Squashed

A blog of politics, law, religion, and the tricky spots where they collide.

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The Constitutionality of the Medicaid Expansion

Zombie Cuddle asked:

What were the constitutional concerns about the Medicaid expansion stick? See my latest post for my understanding — why should the Constitution prohibit the federal Congress from making changes to the way federal monies are used to fund state Medicaid programs? I still do not understand what the basis for this question was.

You have a friend who owns a truck,1 right? You know how every once in a while you score a few kilos of some primo shit from your friend with a truck?2 And sometimes you make a new friend who looks a little lonely,3 and you say, “For you, it’s on me this time. And come find me any time you’re looking for a friend.” So now you’ve got these fifty new friends4 who like to party. And sometimes you ask your friends in need for a few little favors for continuing to feed their cravings.5

So one day your friend with a truck brings you something special. We’re talking 100% pure crystal-shit smuggled into the country by rogue CIA to fund some covert war somewhere.6 And you go friends in need and say, “I’ve got some stuff for you—but I need a huge favor. You need to help me out a bit in return.”7 And some of your friends jump at it and other say, “I’ve heard of your freaky favors.8 I’m not touching it.”

And you say, “Just fucking do it.9 You’re nobody to me.”

And they say, “Fuck you.”10

And you say, “I’m not making you do anything you’re not totally comfortable with—but I’m cutting you off entirely.”11

And that’s where your friends in need get a bit jumpy—because they’re hooked and they know it. They get a bit desperate and go to your friend The Chief.12 And the Chief says, “That’s not cool.13 You know they’re just a bunch of junkies. Just keep giving them the regular shit. And if they want the good stuff, they can implement the full provisions of the Affordable Care Act by the time it goes into effect in 2014.”

If anybody else has questions about today’s healthcare decision, please ask.


  1. Taxpayers 

  2. Medicaid funds 

  3. The states 

  4. From sea to shining sea 

  5. Provision of medical benefits to those under a certain percent of the poverty line who fit into certain categories. 

  6. The medicaid expansion in the ACA 

  7. Expansion of medicaid eligibility to everybody under 133% of the Federal Poverty Line, including the requirement that certain minimum levels of care be followed. 

  8. Death panels 

  9. Pass the ACA along partisan lines. 

  10. File a law suit seeking an injunction to prevent the law from going in effect on the grounds that creating such specific requirements on states violates principles of federalism. 

  11. Cutting off medicaid funds for any states that don’t follow the requirements of the ACA. 

  12. The Chief. 

  13. Unconstitutional.