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After Supreme Court ruling, Medicaid expansion faces uncertainty

A main goal of the Affordable Care Act was to increase the rolls of insured Americans, with about half coming from Medicaid. But the Supreme Court made it easier for states to opt out of the expanded program.

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Rep. Tim Murphy, R-Pa., holds up a copy of the Supreme Court's health care ruling during a news conference by the GOP Doctors Caucus on Capitol Hill Thursday.

Cliff Owen/AP

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This week's Supreme Court on health-care reform represented a legal victory for President Obama on many fronts, but the ruling made it easier for states to opt out of one important area, the expansion of Medicaid for America's poor.

The president won a major enlargement of Medicaid funding as part of the 2010 Affordable Care Act. As many as 17 million people, or about one-third of Americans who lack health insurance, stood to gain coverage under the law.

But many states, which administer the Medicaid program and help to fund it alongside the federal government, joined a legal challenge to the act. Some 26 states argued that this portion of the law was an unlawful federal intrusion into their affairs.

Participation in Medicaid has always been at the discretion of states. In Thursday's ruling, a majority of justices indicated that the federal government could not force states to accept the law's expansion of the program, saying the threat that states refusing to participate in the expansion would lose all federal Medicaid funding was unconstitutionally coercive.

The result, potentially, could be to undercut Mr. Obama's major goal of expanding health insurance to more Americans. As many as half of people gaining coverage were expected to do so within Medicaid.

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