NATIONAL FEDERATION OF INDEPENDENT BUSINESS ET AL. v.
SEBELIUS, SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL.
567 U.S. 519
CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE ELEVENTH CIRCUIT
Argued March 26, 27, 28, 2012—Decided June 28, 2012*
ROBERTS, C. J., announced the judgment of the Court and delivered the
opinion of the Court with respect to Parts I, II, and III–C, in which GINSBURG, BREYER, SOTOMAYOR, and KAGAN, JJ., joined; an opinion with respect to
Part IV, in which BREYER and KAGAN, JJ., joined; and an opinion with respect to
Parts III–A, III–B, and III–D. GINSBURG, J., filed an opinion concurring in part, concurring in the
judgment in part, and dissenting in part, in which SOTOMAYOR, J., joined, and in which BREYER and KAGAN, JJ., joined as to Parts I, II, III, and IV. SCALIA, KENNEDY, THOMAS, and ALITO, JJ., filed a dissenting opinion. THOMAS, J., filed a dissenting opinion.
CHIEF JUSTICE ROBERTS announced the judgment of the Court and delivered the
opinion of the Court with respect to Parts I, II, and III–C, an opinion with
respect to Part IV, in which JUSTICE BREYER and JUSTICE KAGAN join, and an opinion with respect to Parts III–A, III–B,
and III–D.
Today we resolve constitutional
challenges to two provisions of the Patient Protection and Affordable Care Act
of 2010: the individual mandate, which requires individuals to purchase a
health insurance policy providing a minimum level of coverage; and the
Medicaid expansion, which gives funds to the States on the condition that they
provide specified health care to all citizens whose income falls below a
certain threshold. We do not consider whether the Act embodies sound policies.
That judgment is entrusted to the Nation’s elected leaders. We ask only whether
Congress has the power under the Constitution to enact the challenged
provisions.
In our federal system, the
National Government possesses only limited powers; the States and the people
retain the remainder. Nearly two centuries ago, Chief Justice Marshall observed
that “the question respecting the extent of the powers actually
granted” to the Federal Government “is perpetually arising, and will
probably continue to arise, as long as our system shall exist.” McCulloch v.
Maryland, 4 Wheat. 316, 405 (1819). In this case we must again determine
whether the Constitution grants Congress powers it now
asserts, but which many States and individuals believe it does not possess.
Resolving this controversy requires us to examine both the limits of the
Government’s power, and our own limited role in policing those boundaries.
The Federal Government “is
acknowledged by all to be one of enumerated powers.” Ibid. That is,
rather than granting general authority to perform all the conceivable functions
of government, the Constitution lists, or enumerates, the Federal Government’s
powers. Congress may, for example, “coin Money,” “establish Post Offices,” and
“raise and support Armies.” Art. I, §8, cls. 5, 7,
12. The enumeration of powers is also a limitation of powers, because “[t]he
enumeration presupposes something not enumerated.” Gibbons v. Ogden,
9 Wheat. 1, 195 (1824).The Constitution’s express
conferral of some powers makes clear that it does not grant others. And the
Federal Government “can exercise only the powers granted to it.” McCulloch,
supra, at 405.
Today, the restrictions on
government power foremost in many Americans’ minds are likely to be affirmative
prohibitions, such as contained in the Bill of Rights. These affirmative prohibitions
come into play, however, only where the Government possesses authority to act
in the first place. If no enumerated power authorizes Congress to pass a
certain law, that law may not be enacted, even if it would not violate any of
the express prohibitions in the Bill of Rights or elsewhere in the
Constitution.
Indeed, the Constitution did not
initially include a Bill of Rights at least partly because the Framers felt the
enumeration of powers sufficed to restrain the Government. As Alexander
Hamilton put it, “the Constitution is itself, in every rational sense, and to
every useful purpose, A BILL OF RIGHTS.” The Federalist No.
84, p. 515 (C. Rossiter ed. 1961). And when the Bill of Rights was ratified,
it made express what the enumeration of powers necessarily implied: “The
powers not delegated to the United States by the Constitution . . . are
reserved to the States respectively, or to the people.” U. S. Const., Amdt. 10. The Federal Government has expanded dramatically
over the past two centuries, but it still must show that a constitutional
grant of power authorizes each of its actions. See, e.g., United States v.
Comstock, 560 U. S. ___ (2010).
The same does not apply to the
States, because the Constitution is not the source of their power. The Constitution
may restrict state governments—as it does, for example, by forbidding them to
deny any person the equal protection of the laws. But where such prohibitions
do not apply, state governments do not need constitutional authorization to
act. The States thus can and do perform many of the vital functions of modern
government—punishing street crime, running public schools, and zoning property
for development, to name but a few—even though the Constitution’s text does not
authorize any government to do so. Our cases refer to this general power of
governing, possessed by the States but not by the Federal Government, as the
“police power.” See, e.g., United States v. Morrison, 529 U. S.
598, 618–619 (2000).
“State sovereignty is not just an
end in itself: Rather, federalism secures to citizens the liberties that derive
from the diffusion of sovereign power.” New York v. United States,
505 U. S. 144, 181 (1992) (internal quotation marks omitted). Because the
police power is controlled by50 different States instead of one national
sovereign, the facets of governing that touch on citizens’ daily lives are
normally administered by smaller governments closer to the governed. The
Framers thus ensured that powers which “in the ordinary course of affairs, concern
the lives, liberties, and properties of the people” were held by governments
more local and more accountable than a distant federal bureaucracy. The Federalist No. 45, at 293 (J.
Madison). The independent power of the States also serves as a check on the
power of the Federal Government: “By denying any one government complete
jurisdiction over all the concerns of public life, federalism protects the
liberty of the individual from arbitrary power.” Bond v. United
States, 564 U. S. ___, ___ (2011) (slip op., at 9–10).
This case concerns two powers that
the Constitution does grant the Federal Government, but which must be read
carefully to avoid creating a general federal authority akin to the police
power. The Constitution authorizes Congress to “regulate Commerce with foreign
Nations, and among the several States, and with the Indian Tribes.” Art. I, §8,
cl. 3. Our precedents read that to mean that Congress may regulate “the
channels of interstate commerce,” “persons or things in interstate commerce,”
and “those activities that substantially affect interstate commerce.” Morrison,
supra, at 609 (internal quotation marks omitted). The power over
activities that substantially affect interstate commerce can be expansive. That
power has been held to authorize federal regulation of such seemingly local
matters as a farmer’s decision to grow wheat for himself and his livestock, and
a loan shark’s extortionate collections from a neighborhood butcher shop. See Wickard
v. Filburn, 317 U. S. 111 (1942); Perez v. United States,
402 U. S. 146 (1971).
Congress may also “lay and collect
Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the
common Defence and general Welfare of the United
States.” U. S. Const., Art. I, §8, cl. 1. Put simply, Congress may tax and
spend. This grant gives the Federal Government considerable influence even in
areas where it cannot directly regulate. The Federal Government may enact a tax
on an activity that it cannot authorize, forbid, or otherwise control. See, e.g.,
License Tax Cases, 5 Wall. 462, 471 (1867). And in exercising its spending
power, Congress may offer funds to the States, and may condition those offers
on compliance with specified conditions. See, e.g., College Savings Bank v.
Florida Prepaid Postsecondary Ed. Expense Bd., 527 U. S. 666, 686
(1999). These offers may well induce the States to adopt policies that the
Federal Government itself could not impose. See, e.g., South Dakota v. Dole,
483 U. S. 203, 205–206 (1987) (conditioning federal highway funds on States
raising their drinking age to 21).
The reach of the Federal
Government’s enumerated powers is broader still because the Constitution
authorizes Congress to “make all Laws which shall be necessary and proper for
carrying into Execution the foregoing Powers.” Art. I, §8, cl. 18. We have long
read this provision to give Congress great latitude in exercising its powers:
“Let the end be legitimate, let it be within the scope of the constitution,
and all means which are appropriate, which are plainly adapted to that end,
which are not prohibited, but consist with the letter and spirit of the
constitution, are constitutional.” McCulloch, 4 Wheat., at 421.
Our permissive reading of these
powers is explained in part by a general reticence to invalidate the acts of
the Nation’s elected leaders. “Proper respect for a co-ordinate branch of the
government” requires that we strike down an Act of Congress only if “the lack
of constitutional authority to pass [the] act in question is clearly demonstrated.”
United States v. Harris, 106 U. S. 629, 635 (1883).Members of this Court are vested with the authority to
interpret the law; we possess neither the expertise nor the prerogative to make
policy judgments. Those decisions are entrusted to our Nation’s elected
leaders, who can be thrown out of office if the people disagree with them. It
is not our job to protect the people from the consequences of their political
choices.
Our deference in matters of policy
cannot, however, become abdication in matters of law. “The powers of the
legislature are defined and limited; and that those limits may not be mistaken,
or forgotten, the constitution is written.” Marbury v. Madison, 1
Cranch 137, 176 (1803). Our respect for Congress’s
policy judgments thus can never extend so far as to disavow restraints on
federal power that the Constitution carefully constructed. “The peculiar
circumstances of the moment may render a measure more or less wise, but cannot
render it more or less constitutional.” Chief Justice John Marshall, A Friend
of the Constitution No. V, Alexandria
Gazette, July 5, 1819, in John Marshall’s Defense of McCulloch v. Maryland
190–191 (G. Gunther ed. 1969). And there can be no question that it is the
responsibility of this Court to enforce the limits on federal power by
striking down acts of Congress that transgress those limits. Marbury v. Madison,
supra, at 175–176.
The questions before us must be
considered against the background of these basic principles.
I
In 2010, Congress enacted the Patient Protection and Affordable Care
Act, 124 Stat. 119. The Act aims to increase the number of Americans covered
by health insurance and decrease the cost of health care. The Act’s 10 titles
stretch over 900 pages and contain hundreds of provisions. This case concerns
constitutional challenges to two key provisions, commonly referred to as the
individual mandate and the Medicaid expansion. The individual mandate requires
most Americans to maintain “minimum essential” health insurance coverage.26 U.
S. C. §5000A. The mandate does not apply to some individuals, such as prisoners
and undocumented aliens. §5000A(d). Many individuals will receive the required
coverage through their employer, or from a government program such as
Medicaid or Medicare. See §5000A(f). But for individuals who are not exempt and
do not receive health insurance through a third party, the means of satisfying
the requirement is to purchase insurance from a private company. Beginning in
2014, those who do not comply with the mandate must make a “[s]hared responsibility payment” to the Federal Government.
§5000A(b)(1). That payment, which the Act describes as a “penalty,” is
calculated as a percentage of household income, subject to a floor based on a
specified dollar amount and a ceiling based on the average annual premium the
individual would have to pay for qualifying private health insurance.
§5000A(c). In 2016, for example, the penalty will be 2.5 percent of an individual’s
household income, but no less than $695 and no more than the average yearly
premium for insurance that covers 60 percent of the cost of 10 specified
services (e.g., prescription drugs and hospitalization). Ibid.;
42 U. S. C. §18022. The Act provides that the penalty will be paid to the
Internal Revenue Service with an individual’s taxes, and “shall be assessed and
collected in the same manner” as tax penalties, such as the penalty for
claiming too large an income tax refund. 26 U. S. C. §5000A(g)(1). The Act,
however, bars the IRS from using several of its normal enforcement tools, such
as criminal prosecutions and levies. §5000A(g)(2). And some individuals who are
subject to the mandate are nonetheless exempt from the penalty—for example,
those with income below a certain threshold and members of Indian tribes.
§5000A(e).
On the day the President signed
the Act into law, Florida and 12 other States filed a complaint in the Federal
District Court for the Northern District of Florida. Those plaintiffs—who are
both respondents and petitioners here, depending on the issue—were subsequently
joined by 13more States, several individuals, and the National Federation of
Independent Business. The plaintiffs alleged, among other things, that the
individual mandate provisions of the Act exceeded Congress’s powers under
Article I of the Constitution. The District Court agreed, holding that Congress
lacked constitutional power to enact the individual mandate. 780 F. Supp. 2d
1256 (ND Fla. 2011).The District Court determined that
the individual mandate could not be severed from the remainder of the Act, and
therefore struck down the Act in its entirety. Id., at 1305–1306.
The Court of Appeals for the
Eleventh Circuit affirmed in part and reversed in part. The court affirmed the
District Court’s holding that the individual mandate exceeds Congress’s power.
648 F. 3d 1235 (2011). The panel unanimously agreed that the individual mandate
did not impose a tax, and thus could not be authorized by Congress’s power to
“lay and collect Taxes.” U. S. Const., Art. I, §8, cl. 1. A majority also held
that the individual mandate was not supported by Congress’s power to “regulate
Commerce . . . among the several States.” Id., cl. 3. According to the
majority, the Commerce Clause does not empower the Federal Government to order
individuals to engage in commerce, and the Government’s efforts to cast the
individual mandate in a different light were unpersuasive. Judge Marcus
dissented, reasoning that the individual mandate regulates economic activity
that has a clear effect on interstate commerce.
Having held the individual mandate
to be unconstitutional, the majority examined whether that provision could be
severed from the remainder of the Act. The majority determined that, contrary
to the District Court’s view, it could. The court thus struck down only the
individual mandate, leaving the Act’s other provisions intact.648 F. 3d, at
1328.
Other Courts of Appeals have also
heard challenges to the individual mandate. The Sixth Circuit and the D. C.
Circuit upheld the mandate as a valid exercise of Congress’s commerce power.
See Thomas More Law Center v. Obama, 651 F. 3d 529 (CA6 2011); Seven-Sky
v. Holder, 661 F. 3d 1 (CADC 2011). The Fourth Circuit determined
that the Anti-Injunction Act prevents courts from considering the merits of
that question. See Liberty Univ., Inc. v. Geithner, 671 F. 3d 391
(2011). That statute bars suits “for the purpose of restraining the assessment
or collection of any tax.” 26 U. S. C. §7421(a). A majority of the Fourth
Circuit panel reasoned that the individual mandate’s penalty is a tax within
the meaning of the Anti-Injunction Act, because it is a financial assessment
collected by the IRS through the normal means of taxation. The majority
therefore determined that the plaintiffs could not challenge the individual
mandate until after they paid the penalty.1
—————— 1The
Eleventh Circuit did not consider whether the Anti-Injunction Act bars
challenges to the individual mandate. The District Court had determined that it
did not, and neither side challenged that holding on appeal. The same was true
in the Fourth Circuit, but that court examined the question sua
sponte because it viewed the Anti-InjunctionAct
as a limit on its subject matter jurisdiction. See Liberty Univ., 671 F.
3d, at 400–401. The Sixth Circuit and the D. C. Circuit considered the question
but determined that the Anti-Injunction Act did not apply. See Thomas More,
651 F. 3d, at 539–540 (CA6); Seven-Sky, 661 F. 3d, at 5–14 (CADC).——————
The second
provision of the Affordable Care Act directly challenged here is the Medicaid
expansion. Enacted in 1965, Medicaid offers federal funding to States to assist
pregnant women, children, needy families, the blind, the elderly, and the
disabled in obtaining medical care. See 42 U. S. C. §1396a(a)(10).
In order to receive that funding, States must comply
with federal criteria governing matters such as who receives care and what
services are provided at what cost. By 1982 every State had chosen to
participate in Medicaid. Federal funds received through the Medicaid program
have become a substantial part of state budgets, now constituting over 10
percent of most States’ total revenue.
The Affordable Care Act expands
the scope of the Medicaid program and increases the number of individuals the
States must cover. For example, the Act requires state programs to provide
Medicaid coverage to adults with incomes up to 133 percent of the federal
poverty level, whereas many States now cover adults with children only if their
income is considerably lower, and do not cover childless adults at all. See
§1396a(a)(10)(A)(i)(VIII).
The Act increases federal funding to cover the States’ costs in expanding
Medicaid coverage, although States will bear a portion of the costs on their
own. §1396d(y)(1). If a State does not comply with the Act’s new coverage
requirements, it may lose not only the federal funding for those requirements,
but all of its federal Medicaid funds. See §1396c.
Along with their challenge to the individual mandate, the state
plaintiffs in the Eleventh Circuit argued that the Medicaid expansion exceeds
Congress’s constitutional powers.
The Court of Appeals unanimously held that the Medicaid expansion is a valid
exercise of Congress’s power under the Spending Clause. U. S. Const., Art. I,
§8, cl. 1. And the court rejected the States’ claim that the threatened loss
of all federal Medicaid funding violates the Tenth Amendment by coercing them
into complying with the Medicaid expansion. 648 F. 3d, at 1264, 1268.
We granted certiorari to
review the judgment of the Court of Appeals for the Eleventh Circuit with
respect to both the individual mandate and the Medicaid expansion. 565 U. S.
___ (2011). Because no party supports the Eleventh Circuit’s holding that the
individual mandate can be completely severed from the remainder of the
Affordable Care Act, we appointed an amicus curiae
to defend that aspect of the judgment below. And because there is a
reasonable argument that the Anti-Injunction Act deprives us of jurisdiction
to hear challenges to the individual mandate, but no party supports that
proposition, we appointed an amicus curiae to
advance it.2
—————— 2We appointed H. Bartow
Farr III to brief and argue in support of the Eleventh Circuit’s judgment with
respect to severability, and Robert A. Long to brief and argue the proposition
that the Anti-Injunction Act bars the current challenges to the individual
mandate. 565 U. S. ___ (2011). Both amici have ably discharged
their assigned responsibilities.
* * *
III
The Government advances two theories for the
proposition that Congress had constitutional authority to enact the individual
mandate. First, the Government argues that Congress had the power to enact the
mandate under the Commerce Clause. Under that theory, Congress may order
individuals to buy health insurance because the failure to do so affects
interstate commerce, and could undercut the Affordable Care Act’s other
reforms. Second, the Government argues that if the commerce power does not
support the mandate, we should nonetheless uphold it as an exercise of
Congress’s power to tax. According to the Government, even if Congress lacks
the power to direct individuals to buy insurance, the only effect of the individual
mandate is to raise taxes on those who do not do so, and thus the law may be
upheld as a tax.
A
The Government’s first argument is that the individual mandate is a
valid exercise of Congress’s power under the Commerce Clause and the Necessary
and Proper Clause. According to the Government, the health care market is
characterized by a significant cost-shifting problem. Everyone will eventually
need health care at a time and to an extent they cannot predict, but if they do
not have insurance, they often will not be able to pay for it. Because state
and federal laws nonetheless require hospitals to provide a certain degree of
care to individuals without regard to their ability to pay, see, e.g., 42
U. S. C. §1395dd; Fla. Stat. Ann. §395.1041, hospitals end up receiving
compensation for only a portion of the services they provide. To recoup the
losses, hospitals pass on the cost to insurers through higher rates, and
insurers, in turn, pass on the cost to policy holders in the form of higher premiums.
Congress estimated that the cost of uncompensated care raises family health
insurance premiums, on average, by over $1,000 per year. 42 U. S. C.
§18091(2)(F).In the Affordable Care Act, Congress
addressed the problem of those who cannot obtain insurance coverage because of
preexisting conditions or other health issues. It did so through the Act’s
“guaranteed-issue” and “community- rating” provisions. These provisions
together prohibit insurance companies from denying coverage to those with such
conditions or charging unhealthy individuals higher premiums than healthy
individuals. See §§300gg, 300gg–1, 300gg–3, 300gg–4. The
guaranteed-issue and community-rating reforms do not, however, address the
issue of healthy individuals who choose not to purchase insurance to cover
potential healthcare needs. In fact, the reforms sharply exacerbate that
problem, by providing an incentive for individuals to delay purchasing health
insurance until they become sick, relying on the promise of guaranteed and
affordable coverage. The reforms also threaten to
impose massive new costs on insurers, who are required to accept unhealthy
individuals but prohibited from charging them rates necessary to pay for their
coverage. This will lead insurers to significantly increase premiums on
everyone. See Brief for America’s Health Insurance Plans et al. as Amici
Curiae in No. 11– 393 etc. 8–9.
The individual mandate was Congress’s solution to these problems.
By requiring that individuals purchase health insurance, the mandate prevents
cost-shifting by those who would otherwise go without it. In addition, the
mandate forces into the insurance risk pool more healthy individuals, whose
premiums on average will be higher than their health care expenses. This allows
insurers to subsidize the costs of covering the unhealthy individuals the
reforms require them to accept. The Government claims that Congress has power
under the Commerce and Necessary and Proper Clauses to enact this solution.
* * *
2
The
Government next contends that Congress has the power under the Necessary and
Proper Clause to enact the individual mandate because the mandate is an
“integral part of a comprehensive scheme of economic regulation”—the
guaranteed-issue and community-rating insurance reforms. Brief for United
States 24. Under this argument, it is not necessary to consider the effect that
an individual’s inactivity may have on interstate commerce; it is enough that
Congress regulate commercial activity in a way that requires regulation of
inactivity to be effective.
The power
to “make all Laws which shall be necessary and proper for carrying into
Execution” the powers enumerated in the Constitution, Art. I, §8, cl. 18, vests
Congress with authority to enact provisions “incidental to the [enumerated]
power, and conducive to its beneficial exercise,” McCulloch, 4 Wheat., at 418. Although the Clause gives Congress
authority to “legislate on that vast mass of incidental powers which must be
involved in the constitution,” it does not license the exercise of any “great
substantive and independent power[s]” beyond those specifically enumerated.
Id., at 411, 421. Instead, the Clause is “ ‘merely a
declaration, for the removal of all uncertainty, that the means of carrying
into execution those [powers] otherwise granted are included in the grant.’ ” Kinsella v. United States ex rel. Singleton,
361 U. S. 234, 247 (1960) (quoting VI Writings
of James Madison 383 (G. Hunt ed. 1906)).
As our
jurisprudence under the Necessary and Proper Clause has developed, we have been
very deferential to Congress’s determination that a regulation is “necessary.”
We have thus upheld laws that are “ ‘convenient, or
useful’ or ‘conducive’ to the authority’s ‘beneficial exercise.’ ” Comstock, 560 U. S., at ___ (slip op.,
at 5) (quoting McCulloch, supra, at
413, 418). But we have also carried out our responsibility to declare
unconstitutional those laws that undermine the structure of government
established by the Constitution. Such laws, which are not “consist[ent] with the letter and spirit of the constitution,” McCulloch, supra, at 421, are not
“proper [means] for carrying into Execution” Congress’s enumerated powers.
Rather, they are, “in the words of The
Federalist, ‘merely acts of usurpation’ which ‘deserve to be treated as
such.’ ” Printz
v. United States, 521 U. S. 898, 924 (1997) (alterations omitted) (quoting The Federalist No. 33, at 204 (A.
Hamilton)); see also New York, 505 U.
S., at 177; Comstock, supra, at ___
(slip op., at 5) (Kennedy, J., concurring in judgment) (“It is of fundamental
importance to consider whether essential attributes of state sovereignty are
compromised by the assertion of federal power under the Necessary and Proper
Clause . . .”).
Applying
these principles, the individual mandate cannot be sustained under the Necessary
and Proper Clause as an essential component of the insurance reforms. Each of
our prior cases upholding laws under that Clause involved exercises of
authority derivative of, and in service to, a granted power. For example, we
have upheld provisions permitting continued confinement of those already in
federal custody when they could not be safely released, Comstock, supra, at ___ (slip op., at 1–2); criminalizing bribes
involving organizations receiving federal funds, Sabri v. United States, 541 U. S. 600, 602, 605 (2004) ; and tolling state statutes of limitations while cases
are pending in federal court, Jinks v. Richland
County, 538U. S. 456, 459, 462 (2003). The individual mandate, by contrast,
vests Congress with the extraordinary ability to create the necessary predicate
to the exercise of an enumerated power.
This is in
no way an authority that is “narrow in scope,” Comstock, supra, at ___ (slip op., at 20), or “incidental” to the
exercise of the commerce power, McCulloch,
supra, at 418. Rather, such a conception of the Necessary and Proper Clause
would work a substantial expansion of federal authority. No longer would
Congress be limited to regulating under the Commerce Clause those who by some
preexisting activity bring themselves within the sphere of federal regulation.
Instead, Congress could reach beyond the natural limit of its authority and
draw within its regulatory scope those who otherwise would be outside of it.
Even if the individual mandate is “necessary” to the Act’s insurance reforms,
such an expansion of federal power is not a “proper” means for making those
reforms effective.
The
Government relies primarily on our decision in Gonzales v. Raich. In Raich, we considered
“comprehensive legislation to regulate the interstate market” in marijuana. 545
U. S., at 22. Certain individuals sought an exemption from that regulation on the ground that they engaged in only intrastate
possession and consumption. We denied any exemption, on the
ground that marijuana is a fungible commodity, so that any marijuana
could be readily diverted into the interstate market. Congress’s attempt to
regulate the interstate market for marijuana would therefore have been
substantially undercut if it could not also regulate intrastate possession and
consumption. Id., at 19. Accordingly, we recognized that “Congress was acting
well within its authority” under the Necessary and Proper Clause even though
its “regulation ensnare[d] some purely intrastate activity.” Id., at 22; see
also Perez, 402 U. S., at 154. Raich thus did
not involve the exercise of any “great substantive and independent power,” McCulloch, supra, at 411, of the sort at
issue here. Instead, it concerned only the constitutionality of “individual
applications of a concededly valid statutory scheme.” Raich, supra, at 23 (emphasis added).
Just as
the individual mandate cannot be sustained as a law regulating the substantial
effects of the failure to purchase health insurance, neither can it be upheld
as a “necessary and proper” component of the insurance reforms. The commerce
power thus does not authorize the mandate. Accord, post, at 4–16 (joint opinion of Scalia, Kennedy, Thomas, and
Alito, JJ., dissenting).
* * *
As for the Medicaid expansion, that portion of the Affordable Care Act
violates the Constitution by threatening existing Medicaid funding. Congress
has no authority to order the States to regulate according to its instructions.
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.
That remedy does not require striking down other portions of the Affordable
Care Act.
The Framers created a Federal Government of limited powers, and
assigned to this Court the duty of enforcing those limits. The Court does so
today. But the Court does not express any opinion on the wisdom of the
Affordable Care Act. Under the Constitution, that judgment is reserved to the
people.
The judgment of the Court of
Appeals for the Eleventh Circuit is affirmed in part and reversed in part.
It is so ordered.