The 2012 Supreme Court decision in NFIB v. Sebelius held that the threatened loss of all federal Medicaid funds made ObamaCare’s Medicaid expansion unconstitutionally coercive. However, Secretary Sebelius has continued to hold federal Medicaid funds hostage in order to limit the effect of the decision in NFIB and coerce states into implementing elements of the Medicaid expansion that the Court rendered optional.