Four judges say it is Constitutional under Commerce Clause and Chief Justice Roberts says it is constitutional as a de facto "tax" under the federal taxing power.
The oddest ruling? The feds can force the states to expand Medicaid eligibility by denying NEW funds, but they cannot cut them off from the existing program. Wow.
If you recall, the way that the federal government imposed a nationwide 21 year old drinking age was to say that if you did not have a 21 year old drinking age, you got NO highway funds as a state. So...........can the state now reinstate 18 year old drinking ages and get the level of highway funding that they are currently receiving? Certainly the states have a great deal of constitutional support for the position that the states should control alcohol consumption - it is in the repeal of the Prohibition Amendment for goodness sake.
It will be interesting to read the opinions and see how that can possibly be the law, given that withholding $$ is how the fed gets the states to do basically anything to comply with federal policy.