The Roberts Court preserved that precedent, but it reasoned that in some circumstances, such as Medicaid in this case, an expansion could qualify as a new program and thus let states turn it down without sacrificing existing funds. That gives states a new basis under which to challenge future federal expansions of programs without losing their existing funding. That could apply to education programs like No Child Left Behind and, as The Daily Beast noticed, the drinking age.
For nearly 30 years, the legal drinking age of 21 has been enforced via the Federal Aid Highway Act. The Constitution gives states exclusive right to make liquor laws, but states that were resisting raising the age eventually succumbed to federal pressure, highway funds being too tempting to turn down.
In his health care opinion, Chief Justice John Roberts upheld the 1987 ruling that lets Congress impose the drinking age condition -- but only in that instance. If future highway funding bills are more expansive in scope, states could sue to opt out with minimal consequence, and therefore lose an incentive not to lower their drinking age.
"The Court expressly distinguished South Dakota v. Dole, the drinking age case, because only a small portion of highway funds were at risk," said Tim Jost, a professor of law at Washington & Lee University. "There will certainly be future litigation when other federal programs are changed and all of the funding for the existing program is at risk, however."
In other words, Jost said, the Affordable Care Act ruling opens a new door for states that subsequently lower the drinking age to sue to block federal repercussions.
But it's far from certain, and others are skeptical the implications will be that far-reaching.
"The health care decision on Medicaid is likely to be limited to its facts," said Adam Winkler, a constitutional law professor at UCLA. "Where a state's budget is truly dependent on federal dollars to survive, then conditional spending offers will be called into question. The health care decision doesn't purport to call into question any previous conditional spending law. And its not likely to have much impact because there's no clear majority opinion establishing new limits."
The health care ruling offered more details on what unlawful federal "coercion" of states entails. It's not yet conclusive as far as the drinking age is concerned, nor is it clear that states will bite. But if states make a push and if courts end up seeing it their way, Roberts' opinion may eventually be viewed as having opened the door to a lower drinking age.
Image via Shutterstock / Dmitriy Shironosov