However, it is also likely that it could not survive if a large number of states refused to go along with the Medicaid mandate. And opting out of the mandate is a constitutionally orthodox alternative to secession.
Which entirely misses the point, IMHO.
The States can 'opt out' of the mandate all day long, but their citizens will STILL be increasingly 'drained of their sustenance' via the illegitimate income tax.
THE primary duty of the States is to protect their Citizens, even if it means the only way to protect them from the feral federal government is to leave.
"If every infraction of a compact of so many parties is to be resisted at once as a dissolution, none can ever be formed which would last one year. We must have patience and longer endurance then with our brethren while under delusion; give them time for reflection and experience of consequences; keep ourselves in a situation to profit by the chapter of accidents; and separate from our companions only when the sole alternatives left are the dissolution of our Union with them or submission to a government without limitation of powers. Between these two evils, when we must make a choice, there can be no hesitation. But in the meanwhile, the States should be watchful to note every material usurpation on their rights; to denounce them as they occur in the most peremptory terms; to protest against them as wrongs to which our present submission shall be considered, not as acknowledgments or precedents of right, but as a temporary yielding to the lesser evil, until their accumulation shall overweigh that of separation."
Thomas Jefferson to William Branch Giles
That’s a good conclusion pull quote (I used part of it for my title tease) but since the arguement isn’t terribly long or difficult to follow — a read of the entire article really explains it properly.