The Supreme Court itself has said that this specific form of coercion is unconstitutional.
Amendment command appears difficult to discern only because Congress has never tried to violate it before. Congress has always raised the debt ceiling in time, and it might do so again. But some House Republicans seem ready to bring on a global fiscal crisis. Perhaps this is mere posturing. Even so, the situation could easily get out of control if the House turns out to be bad at playing the game of chicken.
The Medicaid expansion provision told the states that either they accept the new terms of coverage or they lose all of their existing Medicaid funds. In the court’s view, this was not a real choice. The existing scheme provided funds that constituted a significant portion of state budgets—in some cases as much as ten percent. Loss of those funds threatened state fiscal disaster.
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