Supreme Court ready to tackle Medicaid expansion While most of the debate over the Patient Protection and Affordable Care Act has focused on its requirement that most Americans have health insurance, the Supreme Court takes up another explosive issue Wednesday afternoon as the justices consider whether states can challenge the law's dramatic expansion of Medicaid. Twenty-six Republican-led states are arguing that federal pressure in the law to expand Medicaid to all low-income Americans violates states' rights. And some legal experts believe that this expansion - which is expected to provide subsidized healthcare for as many as 17 million more low-income people over the next decade - could be a ripe target for conservatives on the court. Such a ruling could also undercut an array of other federal social programs. The Medicaid arguments wrap up three days of historic hearings at the court that underscored deep ideological divisions on the court over the scope of federal power. A ruling in the case, including the contentious insurance mandate, is expected in June. What is at issue in the Medicaid part of the case? Whether the states can be required to offer subsidized healthcare to an additional 17 million low-income people. Begun in 1965, the Medicaid program offers money to the states, which in turn contribute money of their own. States need not participate, but all of them do. On average, the federal government pays 57% of the cost. Having grown steadily for decades, Medicaid in 2008 served about 47 million persons, most of them mothers and children. So what's new in the law? It says states must do more and provide healthcare for all those whose income is below 138% of the poverty line. However, the federal government will pay nearly all the added cost. Its share will be 100% in 2014 and drop to 90% by 2020. Why do 26 states object if the federal government is paying the tab? They say they will be forced to spend at least $20 billion more this decade, and they say they have "no choice" but to go along. Otherwise, they could lose all their Medicaid money, a devastating blow to state budgets. They say this amounts to unconstitutional "coercion" of the sovereign states. How has the Supreme Court dealt with such suits in the past? The justices have never struck down a federal spending law on the grounds it pressures states to go along. For decades, Washington has sent money to states for purposes such as education, transportation and healthcare, but it has required states to follow the federal rules. Original source: Supreme Court ready to tackle Medicaid expansion