Eric Turner


In N.F.I.B. v. Sebelius, a plurality of the Supreme Court struck down the Patient Protection and Affordable Care Act’s Medicaid (PPACA) expansion. The Court did so by holding that the doctrine “coerced” States into implementing federal policy by threatening to withhold Medicaid funding to states that did not reform their Medicaid programs. This marks the first time a program properly enacted under Congress’ Spending Power has been found to coerce the states. The Court’s coercion analysis, however, has raised more questions than it answered. The plurality’s language is vague, and commentators have struggled to analyze the holding. But what factors made the PPACA’s Medicaid expansion a coercive program? Where should courts draw the line between permissible and impermissible conditions? How can future Spending Power programs be analyzed in line with the coercion argument? This note proposes a three part test to follow when analyzing a coercion argument. This test seeks to give structure to the coercion argument in three ways: by incorporating the policies underlying the Court’s plurality opinions in N.F.I.B. v. Sebelius; by suggesting objective, concrete principles that may be followed in a coercion analysis; and by diminishing the importance of subjective or vague aspects of the Court’s coercion analyses.