Who might be left out of coverage as a result of today's landmark Supreme Court decision? Medicare advocates note that Medicaid recipients in some states may get the short end of the stick, as the PPACA's drive for Medicaid expansion is now more or less optional for states who choose not to do so.

As part of the ruling, Justice John Roberts noted that the portion of the PPACA covering the expansion of Medicaid violated the Constitution by threatening existing Medicaid funding.

"Congress has no authority to order the States to regulate according to its instructions," he wrote Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer. The States are given no such choice in this case: They must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding. The remedy for that constitutional violation is to preclude the Federal Government from imposing such a sanction."

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