The constitutional battle over ObamaCare has largely focused on the constitutionality of the individual mandate. Namely, does forcing individuals to buy health insurance violate the commerce clause? But as the Eleventh Circuit Court of Appeals prepares to hear Florida v. United States, a second issue is of equal importance: Was District Court Judge Roger Vinson correct to rule that the federal government can force states to expand their Medicaid programs as a precondition for continuing to receive matching federal funds for the program?

Under the Patient Protection and Affordable Care Act, states have a choice: Expand their Medicaid rolls or bear the full cost of caring for their state’s current Medicaid population, while continuing to subsidize the Medicaid programs of other states. The constitutional danger of such a scheme has long been recognized. In 1936, the Supreme Court warned in U.S. v. Butler that if conditional federal grants were not restrained, the taxing and spending power “could become the instrument for the total subversion of the governmental powers reserved to the individual states.”

The Medicaid provision of ObamaCare spells the death knell to competition among the states. States cannot function as “laboratories of democracy”—as the 10th Amendment intended—if the federal government can use its power to tax and spend to bludgeon all states into conformity.

The constant backdrop of the federal taxing power makes a mockery of the claim that state participation under ObamaCare is voluntary. The only way to prevent this grave intrusion on state autonomy is to strike down the Medicaid provisions of the health-reform law.

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