early commentators puzzled as to which elements of the Court’s reasoning are essential to the outcome. The stakes in that interpretive struggle are large, as conditional federal spending is the lynchpin of a wide range of regulatory regimes, including unemployment insurance, aid to the poor, education standards and incentives, clean air and water, health care for the indigent and those with disabilities, and legal protections against state-sponsored discrimination.
This panel brings together leading commentators on the law of conditional spending in an attempt to decipher the meaning of the new doctrine and its implications for future cases, including its impact on federal programs, states, localities, and school districts.