SCOTUS rules ACA Medicaid expansion optional for states in NFIB v. Sebelius

The Supreme Court upholds the Affordable Care Act's individual mandate in NFIB v. Sebelius (567 U.S. 519, 2012) but rules that the ACA's requirement that states expand Medicaid or lose all federal Medicaid funding is unconstitutionally coercive. Chief Justice Roberts writes that Congress cannot "gun to the head" states to expand the program. As a result, 19 Republican-controlled states initially refuse to expand Medicaid, leaving millions in a coverage gap. By 2026, all but 10 states have adopted expansion.