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(SlipOpinion)

OCTOBERTERM,2011Syllabus

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NOTE:Whereitisfeasible,asyllabus(headnote)willbereleased,asisbeingdoneinconnectionwiththiscase,atthetimetheopinionisissued.ThesyllabusconstitutesnopartoftheopinionoftheCourtbuthasbeenpreparedbytheReporterofDecisionsfortheconvenienceofthereader.SeeUnitedStatesv.DetroitTimber&LumberCo.,200U.S.321,337.

SUPREMECOURTOFTHEUNITEDSTATESSyllabus

NATIONALFEDERATIONOFINDEPENDENTBUSINESSETAL.v.SEBELIUS,SECRETARYOFHEALTHANDHUMANSERVICES,ETAL.CERTIORARITOTHEUNITEDSTATESCOURTOFAPPEALSFORTHEELEVENTHCIRCUITNo.11393.ArguedMarch26,27,28,2012DecidedJune28,2012*

In2010,CongressenactedthePatientProtectionandAffordableCareActinordertoincreasethenumberofAmericanscoveredbyhealthinsuranceanddecreasethecostofhealthcare.Onekeyprovisionistheindividualmandate,whichrequiresmostAmericanstomaintainminimumessentialhealthinsurancecoverage.26U.S

C.5000A.Forindividualswhoarenotexempt,andwhodonotreceivehealthinsurancethroughanemployerorgovernmentprogram,themeansofsatisfyingtherequirementistopurchaseinsurancefromaprivatecompany.Beginningin2014,thosewhodonotcomplywiththemandatemustmakea[s]haredresponsibilitypaymentttheFederalGovernment.5000A(b)(1).TheActprovidesthatthispenaltywillbeptotheInternalRevenueServicewithanindividualstaxes,andshallbeassessedadcollectedinthesamemannerastaxpenalties.5000A(c),(g)(1).AnotherkeyprovsionoftheActistheMedicaidexpansion.ThecurrentMedicaidprogramoffersfederalfundingtoStatestoassistpregnantwomen,children,needyfamilies,theblind,theelderly,andthedisabledinobtainingmedicalcare.42U.S.C.1396d(a).TheAffordableCareActexpandsthescopeoftheMedicaidprogramandincreasesthenumberofindividualstheStatesmustcover.Forex*TogetherwitmentofHealthandHumanServicesetal.v.Floridaetal.,andNo.11400,Florid

aetal.v.DepartmentofHealthandHumanServicesetal.,alsooncertioraritothesamecourt.

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NATIONALFEDERATIONOFINDEPENDENTBUSINESSv.SEBELIUSSyllabusample,theActrequiresstateprogramstoprovideMedicaidcoverageby2014toadultswithincomesupto133percentofthefederalpovertylevel,whereasmanyStatesnowcoveradultswithchildrenonlyiftheirincomeisconsiderablylower,anddonotcoverchildlessadultsatall.1396a(a)(10)(A)(i)(VIII).TheActincreasesfederalfundingtocovertheStatescostsinexpandingMedicaidcoverage.1396d(y)(1).ButifaStatedoesnotcomplywiththeActsnewcoveragerequirements,itmaylosenotonlythefederalfundingforthoserequirements,butallofitsfederalMedicaidfunds.1396c.Twenty-sixStates,severalindividuals,andtheNationalFederationofIndependentBusinessbroughtsuitinFederalDistrictCourt,challengingtheconstitutionalityoftheindividualmandateandtheMedicaidexpansion.TheCourtofAppealsfortheEleventhCircuitupheldtheMedicaidexpansionasavalidexerciseofCongresssspendingpower,butconcludedthatCongresslackedauthoritytoenacttheindividualmandate.FindingthemandateseverablefromtheActsotherprovisions,theEleventhCircuitlefttherestoftheActintact.

Held:Thejudgmentisaffirmedinpartandreversedinpart.648F.3d1235,affirmedinpartandreversedinpart.1.CHIEFJUSTICEROBERTSdeliveredtheopinionoftheCourtwithrespecttoPartII,concludingthattheAnti-InjunctionActdoesnotbarthissuit.TheAnti-InjunctionActprovidesthatnosuitforthepurposeofrestrainingtheassessmentorcollectionofanytaxshallbemaintainedinanycourtbyanyperson,26U.S.C.7421(a),sothatthosesubjecttoataxmus

tfirstpayitandthensueforarefund.Thepresentchallengeseekstorestrainthecollectionofthesharedresponsibilitypaymentfromthosewhodonotcomplywiththeindividualmandate.ButCongressdidnotintendthepaymenttobetreatedasataxforpurposesoftheAnti-InjunctionAct.TheAffordableCareActdesribesthepaymentasapenalty,notatax.ThatlabelcannotcontrolwhetherthisataxforpurposesoftheConstitution,butitdoesdeterminetheapplicationoftheAnti-InjunctionAct.TheAnti-InjunctionActthereforedoesnotbarthissuit.Pp.1115.2.CHIEFJUSTICEROBERTSconcludedinPartIIIAthattheindividalmandateisnotavalidexerciseofCongressspowerundertheCommerceClauseandtheNecessaryandProperClause.Pp.1630.(a)TheConstitutiongrantsCongressthepowertoregulateCommerce.Art.I,8,cl.3(emphasisadded).Thepowertoratecommercepresupposestheexistenceofcommercialactivitytoberegulated.ThisCourtsprecedentreflectsthisunderstanding:AsexpansiveasthisCourtscases

construingthescopeofthecommerce

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powerhavebeen,theyuniformlydescribethepowerasreachingactivity.E.g.,UnitdStatesv.Lopez,514U.S.549,560.Theindividualmandate,however,doesnotregulateexistingcommercialactivity.Itinsteadcompelsindividualstobecomeactiveincommercebypurchasingaproduct,onthegroundthattheirfailuretodosoaffectsinterstatecommerce.ConstruingtheCommerceClausetopermitCongresstoregulateindividualspreciselybecausetheyaredoingnothingwouldopenanewandpotentiallyvastdomaintocongressionalauthority.Congressalreadypossessesexpansivepowertoregulatewhatpeopledo.UpholdingtheAffordableCareActundertheCommerceClausewouldgiveCongressthesamelicensetoregulatewhatpeopledonotdo.TheFramersknewthedifferencebetweendoingsomethinganddoingnothing.TheygaveCongressthepowertoregulatecommerce,nottocompelit.IgnoringthatdistinctionwouldunderminetheprinciplethattheFederalGovernmentisagovernmentoflimitedandenumeratedpowers.TheindividualmandatethuscannotbesustainedunderCongressspowertoregulateCommerce.Pp.b)NorcantheindividualmandatebesustainedundertheNecessaryandProperClauseasanintegralpartoftheAffordableCareActsotherreforms.EachofthisCourtspriorcasesupholdinglawsunderthatClauseinvolvedexercisesofauthorityderivativeof,andinserviceto,agrantedpower.E.g.,UnitedStatesv.Comstock,560U.S.___.Theindividualmandate,bycontrast,vestsCongresswiththeextraordinaryabilitytocreatethenecessarypredicatetotheexerciseofane

numeratedpoweranddrawwithinitsregulatoryscopethosewhowouldotherwisebeoutsideofit.EveniftheindividualmandateisnecessarytotheAffordableCareActsotherreforms,suchanexpansionoffederalpowerisnotapropermeansforgthosereformseffective.Pp.2730.3.CHIEFJUSTICEROBERTSconcludedinPartIIIBthattheindividualmandatemustbeconstruedasimposingataxonthosewhodonothavehealthinsurance,ifsuchaconstructionisreasonable.Themoststraightforwardreadingoftheindividualmandateisthatitcommandsindividualstopurchaseinsurance.But,forthereasonsexplained,theCommerceClausedoesnotgiveCongressthatpower.ItisthereforenecessarytoturntotheGovernmentsalternativeargument:thatthemandatemaybeupheldaswithinCongressspowertolayandcollectTaxes.Art.I,8,cl.1.Inpressingitstaxingpowerargument,theGovernmentaskstheCourttoviewthemandateasimposingataxonthosewhodonotbuythatproduct.Becauseeveryreasonableconstructionmustberesortedto,ino

rdertosaveastatutefromunconstitutionality,Hooperv.California,155U.S.648,657,thequestioniswhetheritisfairlypossibletointer-

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NATIONALFEDERATIONOFINDEPENDENTBUSINESSv.SEBELIUSSyllabuspretthemandateasimposingsuchatax,Crowellv.Benson,285U.S.22,62.Pp.3132.4.CHIEFJUSTICEROBERTSdeliveredtheopinionoftheCourtwithrespecttoPartIIIC,concludingthattheindividualmandatemaybeupheldaswithinCongressspowerundertheTaxingClause.Pp.3344.(a)TheAffordableCareActdescribesthe[s]haredresonsibilitypaymentasapenalty,notatax.ThatlabelisfataltotheapplicAnti-InjunctionAct.Itdoesnot,however,controlwhetheranexactioniswithinCongressspowertotax.Inansweringthatconstitutionalquestion,thisCourtfollowsafunctionalapproach,[d]isregardingthedesignationoftheexaction,andviewingitssubstanceandapplication.UnitedStatesv.Constantine,296U.S.287,294.Pp.3335.(b)Suchananalysissuggeststhatthesharedresponsibilitypaymentmayforconstitutionalpurposesbeconsideredatax.Thepaymentisnotsohighthatthereisreallynochoicebuttobuyhealthinsurance;thepaymentisnotlimitedtowillfulviolations,aspenaltiesforunlawfulactsoftenare;andthepaymentiscollectedsolelybytheIRSthroughthenormalmeansoftaxation.Cf.Baileyv.DrexelFurnitureCo.,259U.S.20,3637.Noneofthisistosaythatpaymentisnotintendedtoinducethepurchaseofhealthinsurance.Butthemandateneednotbereadtodeclarethatfailingtodosoisunlawful.NeithertheAffordableCareActnoranyotherlawattachesnegativelegalconsequencestonotbuyinghealthinsurance,beyondrequiringapaymenttotheIRS.AndCongressschoiceoflanguagestatingthatindividualsshallobtaininsuranceorpayapenalequirereading5000Aaspunishingunlawfulconduct.Itmayalsobereadasimposi

ngataxonthosewhogowithoutinsurance.SeeNewYorkv.UnitedStates,505U.S.144,169174.Pp.3540.(c)Evenifthemandatemayreasonablybecharacterizeasatax,itmuststillcomplywiththeDirectTaxClause,whichprovides:NoCapitation,orotherdirect,Taxshallbelaid,unlessinProportiontotheCensusorEnumerationhereinbeforedirectedtobetaken.Art.I,9,cl.4.AtaxongoingwithouthealthinsuranceisnotlikeacapitationorotherdirecttaxunderthisCourtsprecedents.ItthereforeneednotbeapportionedsothateachStatepaysinproportiontoitspopulation.Pp.4041.5.CHIEFJUSTICEROBERTS,joinedbyJUSTICEBREYERandJUSTICEKAGAN,concludedinPartIVthattheMedicaidexpansionviolatestheConstitutionbythreateningStateswiththelossoftheirexistingMedicaidfundingiftheydeclinetocomplywiththeexpansion.Pp.4558.

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(a)TheSpendingClausegrantsCongressthepowertopaytheDebtsandprovideforthe...generalWelfareoftheUnitedStates.Art.I,8,cl.1.Congressmayusethispowertoestablishcooperativestate-federalSpendingClauseprograms.ThelegitimacyofSpendingClauselegislation,however,dependsonwhetheraStatevoluntarilyandknowinglyacceptsthetermsofsuchprograms.PennhurstStateSchoolandHospitalv.Halderman,451U.S.1,17.[T]heConstitutionsimplydoesnotgiveCongresstheauthoritytorequiretheStatestoregulate.NewYorkv.UnitedStates,505U.S.144,178.WhenCongressthreatenstoterminateothergrantsasameansofpressuringtheStatestoacceptaSpendingClauseprogram,thelegislationrunscountertothisNationssystemoffederalism.Cf.SouthDakotav.Dole,483U.S.203,211.Pp.4551.(b)Section1396cgivestheSecretaryofHealthandHumanServicestheauthoritytopenalizeStatesthatchoosenottoparticipateintheMedicaidexpansionbytakingawaytheirexistingMedicaidfunding.42U.S.C.1396c.Thethreatenedlossofover10percentofaStatesoverallbudgetiseconomicdragooningthatleavestheStateswithnorealoptionbuttoacquiesceintheMedicaidexpansion.TheGovernmentclaimsthattheexpansionisproperlyviewedasonlyamodificationoftheexistingprogram,andthatthismodificationispermissiblebecauseCongressreservedtherighttoalter,amend,orrepealanyprovisionofMedicaid.1304.Buttheexpansionaccomplishesashiftinkind,notmerelydegree.Theoriginalprogramwasdesignedtocovermedicalservicesfor

particularcategoriesofvulnerableindividuals.UndertheAffordableCareAct,Medicaidistransformedintoaprogramtomeetthehealthcareneedsoftheentirenonelderlypopulationwithincomebelow133percentofthepovertylevel.AStatecouldhardlyanticipatethatCongresssreservationoftherighttoalteroreMedicaidprogramincludedthepowertotransformitsodramatically.TheMedicaidexpansionthusviolatestheConstitutionbythreateningStateswiththelossoftheirexistingMedicaidfundingiftheydeclinetocomplywiththeexpansion.Pp.5155.(c)TheconstitutionalviolationisfullyremediedbyprecludingtheSecretaryfromapplying1396ctowithdrawexistingMedicaidfundsforfailuretocomplywiththerequirementssetoutintheexpansion.See1303.TheotherprovisionsoftheAffordableCareActarenotaffected.CongresswouldhavewantedtherestoftheActtostand,haditknownthatStateswouldhaveagenuinechoicewhethertoparticipateintheMedicaidexpansion.Pp.5558.6.JUSTICEGINSBURG,jo

inedbyJUSTICESOTOMAYOR,isoftheviewthattheSpendingClausedoesnotprecludetheSecretaryfromwithholdingMedicaidfundsbasedonaStatesrefusaltocomplywiththe

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NATIONALFEDERATIONOFINDEPENDENTBUSINESSv.SEBELIUSSyllabusexpandedMedicaidprogram.Butgiventhemajorityview,sheagreeswithTHECHIEFJUSTICEsconclusioninPartIVBthattheMedicaidActsseverabilityclause,42U.S.C.1303,detinestheappropriateremedy.BecauseTHECHIEFJUSTICEfindsthewithholdingnotthegrantingoffederalfundsincompatiblewiththeSpendingClause,CongressextensioofMedicaidremainsavailabletoanyStatethataffirmsitswillingnesstoparticipate.Evenabsent1303scommand,theCourtwouldhavenowarranttoinvalidatethefundingofferedbytheMedicaidexpansion,andsurelynobasistoteardowntheACAinitsentirety.Whenacourtconfrontsanunconstitutionalstatute,itsendeavormustbetoconserve,notdestroy,thelegislation.See,e.g.,Ayottev.PlannedParenthoodofNorthernNewEng.,546U.S.320,328330.Pp.6061.

ROBERTS,C.J.,announcedthejudgmentoftheCourtanddeliveredtheopinionoftheCourtwithrespecttoPartsI,II,andIIIC,inwhichGINSBURG,BREYER,SOTOMAYOR,andKAGAN,JJ.,joined;anopinionwithrespecttoPartIV,inwhichBREYERandKAGAN,JJ.,joined;andanopinionwithrespecttoPartsIIIA,IIIB,andIIIINSBURG,J.,filedanopinionconcurringinpart,concurringinthejudgmentinpart,anddissentinginpart,inwhichSOTOMAYOR,J.,joined,andinwhichBREYERandKAGAN,JJ.,joinedastoPartsI,II,III,andIV.SCALIA,KENNEDY,THOMAS,andALITO,JJ.,filedadissentingopinion.THOMAS,J.,filedadissentingopinion.

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Citeas:567U.S.____(2012)OpinionofROBERTS,C.J.NOTICE:ThisopinionissubjecttoformalrevisionbeforepublicationinthepreliminaryprintoftheUnitedStatesReports.ReadersarerequestedtonotifytheReporterofDecisions,SupremeCourtoftheUnitedStates,Washington,D.C.20543,ofanytypographicalorotherformalerrors,inorderthatcorrectionsmaybemadebeforethepreliminaryprintgoestopress.

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SUPREMECOURTOFTHEUNITEDSTATES_________________

Nos.11393,11398and11400_________________

NATIONALFEDERATIONOFINDEPENDENTBUSINESS,ETAL.,PETITIONERS11393v.KATHLEENSEBELIUS,SECRETARYOFHEALTHANDHUMANSERVICES,ETAL.DEPARTMENTOFHEALTHANDHUMANSERVICES,ETAL.,PETITIONERS11398v.FLORIDAETAL.11400FLORIDA,ETAL,PETITIONERSv.DEPARTMENTOFHEALTHANDHUMANSERVICESETAL.

ONWRITSOFCERTIORARITOTHEUNITEDSTATESCOURTOFAPPEALSFORTHEELEVENTHCIRCUIT[June28,2012]

CHIEFJUSTICEROBERTSannouncedthejudgmentoftheCourtanddeliveredtheopin

ionoftheCourtwithrespecttoPartsI,II,andIIIC,anopinionwithrespecttoPartIV,inwhichJUSTICEBREYERandJUSTICEKAGANjoin,andanopinionwithrespecttoPartsIIIA,IIIB,andIIID.TodayweresolveconstitutionalchallengestprovisionsofthePatientProtectionandAffordableCareActof

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NATIONALFEDERATIONOFINDEPENDENTBUSINESSv.SEBELIUSOpinionofROBERTS,C.J.

2010:theindividualmandate,whichrequiresindividualstopurchaseahealthinsurancepolicyprovidingaminimumlevelofcoverage;andtheMedicaidexpansion,whichgivesfundstotheStatesontheconditionthattheyprovidespecifiedhealthcaretoallcitizenswhoseincomefallsbelowacertainthreshold.WedonotconsiderwhethertheActembodiessoundpolicies.ThatjudgmentisentrustedtotheNationselectedleaders.WeaskonlywhetherCongresshasthepowerundertheConstitutiontoenactthechallengedprovisions.Inourfederalsystem,theNationalGovernmentpossessesonlylimitedpowers;theStatesandthepeopleretaintheremainder.Nearlytwocenturiesago,ChiefJusticeMarshallobservedthatthequestionrespectingtheextentofthepowersactuallygrantedtotheFederalGvernmentisperpetuallyarising,andwillprobablycontinuetoarise,aslongasoursystemshallexist.McCullochv.Maryland,4Wheat.316,405(1819).InthiscasewemustagaindeterminewhethertheConstitutiongrantsCongresspowersitnowasserts,butwhichmanyStatesandindividualsbelieveitdoesnotpossess.ResolvingthiscontroversyrequiresustoexamineboththelimitsoftheGovernmentspower,andourownlimitedroleinpolicingthoseboundaries.TheFederalGovernmentisacknowledgedbyalltobeoneofenumeratedpowers.Ibid.Thatis,ratherhangrantinggeneralauthoritytoperformalltheconceivablefunctionsofgovernment,theConstitutionlists,orenumerates,theFederalGovernmentspowers.Cong

ressmay,forexample,coinMoney,establishPostOffices,andraiseandsupp.I,8,cls.5,7,12.Theenumerationofpowersisalsoalimitationofpowers,because[t]heenumerationpresupposessomethingnotenumerated.Gibbonsv.Ogden,9Wheat.1,195(1824).TheConstitutionsexpressconferralofsomepowersmakesclearthatitdoesnotgrantothers.AndtheFederal

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Governmentcanexerciseonlythepowersgrantedtoit.McCulloch,supra,at405.Toay,therestrictionsongovernmentpowerforemostinmanyAmericansmindsarelikelytobeaffirmativeprohibitions,suchascontainedintheBillofRights.Theseaffirmativeprohibitionscomeintoplay,however,onlywheretheGovernmentpossessesauthoritytoactinthefirstplace.IfnoenumeratedpowerauthorizesCongresstopassacertainlaw,thatlawmaynotbeenacted,evenifitwouldnotviolateanyoftheexpressprohibitionsintheBillofRightsorelsewhereintheConstitution.Indeed,theConstitutiondidnotinitiallyincludeaBillofRightsatleastpartlybecausetheFramersfelttheenumerationofpowerssufficedtorestraintheGovernment.AsAlexanderHamiltonputit,theConstitutionisitself,ineveryrationalsense,andtoeveryusefulpurpose,ABILLOFRIGHTS.TheFederalistNo.84,p.515(C.Rossitered.1961).AndwhentheBillofRightswasratified,itmadeexpresswhattheenumerationofpowersnecessarilyimplied:ThepowersnotdelegatedtotheUnitedStatesbytheConstitution...arereservedtotheStatesrespectively,ortothepeople.U.S.Const.,Amdt.10.TheFederalGovernmenthasexpandeddramaticallyoverthepasttwocenturies,butitstillmustshowthataconstitutionalgrantofpowerauthorizeseachofitsactions.See,e.g.,UnitedStatesv.Comstock,560U.S.___(2010).ThesamedoesnotapplytotheStates,becausetheConstitutionisnotthesourceoftheirpower.TheConstitutionmayrestrictstategovernmentsasitdoes,forexample,byforbiddin

gthemtodenyanypersontheequalprotectionofthelaws.Butwheresuchprohibitionsdonotapply,stategovernmentsdonotneedconstitutionalauthorizationtoact.TheStatesthuscananddoperformmanyofthevitalfunctionsofmoderngovernmentpunishingstreetcrime,runningpublicschools,andzoningpropertyfordevelopment,tonamebutafeweventhough

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theConstitutionstextdoesnotauthorizeanygovernmenttodoso.Ourcasesrefertothisgeneralpowerofgoverning,possessedbytheStatesbutnotbytheFederalGovernment,asthepolicepower.See,e.g.,UnitedStatesv.Morrison,529U.598,618619(2000).Statesovereigntyisnotjustanendinitself:Rather,federaismsecurestocitizensthelibertiesthatderivefromthediffusionofsovereignpower.NewYorkv.UnitedStates,505U.S.144,181(1992)(internalquotationmarksomitted).Becausethepolicepoweriscontrolledby50differentStatesinsteadofonenationalsovereign,thefacetsofgoverningthattouchoncitizensdailylivesarenormallyadministeredbysmallergovernmentsclosertothegoverned.TheFramersthusensuredthatpowerswhichintheordinarycourseofaffairs,concernthelives,liberties,andpropertiesofthepeoplewereheldbygovernmentsmorelocalandmoreaccountablethanadistantfederalbureaucracy.TheFederalistNo.45,at293(J.Madison).TheindependentpoweroftheStatesalsoservesasacheckonthepoweroftheFederalGovernment:Bydenyinganyonegovernmentcompletejurisdictionoveralltheconcernsofpubliclife,federalismprotectsthelibertyoftheindividualfromarbitrarypower.Bondv.UnitedStates,564U.S.___,___(2011)(slipop.,at910).ThiscaseconcernstwopowersthattheConstitutiondoesgranttheFederalGovernment,butwhichmustbereadcarefullytoavoidcreatingageneralfederalauthorityakintothepolicepower.TheConstit

utionauthorizesCongresstoregulateCommercewithforeignNations,andamongtheseveralStates,andwiththeIndianTribes.Art.I,8,cl.3.OurprecedentsreadthattomeanthatCongressmayregulatethechannelsofinterstatecommerce,persrthingsininterstatecommerce,andthoseactivitiesthatsubstantiallyaffectintrstatecommerce.Morrison,supra,at609(internalquotationmarksomitted).Thepoweroveractivitiesthatsubstantially

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affectinterstatecommercecanbeexpansive.Thatpowerhasbeenheldtoauthorizefederalregulationofsuchseeminglylocalmattersasafarmersdecisiontogrowwheatforhimselfandhislivestock,andaloansharksextortionatecollectionsfromaneighborhoodbutchershop.SeeWickardv.Filburn,317U.S.111(1942);Perezv.UnitedStates,402U.S.146(1971).CongressmayalsolayandcollectTaxes,Duties,ImpostsandExcises,topaytheDebtsandprovideforthecommonDefenceandgeneralWelfareoftheUnitedStates.U.S.Const.,Art.I,8,cl.1.Putsimply,Congressmaytaxandspend.ThisgrantgivestheFederalGovernmentconsiderableinfluenceeveninareaswhereitcannotdirectlyregulate.TheFederalGovernmentmayenactataxonanactivitythatitcannotauthorize,forbid,orotherwisecontrol.See,e.g.,LicenseTaxCases,5Wall.462,471(1867).Andinexercisingitsspendingpower,CongressmayofferfundstotheStates,andmayconditionthoseoffersoncompliancewithspecifiedconditions.See,e.g.,CollegeSavingsBankv.FloridaPrepaidPostsecondaryEd.ExpenseBd.,527U.S.666,686(1999).TheseoffersmaywellinducetheStatestoadoptpoliciesthattheFederalGovernmentitselfcouldnotimpose.See,e.g.,SouthDakotav.Dole,483U.S.203,205206(1987)(conditioningfederalhighwayfundsonStatesraisingtheirdrinkingageto21).ThereachoftheFederalGovernmentsenumeratedpowersisbroaderstillbecausetheConstitutionauthorizesCongresstomakeallLawswhichshallbenecessaryandproperforcarryingintoExecutiontheforegoingPowers.A

rt.I,8,cl.18.WehavelongreadthisprovisiontogiveCongressgreatlatitudeinexercisingitspowers:Lettheendbelegitimate,letitbewithinthescopeoftheconstitution,andallmeanswhichareappropriate,whichareplainlyadaptedtothatend,whicharenotprohibited,butconsistwiththeletterandspiritoftheconstitution,are

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constitutional.McCulloch,4Wheat.,at421.OurpermissivereadingofthesepowersisexplainedinpartbyageneralreticencetoinvalidatetheactsoftheNationselectedleaders.Properrespectforaco-ordinatebranchofthegovernmentresthatwestrikedownanActofCongressonlyifthelackofconstitutionalauthoritytopass[the]actinquestionisclearlydemonstrated.UnitedStatesv.Harris,106U.S.629,635(1883).MembersofthisCourtarevestedwiththeauthoritytointerpretthelaw;wepossessneithertheexpertisenortheprerogativetomakepolicyjudgments.ThosedecisionsareentrustedtoourNationselectedleaders,whocanbethrownoutofofficeifthepeopledisagreewiththem.Itisnotourjobtoprotectthepeoplefromtheconsequencesoftheirpoliticalchoices.Ourdeferenceinmattersofpolicycannot,however,becomeabdicationinmattersoflaw.Thepowersofthelegislaturearedefinedandlimited;andthatthoselimitsmaynotbemistaken,orforgotten,theconstitutioniswritten.Marburyv.Madison,1Cranch137,176(1803).OurrespectforCongressspolicyjudgmentsthuscanneverextendsofarastodisavowrestraintsonfederalpowerthattheConstitutioncarefullyconstructed.Thepeculiarcircumstancesofthemomentmayrenderameasuremoreorlesswise,butcannotrenderitmoreorlessconstitutional.ChiefJusticeJohnMarshall,AFriendoftheConstitutionNo.V,AlexandriaGazette,July5,1819,inJohnMarshallsDefenseofMcCullochv.Maryland190191(G.Gunther

d.1969).AndtherecanbenoquestionthatitistheresponsibilityofthisCourttoenforcethelimitsonfederalpowerbystrikingdownactsofCongressthattransgressthoselimits.Marburyv.Madison,supra,at175176.Thequestionsbeforeusmustbeconsideredagainstthebackgroundofthesebasicprinciples.

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IIn2010,CongressenactedthePatientProtectionandAffordableCareAct,124Stat.119.TheActaimstoincreasethenumberofAmericanscoveredbyhealthinsuranceanddecreasethecostofhealthcare.TheActs10titlesstretchover900pagesandcontainhundredsofprovisions.Thiscaseconcernsconstitutionalchallengestotwokeyprovisions,commonlyreferredtoastheindividualmandateandtheMedicaidexpansion.TheindividualmandaterequiresmostAmericanstomaintainminimumessentialhealthinsurancecoverage.26U.S.C.5000A.Themandatedonotapplytosomeindividuals,suchasprisonersandundocumentedaliens.5000A(d).Manyindividualswillreceivetherequiredcoveragethroughtheiremployer,orfromagovernmentprogramsuchasMedicaidorMedicare.See5000A(f).Butforindividualswhoarenotexemptanddonotreceivehealthinsurancethroughathirdparty,themeansofsatisfyingtherequirementistopurchaseinsurancefromaprivatecompany.Beginningin2014,thosewhodonotcomplywiththemandatemustmakea[s]haredresponsibilitypaymenttotheFederalGovernment.5000A(b)(1).tpayment,whichtheActdescribesasapenalty,iscalculatedasapercentageofhuseholdincome,subjecttoafloorbasedonaspecifieddollaramountandaceilingbasedontheaverageannualpremiumtheindividualwouldhavetopayforqualifyingprivatehealthinsurance.5000A(c).In2016,forexample,thepenaltywillbe2.5percentofanindividualshouseholdincome,butnolessthan$695andnomorethantheaverageyearlypremiumforinsurancethatcovers60percentofthe

costof10specifiedservices(e.g.,prescriptiondrugsandhospitalization).Ibid.;42U.S.C.18022.TheActprovidesthatthepenaltywillbepaidtotheInternalRevenueServicewithanindividualstaxes,andshallbeassessedandcollectdinthesamemanner

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engageincommerce,andtheGovernmentseffortstocasttheindividualmandateinadifferentlightwereunpersuasive.JudgeMarcusdissented,reasoningthattheindividualmandateregulateseconomicactivitythathasacleareffectoninterstatecommerce.Havingheldtheindividualmandatetobeunconstitutional,themajorityexaminedwhetherthatprovisioncouldbeseveredfromtheremainderoftheAct.Themajoritydeterminedthat,contrarytotheDistrictCourtsview,itcould.Thecourtthusstruckdownonlytheindividualmandate,leavingtheActsotherprovisionsintact.648F.3d,at1328.OtherCourtsofAppealshavealsoheardchallengestotheindividualmandate.TheSixthCircuitandtheD.C.CircuitupheldthemandateasavalidexerciseofCongressscommercepower.SeeThomasMoreLawCenterv.Obama,651F.3d529(CA62011);Seven-Skyv.Holder,661F.3d1(CADC2011).TheFourthCircuitdeterminedthattheAnti-InjunctionActpreventscourtsfromconsideringthemeritsofthatquestion.SeeLibertyUniv.,Inc.v.Geithner,671F.3d391(2011).Thatstatutebarssuitsforthepurposeofrestrainingtheassessmentorcollectionofanytax.26U.S.C.7421(a).AmajorityoftheFourthCircuitpanelreasonedthattheindividualmandatespenaltyisataxwithinthemeaningoftheAnti-InjunctionAct,becauseitisafinancialassessmentcollectedbytheIRSthroughthenormalmeansoftaxation.Themajoritythereforedeterminedthattheplaintiffscouldnotchallengetheindividualmandateuntilaftertheypaidthepenalty.1

1TheEleventhCircuitdidnotconsiderwhethertheAnti-InjunctionActbarschallengestotheindividualmandate.TheDistrictCourthaddeterminedthatitdidnot,andneithersidechallengedthatholdingonappeal.ThesamewastrueintheFourthCircuit,butthatcourtexaminedthequestionsuaspontebecauseitviewedtheAnti-InjunctionActasalimitonitssubjectmatterjurisdiction.SeeLibertyUniv.,671

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powers.TheCourtofAppealsunanimouslyheldthattheMedicaidexpansionisavalidexerciseofCongressspowerundertheSpendingClause.U.S.Const.,Art.I,8,cl.1.AndthecourtrejectedtheStatesclaimthatthethreatenedlossofallfederalMedicaidfundingviolatestheTenthAmendmentbycoercingthemintocomplyingwiththeMedicaidexpansion.648F.3d,at1264,1268.WegrantedcertioraritoreviewthejudgmentoftheCourtofAppealsfortheEleventhCircuitwithrespecttoboththeindividualmandateandtheMedicaidexpansion.565U.S.___(2011).BecausenopartysupportstheEleventhCircuitsholdingthattheindividualmandatecanbecompletelyseveredfromtheremainderoftheAffordableCareAct,weappointedanamicuscuriaetodefendthataspectofthejudgmentbelow.AndbecausethereisareasonableargumentthattheAnti-InjunctionActdeprivesusofjurisdictiontohearchallengestotheindividualmandate,butnopartysupportsthatproposition,weappointedanamicuscuriaetoadvanceit.2IIBeforeturningtothemerits,weneedtobesurewehavetheauthoritytodoso.TheAnti-InjunctionActprovidesthatnosuitforthepurposeofrestrainingtheassessmentorcollectionofanytaxshallbemaintainedinanycourtbyanyperson,whetherornotsuchpersonisthepersonagainstwhomsuchtaxwasassessed.26U.S.C.7421(a).ThisstatuteprotectstheGovernmentsabilitytocollectaconsistentstreamofrevenue,bybarringlitigationtoenjoinorotherwiseobstructthecollectionoftaxes.BecauseoftheAnti-InjunctionAct,taxescanordinarilybe

2WeappointedH.BartowFarrIIItobriefandargueinsupportoftheEleventhCircuitsjudgmentwithrespecttoseverability,andRobertA.LongtobriefandarguethepropositionthattheAnti-InjunctionActbarsthecurrentchallengestotheindividualmandate.565U.S.___(2011).Bothamicihaveablydischargedtheirassignedresponsibilities.

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NATIONALFEDERATIONOFINDEPENDENTBUSINESSv.SEBELIUSOpinionofofOBERTS,C.J.OpinionRtheCourt

challengedonlyaftertheyarepaid,bysuingforarefund.SeeEnochsv.WilliamsPacking&Nav.Co.,370U.S.1,78(1962).ThepenaltyfornotcomplyingwiththeAffordableCareActsindividualmandatefirstbecomesenforceablein2014.Thepresentchallengetothemandatethusseekstorestrainthepenaltysfuturecollection.AmicuscontendsthattheInternalRevenueCodetreatsthepenaltyasatax,andthattheAnti-InjunctionActthereforebarsthissuit.Thetextofthepertinentstatutessuggestsotherwise.TheAnti-InjunctionActappliestosuitsforthepurposeofrestrainingtheassessmentorcollectionofanytax.7421(a)(emphasisadded).Congress,however,chosetodescribethe[s]haredresponsibilitypaymentimposedonthosewhoforgohealthinsurancenotasatax,butasapenalty.2).Thereisnoimmediatereasontothinkthatastatuteapplyingtoanytaxwouldpplytoapenalty.CongresssdecisiontolabelthisexactionapenaltyrathergnificantbecausetheAffordableCareActdescribesmanyotherexactionsitcreatesastaxes.SeeThomasMore,651F.3d,at551.WhereCongressusescertainlangugeinonepartofastatuteanddifferentlanguageinanother,itisgenerallypresumedthatCongressactsintentionally.SeeRussellov.UnitedStates,464U.S.16,23(1983).AmicusarguesthateventhoughCongressdidnotlabelthesharedresponsibilitypaymentatax,weshouldtreatitassuchundertheAnti-InjunctionActbecauseitfunctionslikeatax.ItistruethatCongresscannotchang

ewhetheranexactionisataxorapenaltyforconstitutionalpurposessimplybydescribingitasoneortheother.Congressmaynot,forexample,expanditspowerundertheTaxingClause,orescapetheDoubleJeopardyClausesconstraintoncriminalsanctions,bylabelingaseverefinancialpun-

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ishmentatax.SeeBaileyv.DrexelFurnitureCo.,259U.S.20,3637(1922);DepntofRevenueofMont.v.KurthRanch,511U.S.767,779(1994).TheAnti-InjunctionActandtheAffordableCareAct,however,arecreaturesofCongresssowncreation.HowtheyrelatetoeachotherisuptoCongress,andthebestevidenceofCongresssintentisthestatutorytext.WehavethusappliedtheAnti-InjunctionActtostatutorilydescribedtaxesevenwherethatlabelwasinaccurate.SeeBaileyv.George,259U.S.16(1922)(Anti-InjunctionActappliestoChildLaborTaxstrukdownasexceedingCongressstaxingpowerinDrexelFurniture).Congresscan,ofcourse,describesomethingasapenaltybutdirectthatitnonethelessbetreatedasataxforpurposesoftheAnti-InjunctionAct.Forexample,26U.S.C.6671(a)providesthatanyreferenceinthistitletotaximposedbythistitleshallemedalsotorefertothepenaltiesandliabilitiesprovidedbysubchapter68BoftheInternalRevenueCode.Penaltiesinsubchapter68BarethustreatedastaxesunderTitle26,whichincludestheAnti-InjunctionAct.Theindividualmandate,however,isnotinsubchapter68BoftheCode.NordoesanyotherprovisionstatethatreferencestotaxesinTitle26shallalsobedeemedtoapplytotheindiviualmandate.AmicusattemptstoshowthatCongressdidrendertheAnti-InjunctionActapplicabletotheindividualmandate,albeitbyamorecircuitousroute.Section5000A(g)(1)specifiesthatthepenaltyfornotcomplyingwiththemandateshallbeassessedandcollectedinthesamemannerasanassessablepenaltyunder

subchapterBofchapter68.Assessablepenaltiesinsubchapter68B,inturn,shallbeassessedandcollectedinthesamemannerastaxes.6671(a).Accordingtoamicus,bydirectingthatthepenaltybeassessedandcollectedinthesamemannerastaxes,5000A(g)(1)madetheAnti-InjunctionActapplicabletothispenalty.

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TheGovernmentdisagrees.Itarguesthat5000A(g)(1)doesnotdirectcourtstoapplytheAnti-InjunctionAct,because5000A(g)isadirectiveonlytotheSecretaryoftheTreasurytousethesamemethodologyandprocedurestocollectthepatheusestocollecttaxes.BriefforUnitedStates3233(quotingSeven-Sky,661F.3d,at11).WethinktheGovernmenthasthebetterreading.Asitobserves,AssessmentandCollectionarechaptersoftheInternalRevenueCodeprovidingtheSeryauthoritytoassessandcollecttaxes,andgenerallyspecifyingthemeansbywhichheshalldoso.See6201(assessmentauthority);6301(collectionauthority).Section5000A(g)(1)scommandthatthepenaltybeassessedandcollectedinthesaemannerastaxesisbestreadasreferringtothosechaptersandgivingtheSecretarythesameauthorityandguidancewithrespecttothepenalty.Thatinterpretationisconsistentwiththeremainderof5000A(g),whichinstructstheSecretaryonthetoolshemayusetocollectthepenalty.See5000A(g)(2)(A)(barringcriminalprosecutions);5000A(g)(2)(B)(prohibitingtheSecretaryfromusingnoticesoflienandlevies).TheAnti-InjunctionAct,bycontrast,saysnothingabouttheprocedurestobeusedinassessingandcollectingtaxes.AmicusarguesinthealternativethatadifferentsectionoftheInternalRevenueCoderequirescourtstotreatthepenaltyasataxundertheAnti-InjunctionAct.Section6201(a)authorizestheSecretarytomakeassessmentsofalltaxes(includinginterest,addi

tionalamounts,additionstothetax,andassessablepenalties).(Emphasisadded.)Amicuscontendsthatthepenaltymustbeatax,becauseitisanassessablepenaltyand6201(a)saysthattaxesincludeassessablepenalties.Thatargumenthasforceonlyif6201(a)isreadinisolation.TheCodecontainsmanyprovisionstreatingtaxesandassessablepenaltiesasdistinctterms.See,e.g.,

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860(h)(1),6324A(a),6601(e)(1)(2),6602,7122(b).Therewould,forexample,benoeedfor6671(a)todeemtaxtorefertocertainassessablepenaltiesiftheCodeadyincludedallsuchpenaltiesinthetermtax.Indeed,amicussearlierobservathattheCoderequiresassessablepenaltiestobeassessedandcollectedinthesamemannerastaxesmakeslittlesenseifassessablepenaltiesarethemselvestaxes.InlightoftheCodesconsistentdistinctionbetweenthetermstaxandassessaty,wemustaccepttheGovernmentsinterpretation:6201(a)instructstheSecretaryathisauthoritytoassesstaxesincludestheauthoritytoassesspenalties,butitdoesnotequateassessablepenaltiestotaxesforotherpurposes.TheAffordableCareActdoesnotrequirethatthepenaltyforfailingtocomplywiththeindividualmandatebetreatedasataxforpurposesoftheAnti-InjunctionAct.TheAnti-InjunctionActthereforedoesnotapplytothissuit,andwemayproceedtothemerits.IIITheGovernmentadvancestwotheoriesforthepropositionthatCongresshadconstitutionalauthoritytoenacttheindividualmandate.First,theGovernmentarguesthatCongresshadthepowertoenactthemandateundertheCommerceClause.Underthattheory,Congressmayorderindividualstobuyhealthinsurancebecausethefailuretodosoaffectsinterstatecommerce,andcouldundercuttheAffordableCareActsotherreforms.Second,theGovernmentarguesthatifthecommercepowerdoesnotsupportthemandate,weshouldnonethelessupholditasanexerciseofCongressspowertotax.AccordingtotheGovernment,even

ifCongresslacksthepowertodirectindividualstobuyinsurance,theonlyeffectoftheindividualmandateistoraisetaxesonthosewhodonotdoso,andthusthelawmaybeupheldasatax.

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ATheGovernmentsfirstargumentisthattheindividualmandateisavalidexerciseofCongressspowerundertheCommerceClauseandtheNecessaryandProperClause.AccordingtotheGovernment,thehealthcaremarketischaracterizedbyasignificantcost-shiftingproblem.Everyonewilleventuallyneedhealthcareatatimeandtoanextenttheycannotpredict,butiftheydonothaveinsurance,theyoftenwillnotbeabletopayforit.Becausestateandfederallawsnonethelessrequirehospitalstoprovideacertaindegreeofcaretoindividualswithoutregardtotheirabilitytopay,see,e.g.,42U.S.C.1395dd;Fla.Stat.Ann.395.1041,hospitalsendupreceivingcompensationforonlyaportionoftheservicestheyprovide.Torecoupthelosses,hospitalspassonthecosttoinsurersthroughhigherrates,andinsurers,inturn,passonthecosttopolicyholdersintheformofhigherpremiums.Congressestimatedthatthecostofuncompensatedcareraisesfamilyhealthinsurancepremiums,onaverage,byover$1,000peryear.42U.S.C.18091(2)(F).IntheAffordableCareAct,Congressaddressedtheproblemofthosewhocannotobtaininsurancecoveragebecauseofpreexistingconditionsorotherhealthissues.ItdidsothroughtheActsguaranteed-issueandcomingprovisions.Theseprovisionstogetherprohibitinsurancecompaniesfromdenyingcoveragetothosewithsuchconditionsorchargingunhealthyindividualshigherpremiumsthanhealthyindividuals.See300gg,300gg1,300gg3,300gg4.Thegua

ssueandcommunity-ratingreformsdonot,however,addresstheissueofhealthyindividualswhochoosenottopurchaseinsurancetocoverpotentialhealthcareneeds.Infact,thereformssharplyexacerbatethatproblem,byprovidinganincentiveforindividualstodelaypurchasinghealthinsuranceuntiltheybecomesick,relyingonthepromiseofguaranteedandaffordablecoverage.

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Thereformsalsothreatentoimposemassivenewcostsoninsurers,whoarerequiredtoacceptunhealthyindividualsbutprohibitedfromchargingthemratesnecessarytopayfortheircoverage.Thiswillleadinsurerstosignificantlyincreasepremiumsoneveryone.SeeBriefforAmericasHealthInsurancePlansetal.asAmiciCuriaeinNo.11393etc.89.TheindividualmandatewasCongressssolutioneseproblems.Byrequiringthatindividualspurchasehealthinsurance,themandatepreventscost-shiftingbythosewhowouldotherwisegowithoutit.Inaddition,themandateforcesintotheinsuranceriskpoolmorehealthyindividuals,whosepremiumsonaveragewillbehigherthantheirhealthcareexpenses.Thisallowsinsurerstosubsidizethecostsofcoveringtheunhealthyindividualsthereformsrequirethemtoaccept.TheGovernmentclaimsthatCongresshaspowerundertheCommerceandNecessaryandProperClausestoenactthissolution.1TheGovernmentcontendsthattheindividualmandateiswithinCongressspowerbecausethefailuretopurchaseinsurancehasasubstantialanddeleteriouseffectoninterstatecommercebycreatingthecost-shiftingproblem.BriefforUnitedStates34.ThepathofourCommerceClausedecisionshasnotalwaysrunsmooth,seeUnitedStatesv.Lopez,514U.S.549,552559(1995),butitisnowwellestablishedthatCongresshasbroadauthorityundertheClause.Wehaverecognized,forexample,that[t]hepowerofCongressoverinterstatecommerceisnotconfinedtotheregulationofcommerceamongthestates,butextendstoactivitiesthathaveasubstantia

effectoninterstatecommerce.UnitedStatesv.Darby,312U.S.100,118119(1941.Congressspower,moreover,isnotlimitedtoregulationofanactivitythatbyitselfsubstantiallyaffectsinterstatecommerce,butalsoextends

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tained);Perez,402U.S.,at154(Wheretheclassofactivitiesisregulatedandtatclassiswithinthereachoffederalpower,thecourtshavenopowertoexcise,astrivial,individualinstancesoftheclass(emphasisinoriginal;internalquotationmarksomitted));Wickard,supra,at125([E]venifappelleesactivitybelcalandthoughitmaynotberegardedascommerce,itmaystill,whateveritsnature,bereachedbyCongressifitexertsasubstantialeconomiceffectoninterstatecommerce);NLRBv.Jones&LaughlinSteelCorp.,301U.S.1,37(1937)(Althughactivitiesmaybeintrastateincharacterwhenseparatelyconsidered,iftheyhavesuchacloseandsubstantialrelationtointerstatecommercethattheircontrolisessentialorappropriatetoprotectthatcommercefromburdensandobstructions,Congresscannotbedeniedthepowertoexercisethatcontrol);seealsopost,at15,2526,28,32(GINSBURG,J.,concurringinpart,concurringinjudgmentinpart,anddissentinginpart).5Theindividualmandate,however,doesnotregulateexistingcommercialactivity.Itinsteadcompelsindividualstobecomeactiveincommercebypurchasingaproduct,onthegroundthattheirfailuretodosoaffectsinterstatecommerce.ConstruingtheCommerceClausetopermitCongresstoregulateindividualspreciselybecausetheyaredoingnothingwouldopenanewandpotentiallyvastdomaintocongressionalauthority.Everydayindividualsdonotdoaninfinitenumberofthings.Insomecasesthey

5JUSTICEGINSBURGcitestwoeminentdomaincasesfromthe1890stosupportthepropositionthatourcaselawdoesnottoetheactivityversusinactivityline.Pos,at2425(citingMonongahelaNav.Co.v.UnitedStates,148U.S.312,335337(189),andCherokeeNationv.SouthernKansasR.Co.,135U.S.641,657659(1890)).ThefactthattheFifthAmendmentrequiresthepaymentofjustcompensationwhentheGovernmentexercisesitspowerofeminentdomaindoesnotturnthetakingintoacommercialtransactionbetweenthelandownerandtheGovernment,letaloneagovernment-compelledtransactionbetweenthelandownerandathirdparty.

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decidenottodosomething;inotherstheysimplyfailtodoit.AllowingCongresstojustifyfederalregulationbypointingtotheeffectofinactiononcommercewouldbringcountlessdecisionsanindividualcouldpotentiallymakewithinthescopeoffederalregulation,andundertheGovernmentstheoryempowerCongresstethosedecisionsforhim.ApplyingtheGovernmentslogictothefamiliarcaseofWickardv.Filburnshowshowfarthatlogicwouldcarryusfromthenotionofagovernmentoflimitedpowers.InWickard,theCourtfamouslyupheldafederalpenaltyimposedonafarmerforgrowingwheatforconsumptiononhisownfarm.317U.S.,at114115,128129.Thatamountofwheatcausedthefarmertoexceedhisquoaunderaprogramdesignedtosupportthepriceofwheatbylimitingsupply.TheCourtrejectedthefarmersargumentthatgrowingwheatforhomeconsumptionwasbeyondthereachofthecommercepower.Itdidsoonthegroundthatthefarmersdecisiontogrowwheatforhisownuseallowedhimtoavoidpurchasingwheatinthemarket.Thatdecision,whenconsideredintheaggregatealongwithsimilardecisionsofothers,wouldhavehadasubstantialeffectontheinterstatemarketforwheat.Id.,at127129.WickardhaslongbeenregardedasperhapsthemostfarrechingexampleofCommerceClauseauthorityoverintrastateactivity,Lopez,514U.S.,at560,buttheGovernmentstheoryinthiscasewouldgomuchfurther.UnderWickarditiswithinCongressspowertoregulatethemarketforwheatbysupportingitsprice.Butpricecanbesupportedbyincreasingdemandaswellasbydecre

asingsupply.Theaggregateddecisionsofsomeconsumersnottopurchasewheathaveasubstantialeffectonthepriceofwheat,justasdecisionsnottopurchasehealthinsurancehaveonthepriceofinsurance.Congresscanthereforecommandthatthosenotbuyingwheatdoso,justasitarguesherethatitmaycommandthatthosenot

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buyinghealthinsurancedoso.ThefarmerinWickardwasatleastactivelyengagedintheproductionofwheat,andtheGovernmentcouldregulatethatactivitybecauseofitseffectoncommerce.TheGovernmentstheoryherewouldeffectivelyoverridethatlimitation,byestablishingthatindividualsmayberegulatedundertheCommerceClausewheneverenoughofthemarenotdoingsomethingtheGovernmentwouldhavethemdo.Indeed,theGovernmentslogicwouldjustifyamandatorypurchasetosolvealmostanyproblem.SeeSeven-Sky,661F.3d,at1415(notingtheGovernmentsinabilitytoidentifyanymandatetopurchaseaproductorserviceinierstatecommercethatwouldbeunconstitutionalunderitstheoryofthecommercepower).Toconsideradifferentexampleinthehealthcaremarket,manyAmericansdonoteatabalanceddiet.Thatgroupmakesupalargerpercentageofthetotalpopulationthanthosewithouthealthinsurance.See,e.g.,Dept.ofAgricultureandDept.ofHealthandHumanServices,DietaryGuidelinesforAmericans1(2010).Thefailureofthatgrouptohaveahealthydietincreaseshealthcarecosts,toagreaterextentthanthefailureoftheuninsuredtopurchaseinsurance.See,e.g.,Finkelstein,Trogdon,Cohen,&Dietz,AnnualMedicalSpendingAttributabletoObesity:Payer-andService-SpecificEstimates,28HealthAffairsw822(2009)(detailingtheundeniablelinkbetweenrisingratesofobesityandrisingmedicalspending,andestimatingthattheannualmedicalburdenofobesityhasrisen

toalmost10percentofallmedicalspendingandcouldamountto$147billionperyearin2008).ThoseincreasedcostsareborneinpartbyotherAmericanswhomustpaymore,justastheuninsuredshiftcoststotheinsured.SeeCenterforAppliedEthics,VoluntaryHealthRisks:WhoShouldPay?,6IssuesinEthics6(1993)(notingoverwhelmingevidencethatindividualswithunhealthyhabitspayonlyafractionofthecostsassociated

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withtheirbehaviors;mostoftheexpenseisbornebytherestofsocietyintheformofhigherinsurancepremiums,governmentexpendituresforhealthcare,anddisabilitybenefits).Congressaddressedtheinsuranceproblembyorderingeveryonetobuyinsurance.UndertheGovernmentstheory,Congresscouldaddressthedietproblembyorderingeveryonetobuyvegetables.SeeDietaryGuidelines,supra,at19(Improvednutrition,appropriateeatingbehaviors,andincreasedphysicalactivityhavetremendouspotentialto...reducehealthcarecosts).People,forreasonsoftheirown,oftenfailtodothingsthatwouldbegoodforthemorgoodforsociety.Thosefailuresjoinedwiththesimilarfailuresofotherscanreadilyhveasubstantialeffectoninterstatecommerce.UndertheGovernmentslogic,thatauthorizesCongresstouseitscommercepowertocompelcitizenstoactastheGovernmentwouldhavethemact.ThatisnotthecountrytheFramersofourConstitutionenvisioned.JamesMadisonexplainedthattheCommerceClausewasanadditionwhichfewopposeandfromwhichnoapprehensionsareentertained.TheFederalistNo.45,at293.WhileCongresssauthorityundertheCommerceClausehasofcourseexpandedwiththegrowthofthenationaleconomy,ourcaseshavealwaysrecognizedthatthepowertoregulatecommerce,thoughbroadindeed,haslimits.Marylandv.Wirtz,392U.S.183,196(1968).TheGovernmentstheorywoulderodethoselimits,permittingCongresstoreachbeyondthenaturalextentofitsauthority,everywhereextendingthesphereofitsactivityanddrawingallpowerintoitsimpetuo

usvortex.TheFederalistNo.48,at309(J.Madison).Congressalreadyenjoysvastpowertoregulatemuchofwhatwedo.AcceptingtheGovernmentstheorywouldgiveCongressthesamelicensetoregulatewhatwedonotdo,fundamentallychangingtherelationbetweenthecitizenandtheFederal

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Government.6Toaneconomist,perhaps,thereisnodifferencebetweenactivityandinactivity;bothhavemeasurableeconomiceffectsoncommerce.ButthedistinctionbetweendoingsomethinganddoingnothingwouldnothavebeenlostontheFramers,whowerepracticalstatesmen,notmetaphysicalphilosophers.IndustrialUnonDept.,AFLCIOv.AmericanPetroleumInstitute,448U.S.607,673(1980)(Rehnquist,J.,concurringinjudgment).Aswehaveexplained,theframersoftheConstitutionwerenotmerevisionaries,toyingwithspeculationsortheories,butpracticalmen,dealingwiththefactsofpoliticallifeastheyunderstoodthem,puttingintoformthegovernmenttheywerecreating,andprescribinginlanguageclearandintelligiblethepowersthatgovernmentwastotake.SouthCarolinav.UnitedStates,199U.S.437,449(1905).TheFramersgaveCongressthepowertoregulatecommerce,nottocompelit,andforover200yearsbothourdecisionsandCongresssactionshavereflectedthisunderstanding.Thereisnoreasontodepartfromthatunderstandingnow.TheGovernmentseesthingsdifferently.Itarguesthatbecausesicknessandinjuryareunpredictablebutunavoidable,theuninsuredasaclassareactiveinthemarketforhealthcare,whichtheyregularlyseekandobtain.BriefforUnitedStates50.Theindividualmandatemerelyregulateshowndividualsfinanceandpayforthat

6Inanattempttorecasttheindividualmandateasaregulationofcommercialactivity,JUSTICEGINSBURGsuggeststhat[a]nindividualwhooptsnottopurchaseinsurancefromaprivateinsurercanbeseenasactivelyselectinganotherformofinsurance:self-insurance.Post,at26.Butself-insuranceis,inthiscontext,ingmorethanadescriptionofthefailuretopurchaseinsurance.Individualsarenomoreactiv[e]intheself-insurancemarketwhentheyfailtopurchaseinsuranc,ibid.,thantheyareactiveintherestmarketwhendoingnothing.

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activeparticipationrequiringthattheydosothroughinsurance,ratherthanthroughattemptedself-insurancewiththeback-stopofshiftingcoststoothers.Ibid.TheGovernmentrepeatsthephraseactiveinthemarketforhealthcarethroughoutisbrief,seeid.,at7,18,34,50,butthatconcepthasnoconstitutionalsignificance.Anindividualwhoboughtacartwoyearsagoandmaybuyanotherinthefutureisnotactiveinthecarmarketinanypertinentsense.Thephraseactivehemarketcannotobscurethefactthatmostofthoseregulatedbytheindividualmandatearenotcurrentlyengagedinanycommercialactivityinvolvinghealthcare,andthatfactisfataltotheGovernmentsefforttoregulatetheuninsuredasalass.Id.,at42.OurprecedentsrecognizeCongressspowertoregulateclass[es]tivities,Gonzalesv.Raich,545U.S.1,17(2005)(emphasisadded),notclassesofindividuals,apartfromanyactivityinwhichtheyareengaged,see,e.g.,Perez,402U.S.,at153(Petitionerisclearlyamemberoftheclasswhichengagesinextortionatecredittransactions...(emphasisdeleted)).Theindividualmanegulationoftheuninsuredasaclassis,infact,particularlydivorcedfromanylinktoexistingcommercialactivity.Themandateprimarilyaffectshealthy,oftenyoungadultswhoarelesslikelytoneedsignificanthealthcareandhaveotherprioritiesforspendingtheirmoney.Itispreciselybecausetheseindividuals,asanactuarialclass,incurrelativelylowhealthcarecoststhatthemandatehelpscountertheeffectofforcinginsurancecompaniestocoverotherswho

imposegreatercoststhantheirpremiumsareallowedtoreflect.See42U.S.C.18091(2)(I)(recognizingthatthemandatewouldbroadenthehealthinsuranceriskpooltoincludehealthyindividuals,whichwilllowerhealthinsurancepremiums).Iftheindividualmandateistargetedataclass,itisaclasswhosecommercialinactivityratherthanactivityisitsdefiningfeature.

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TheGovernment,however,claimsthatthisdoesnotmatter.TheGovernmentregardsitassufficienttotriggerCongresssauthoritythatalmostallthosewhoareuninsuredwill,atsomeunknownpointinthefuture,engageinahealthcaretransaction.Assertingthat[t]hereisnotemporallimitationintheCommerceClause,thGovernmentarguesthatbecause[e]veryonesubjecttothisregulationisinorwillbeinthehealthcaremarket,theycanberegulatedinadvance.Tr.ofOralArg(Mar.27,2012).ThepropositionthatCongressmaydictatetheconductofanindividualtodaybecauseofprophesiedfutureactivityfindsnosupportinourprecedent.WehavesaidthatCongresscananticipatetheeffectsoncommerceofaneconomicactivity.See,e.g.,ConsolidatedEdisonCo.v.NLRB,305U.S.197(1938)(regulatingthelaborpracticesofutilitycompanies);HeartofAtlantaMotel,Inc.v.UnitedStates,379U.S.241(1964)(prohibitingdiscriminationbyhoteloperators);Katzenbachv.McClung,379U.S.294(1964)(prohibitingdiscriminationbyrestaurantowners).ButwehaveneverpermittedCongresstoanticipatethatactivityitselfinordertoregulateindividualsnotcurrentlyengagedincommerce.Eachoneofourcases,includingthosecitedbyJUSTICEGINSBURG,post,at2021,involvedpreexistingeconomicactivity.See,e.g.,Wickard,317U.S.,at127129(producingwheat);Raich,supra,at25(growingmarijuana).Everyonewilllikelyparticipateinthemarketsforfood,clothing,transportation,shelter

,orenergy;thatdoesnotauthorizeCongresstodirectthemtopurchaseparticularproductsinthoseorothermarketstoday.TheCommerceClauseisnotagenerallicensetoregulateanindividualfromcradletograve,simplybecausehewillpredictablyengageinparticulartransactions.Anypolicepowertoregulateindividualsassuch,asopposedtotheiractivities,remainsvestedintheStates.

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TheGovernmentarguesthattheindividualmandatecanbesustainedasasortofexceptiontothisrule,becausehealthinsuranceisauniqueproduct.AccordingtotheGovernment,upholdingtheindividualmandatewouldnotjustifymandatorypurchasesofitemssuchascarsorbroccolibecause,astheGovernmentputsit,[h]ealthinsuranceisnotpurchasedforitsownsakelikeacarorbroccoli;itisameansoffinancinghealth-careconsumptionandcoveringuniversalrisks.ReplyBriefforUnitedStates19.Butcarsandbroccoliarenomorepurchasedfortheirownsakethanhealthinsurance.Theyarepurchasedtocovertheneedfortransporationandfood.TheGovernmentsaysthathealthinsuranceandhealthcarefinancingareinherentlyintegrated.BriefforUnitedStates41.Butthatdoesnotmeanecompelledpurchaseofthefirstisproperlyregardedasaregulationofthesecond.Nomatterhowinherentlyintegratedhealthinsuranceandhealthcareconsumptonmaybe,theyarenotthesamething:Theyinvolvedifferenttransactions,enteredintoatdifferenttimes,withdifferentproviders.Andformostofthosetargetedbythemandate,significanthealthcareneedswillbeyears,orevendecades,away.TheproximityanddegreeofconnectionbetweenthemandateandthesubsequentcommercialactivityistoolackingtojustifyanexceptionofthesorturgedbytheGovernment.Theindividualmandateforcesindividualsintocommercepreciselybecausetheyelectedtorefrainfromcommercialactivity.SuchalawcannotbesustainedunderaclauseauthorizingCongresstoregulateCommerce.2The

GovernmentnextcontendsthatCongresshasthepowerundertheNecessaryandProperClausetoenacttheindividualmandatebecausethemandateisanintegralpartofacomprehensiveschemeofeconomicregulation

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theguaranteed-issueandcommunity-ratinginsurancereforms.BriefforUnitedStates24.Underthisargument,itisnotnecessarytoconsidertheeffectthatanindividualsinactivitymayhaveoninterstatecommerce;itisenoughthatCongressregulatecommercialactivityinawaythatrequiresregulationofinactivitytobeeffective.ThepowertomakeallLawswhichshallbenecessaryandproperforcarryingintoExecutionthepowersenumeratedintheConstitution,Art.I,8,cl.18,vestsCongresswithauthoritytoenactprovisionsincidentaltothe[enumerated]power,andconducivetoitsbeneficialexercise,McCulloch,4Wheat.,at418.AlthoughtheClausegivesCongressauthoritytolegislateonthatvastmassofincidentalpowerswhichmustbeinvolvedintheconstitution,itdoesnotlicensetheexerciseofanygreatsubstantiveandindependentpower[s]beyondthosespecificallenumerated.Id.,at411,421.Instead,theClauseismerelyadeclaration,forthremovalofalluncertainty,thatthemeansofcarryingintoexecutionthose[powers]otherwisegrantedareincludedinthegrant.Kinsellav.UnitedStatesexre.Singleton,361U.S.234,247(1960)(quotingVIWritingsofJamesMadison383(G.Hunted.1906)).AsourjurisprudenceundertheNecessaryandProperClausehasdeveloped,wehavebeenverydeferentialtoCongresssdeterminationthataregulationisnecessary.Wehavethusupheldlawsthatareconvenient,orusefulotheauthoritysbeneficialexercise.Comstock,560U.S.,at___(slipop.,a

tingMcCulloch,supra,at413,418).ButwehavealsocarriedoutourresponsibilitytodeclareunconstitutionalthoselawsthatunderminethestructureofgovernmentestablishedbytheConstitution.Suchlaws,whicharenotconsist[ent]withtheletterandspiritoftheconstitution,McCulloch,supra,at421,arenotprope[means]forcarryingintoExecutionCongresssenumeratedpowers.Rather,theyare

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thewordsofTheFederalist,merelyactsofusurpationwhichdeservetobetreatesuch.Printzv.UnitedStates,521U.S.898,924(1997)(alterationsomitted)(qutingTheFederalistNo.33,at204(A.Hamilton));seealsoNewYork,505U.S.,at177;Comstock,supra,at___(slipop.,at5)(KENNEDY,J.,concurringinjudgment)(ItisoffundamentalimportancetoconsiderwhetheressentialattributesofstatesovereigntyarecompromisedbytheassertionoffederalpowerundertheNecessaryandProperClause...).Applyingtheseprinciples,theindividualmandatecannotbesustainedundertheNecessaryandProperClauseasanessentialcomponentoftheinsurancereforms.EachofourpriorcasesupholdinglawsunderthatClauseinvolvedexercisesofauthorityderivativeof,andinserviceto,agrantedpower.Forexample,wehaveupheldprovisionspermittingcontinuedconfinementofthosealreadyinfederalcustodywhentheycouldnotbesafelyreleased,Comstock,supra,at___(slipop.,at12);criminalizingbribesinvolvingorganizationsreceivingfederalfunds,Sabriv.UnitedStates,541U.S.600,602,605(2004);andtollingstatestatutesoflimitationswhilecasesarependinginfederalcourt,Jinksv.RichlandCounty,538U.S.456,459,462(2003).Theindividualmandate,bycontrast,vestsCongresswiththeextraordinaryabilitytocreatethenecessarypredicatetotheexerciseofanenumeratedpower.Thisisinnowayanauthoritythatisnarrowinscope,Comstock,supra,at___(slipop.,at0),orincidentaltotheexerciseofthecommercepower,McCulloch,supra,at418.

ather,suchaconceptionoftheNecessaryandProperClausewouldworkasubstantialexpansionoffederalauthority.NolongerwouldCongressbelimitedtoregulatingundertheCommerceClausethosewhobysomepreexistingactivitybringthemselveswithinthesphereoffederalregulation.Instead,Congresscouldreachbeyond

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BThatisnottheendofthematter.BecausetheCommerceClausedoesnotsupporttheindividualmandate,itisnecessarytoturntotheGovernmentssecondargument:thatthemandatemaybeupheldaswithinCongresssenumeratedpowertolayandollectTaxes.Art.I,8,cl.1.TheGovernmentstaxpowerargumentasksustoviewestatutedifferentlythanwedidinconsideringitscommercepowertheory.InmakingitsCommerceClauseargument,theGovernmentdefendedthemandateasaregulationrequiringindividualstopurchasehealthinsurance.TheGovernmentdoesnotclaimthatthetaxingpowerallowsCongresstoissuesuchacommand.Instead,theGovernmentasksustoreadthemandatenotasorderingindividualstobuyinsurance,butratherasimposingataxonthosewhodonotbuythatproduct.Thetextofastatutecansometimeshavemorethanonepossiblemeaning.Totakeafamiliarexample,alawthatreadsnovehiclesintheparkmight,ormightnot,babicyclesinthepark.Anditiswellestablishedthatifastatutehastwopossiblemeanings,oneofwhichviolatestheConstitution,courtsshouldadoptthemeaningthatdoesnotdoso.JusticeStorysaidthat180yearsago:Nocourtought,unlessthetermsofanactrendereditunavoidable,togiveaconstructiontoitwhichshouldinvolveaviolation,howeverunintentional,oftheconstitution.Parsonsv.Bedford,3Pet.433,448449(1830).JusticeHolmesmadethesamepointacenturylater:[T]heruleissettledthatasbetweentwopossibleinterpretationsofastatute,byoneofwhichitwouldbeunconstitutionalandbytheothervali

d,ourplaindutyistoadoptthatwhichwillsavetheAct.Blodgettv.Holden,275U.S.142,148(1927)(concurringopinion).Themoststraightforwardreadingofthemandateisthatitcommandsindividualstopurchaseinsurance.

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Afterall,itstatesthatindividualsshallmaintainhealthinsurance.26U.S.C.00A(a).CongressthoughtitcouldenactsuchacommandundertheCommerceClause,andtheGovernmentprimarilydefendedthelawonthatbasis.But,forthereasonsexplainedabove,theCommerceClausedoesnotgiveCongressthatpower.Underourprecedent,itisthereforenecessarytoaskwhethertheGovernmentsalternativereadingofthestatutethatitonlyimposesataxonthosewithoutinsuranceisareasonableone.Underthemandate,ifanindividualdoesnotmaintainhealthinsurance,theonlyconsequenceisthathemustmakeanadditionalpaymenttotheIRSwhenhepayshistaxes.See5000A(b).That,accordingtotheGovernment,meansthemandatecanberegardedasestablishingaconditionnotowninghealthinsurancethattriggersataxtherequiredpaymenttotheIRS.Underthattheory,themandateisnotalegalcommandtobuyinsurance.Rather,itmakesgoingwithoutinsurancejustanotherthingtheGovernmenttaxes,likebuyinggasolineorearningincome.Andifthemandateisineffectjustataxhikeoncertaintaxpayerswhodonothavehealthinsurance,itmaybewithinCongresssconstitutionalpowertotax.Thequestionisnotwhetherthatisthemostnaturalinterpretationofthemandate,butonlywhetheritisafairlypossibleone.Crowellv.Benson,285U.S.22,2(1932).Aswehaveexplained,everyreasonableconstructionmustberesortedto,inordertosaveastatutefromunconstitutionality.Hooperv.California,155U.

S.648,657(1895).TheGovernmentasksustointerpretthemandateasimposingatax,ifitwouldotherwiseviolatetheConstitution.GrantingtheActthefullmeasureofdeferenceowedtofederalstatutes,itcanbesoread,forthereasonssetforthbelow.

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CTheexactiontheAffordableCareActimposesonthosewithouthealthinsurancelookslikeataxinmanyrespects.The[s]haredresponsibilitypayment,asthestauteentitlesit,ispaidintotheTreasurybytaxpayer[s]whentheyfiletheirtaxeturns.26U.S.C.5000A(b).ItdoesnotapplytoindividualswhodonotpayfederalincometaxesbecausetheirhouseholdincomeislessthanthefilingthresholdintheInternalRevenueCode.5000A(e)(2).Fortaxpayerswhodoowethepayment,itsamountisdeterminedbysuchfamiliarfactorsastaxableincome,numberofdependents,andjointfilingstatus.5000A(b)(3),(c)(2),(c)(4).TherequirementtopayisfoundintheInternalRevenueCodeandenforcedbytheIRS,whichaswepreviouslyexplainedmustassessandcollectitinthesamemannerastaxes.Supr1314.Thisprocessyieldstheessentialfeatureofanytax:itproducesatleastsomerevenuefortheGovernment.UnitedStatesv.Kahriger,345U.S.22,28,n.4(1953).Indeed,thepaymentisexpectedtoraiseabout$4billionperyearby2017.CongressionalBudgetOffice,PaymentsofPenaltiesforBeingUninsuredUnderthePatientProtectionandAffordableCareAct(Apr.30,2010),inSelectedCBOPublicationsRelatedtoHealthCareLegislation,20092010,p.71(rev.2010).ItisofcoursetruethattheActdescribesthepaymentasapenalty,notatax.lethatlabelisfataltotheapplicationoftheAnti-InjunctionAct,supra,at1213,itdoesnotdeterminewhetherthepaymentmaybeviewedasanexerciseofCongressstaxingpower.ItisuptoCongresswhethertoapplytheAnti-InjunctionAc

ttoanyparticularstatute,soitmakessensetobeguidedbyCongressschoiceoflabelonthatquestion.Thatchoicedoesnot,however,controlwhetheranexactioniswithinCongresssconstitutionalpowertotax.Ourprecedentreflectsthis:In1922,wedecidedtwo

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challengestotheChildLaborTaxonthesameday.Inthefirst,weheldthatasutoenjoincollectionofthesocalledtaxwasbarredbytheAnti-InjunctionAct.George,259U.S.,at20.CongressknewthatsuitstoobstructtaxeshadtoawaitpaymentundertheAnti-InjunctionAct;Congresscalledthechildlabortaxatax;CongressthereforeintendedtheAnti-InjunctionActtoapply.Inthesecondcase,however,weheldthatthesameexaction,althoughlabeledatax,wasnotinfactauthorizedbyCongressstaxingpower.DrexelFurniture,259U.S.,at38.ThatconstitutionalquestionwasnotcontrolledbyCongressschoiceoflabel.WehavesimilarlyheldthatexactionsnotlabeledtaxesnonethelesswereauthorizedbyCongressspowertotax.IntheLicenseTaxCases,forexample,weheldthatfederallicensestosellliquorandlotteryticketsforwhichthelicenseehadtopayafeecouldbesustainedasexercisesofthetaxingpower.5Wall.,at471.AndinNewYorkv.UnitedStatesweupheldasataxasurchargeonout-ofstatenuclearwaseshipments,aportionofwhichwaspaidtotheFederalTreasury.505U.S.,at171.WethusaskwhetherthesharedresponsibilitypaymentfallswithinCongressstaxingpower,[d]isregardingthedesignationoftheexaction,andviewingitssubstanceandapplication.UnitedStatesv.Constantine,296U.S.287,294(1935);cf.QuillCorp.v.NorthDakota,504U.S.298,310(1992)([M]agicwordsorlabelssouldnotdisableanotherwiseconstitutionallevy(internalquotationmarksomitted

);Nelsonv.Sears,Roebuck&Co.,312U.S.359,363(1941)(Inpassingontheconstitutionalityofataxlaw,weareconcernedonlywithitspracticaloperation,notitsdefinitionorthepreciseformofdescriptivewordswhichmaybeappliedtoit(internalquotationmarksomitted));UnitedStatesv.Sotelo,436U.S.268,275(1978)(Thatthefundsduearereferredtoasapenalty

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beareasonablefinancialdecisiontomakethepaymentratherthanpurchaseinsurance,unliketheprohibitoryfinancialpunishmentinDrexelFurniture.259U.S.,t37.Second,theindividualmandatecontainsnoscienterrequirement.Third,thepaymentiscollectedsolelybytheIRSthroughthenormalmeansoftaxationexceptthattheServiceisnotallowedtousethosemeansmostsuggestiveofapunitivesanction,suchascriminalprosecution.See5000A(g)(2).ThereasonstheCourtinDrexelFurnitureheldthatwhatwascalledataxtherewasapenaltysupportthconclusionthatwhatiscalledapenaltyheremaybeviewedasatax.9Noneofthistosaythatthepaymentisnotintendedtoaffectindividualconduct.Althoughthepaymentwillraiseconsiderablerevenue,itisplainlydesignedtoexpandhealthinsurancecoverage.Buttaxesthatseektoinfluenceconductarenothingnew.Someofourearliestfederaltaxessoughttodeterthepurchaseofimportedmanufacturedgoodsinordertofosterthegrowthofdomesticindustry.SeeW.Brownlee,FederalTaxationinAmerica22(2ded.2004);cf.2J.Story,CommentariesontheConstitutionoftheUnitedStates962,p.434(1833)(thetaxingpowerisoften,veryoften,appliedforotherpurposes,thanrevenue).Today,federalandstatetaxescancomposemorethanhalftheretailpriceofcigarettes,policyisprojectedtobearound$400permonth.SeeD.Newman,CRSReportdividualMandateandRelatedInformationRequirementsUnderPPACA7,andn.25(

2011).9WedonotsuggestthatanyexactionlackingascienterrequirementandenforcedbytheIRSiswithinthetaxingpower.Seepost,at2324(jointopinionofSCALIA,KENNEDY,THOMAS,andALITO,JJ.,dissenting).Congresscouldnot,forexample,expanditsauthoritytoimposecriminalfinesbycreatingstrictliabilityoffensesenforcedbytheIRSratherthantheFBI.Butthefacttheexactionhereispaidlikeatax,totheagencythatcollectstaxesratherthan,forexample,exactedbyDepartmentofLaborinspectorsafterferretingoutwillfulmalfeasancesuggeststhatthisexactionmaybeviewedasatax.

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notjusttoraisemoremoney,buttoencouragepeopletoquitsmoking.Andwehaveupheldsuchobviouslyregulatorymeasuresastaxesonsellingmarijuanaandsawed-offshotguns.SeeUnitedStatesv.Sanchez,340U.S.42,4445(1950);Sonzinskyv.UnitedStates,300U.S.506,513(1937).Indeed,[e]verytaxisinsomemeasureregulatory.Tosomeextentitinterposesaneconomicimpedimenttotheactivitytaxedascomparedwithothersnottaxed.Sonzinsky,supra,at513.That5000Aseekstoshapedecisionsaboutwhethertobuyhealthinsurancedoesnotmeanthatitcannotbeavalidexerciseofthetaxingpower.Indistinguishingpenaltiesfromtaxes,thisCourthasexplainedthatiftheconceptofpenaltymeansanything,itmeanspunishmentforanunlawfulactoromission.UnitedStatesv.ReorganizedCF&IFabricatorsofUtah,Inc.,518U.S.213,224(1996);seealsoUnitedStatesv.LaFranca,282U.S.568,572(1931)([A]penalty,asthewordishereused,isanexactionimposedbystatuteaspunishmentforanunlawfulact).Whiletheindividualmandateclearlyaimstoinducethepurchaseofhealthinsurance,itneednotbereadtodeclarethatfailingtodosoisunlawful.NeithertheActnoranyotherlawattachesnegativelegalconsequencestonotbuyinghealthinsurance,beyondrequiringapaymenttotheIRS.TheGovernmentagreeswiththatreading,confirmingthatifsomeonechoosestopayratherthanobtainhealthinsurance,theyhavefullycompliedwiththelaw.BriefforUnitedStates6061;Tr.ofOralArg.4950(Mar.26,2012).Indeed,itisestimatedthatfourmillionpeople

eachyearwillchoosetopaytheIRSratherthanbuyinsurance.SeeCongressionalBudgetOffice,supra,at71.WewouldexpectCongresstobetroubledbythatprospectifsuchconductwereunlawful.ThatCongressapparentlyregardssuchextensivefailuretocomplywiththemandateas

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tolerablesuggeststhatCongressdidnotthinkitwascreatingfourmillionoutlaws.Itsuggestsinsteadthatthesharedresponsibilitypaymentmerelyimposesataxcitizensmaylawfullychoosetopayinlieuofbuyinghealthinsurance.TheplaintiffscontendthatCongressschoiceoflanguagestatingthatindividualsshaininsuranceorpayapenaltyrequiresreading5000Aaspunishingunlawfulconduifthatinterpretationwouldrenderthelawunconstitutional.Wehaverejectedasimilarargumentbefore.InNewYorkv.UnitedStatesweexaminedastatuteprovidingthat[e]achStateshallberesponsibleforproviding...forthedisposaof...low-levelradioactivewaste.505U.S.,at169(quoting42U.S.C.20a)(1)(A)).AStatethatshippeditswastetoanotherStatewasexposedtosurchargesbythereceivingState,aportionofwhichwouldbepaidovertotheFederalGovernment.AndaStatethatdidnotadheretothestatutoryschemefaced[p]enaltiesforfailuretocomply,includingincreasesinthesurcharge.2021e(e)(2);NewYork,505U.S.,at152153.NewYorkurgedustoreadthestatuteasafederalcommandthatthestatelegislatureenactlegislationtodisposeofitswaste,whichwouldhaveviolatedtheConstitution.Toavoidthatoutcome,weinterpretedthestatutetoimposeonlyaseriesofincentivesfortheStatetotakeresponsibilitforitswaste.WethensustainedthechargepaidtotheFederalGovernmentasanexerciseofthetaxingpower.Id.,at169174.Weseenoinsurmountableobstacle

toasimilarapproachhere.1010ThejointdissentattemptstodistinguishNewYorkv.UnitedStatesonthegroundthattheseeminglyimperativelanguageinthatcasewasinanintroductoryprovisionthathadnolegalconsequences.Post,at19.WedidnotrelyonthatreainNewYork.See505U.S.,at169170.Norcouldwehave.WhiletheCourtquotedonlythebroadstatementthat[e]achStateshallberesponsibleforitswaste,that

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Thejointdissentersarguethatwecannotuphold5000AasataxbecauseCongressdidnotframeitassuch.Post,at17.Ineffect,theycontendthateveniftheContitutionpermitsCongresstodoexactlywhatweinterpretthisstatutetodo,thelawmustbestruckdownbecauseCongressusedthewronglabels.Anexamplemayhelpillustratewhylabelsshouldnotcontrolhere.SupposeCongressenactedastatuteprovidingthateverytaxpayerwhoownsahousewithoutenergyefficientwindowsmustpay$50totheIRS.Theamountdueisadjustedbasedonfactorssuchastaxableincomeandjointfilingstatus,andispaidalongwiththetaxpayersincometaxreturn.Thosewhoseincomeisbelowthefilingthresholdneednotpay.Therequiredpaymentisnotcalledatax,apenalty,oranythingelse.Nooneubtthatthislawimposedatax,andwaswithinCongressspowertotax.ThatconclusionshouldnotchangesimplybecauseCongressusedthewordpenaltytodescribetepayment.Interpretingsuchalawtobeataxwouldhardly[i]mpos[e]ataxthroughjudiciallegislation.Post,at25.Rather,itwouldgivepracticaleffecttotheLegislaturesenactment.OurprecedentdemonstratesthatCongresshadthepowertoimposetheexactionin5000Aunderthetaxingpower,andthat5000Aneednotbereadtodomorethanimposeatax.Thatissufficienttosustainit.ThequestionoftheconstitutionalityofactiontakenbyCongressdoesnotdependonrecitalsofthepowerwhichitundertakestoexercise.Woodsv.CloydW.MillerCo.,333U.S.

languagewasimplementedthroughoperativeprovisionsthatalsousethewodissentrelies.See42U.S.C.2021e(e)(1)(entitledRequirementsfornon-sitedcompactregionsandnon-memberStatesanddirectingthatthoseentitiesshallcomplyiththefollowingrequirements);2021e(e)(2)(describingPenaltiesforfailuretoply).TheCourtupheldthoseprovisionsnotaslawfulcommands,butasincentives.505U.S.,at152153,171173.

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138,144(1948).EvenifthetaxingpowerenablesCongresstoimposeataxonnotobtaininghealthinsurance,anytaxmuststillcomplywithotherrequirementsintheConstitution.Plaintiffsarguethatthesharedresponsibilitypaymentdoesnotdoso,citingArticleI,9,clause4.Thatclauseprovides:NoCapitation,orotherdirect,Taxshallbelaid,unlessinProportiontotheCensusorEnumerationhereinbeforedirectedtobetaken.ThisrequirementmeansthatanydirectTaxtbeapportionedsothateachStatepaysinproportiontoitspopulation.Accordingtotheplaintiffs,iftheindividualmandateimposesatax,itisadirecttax,anditisunconstitutionalbecauseCongressmadenoefforttoapportionitamongtheStates.EvenwhentheDirectTaxClausewaswrittenitwasunclearwhatelse,otherthanacapitation(alsoknownasaheadtaxorapolltax),mightcttax.SeeSpringerv.UnitedStates,102U.S.586,596598(1881).Soonaftertheframing,Congresspassedataxonownershipofcarriages,overJamesMadisonsobjectionthatitwasanunapportioneddirecttax.Id.,at597.ThisCourtupheldthetax,inpartreasoningthatapportioningsuchataxwouldmakelittlesense,becauseitwouldhaverequiredtaxingcarriageownersatdramaticallydifferentratesdependingonhowmanycarriageswereintheirhomeState.SeeHyltonv.UnitedStates,3Dall.171,174(1796)(opinionofChase,J.).TheCourtwasunanimous,andthoseJusticeswhowroteopinionseitherdirectlyassertedorstrongl

ysuggestedthatonlytwoformsoftaxationweredirect:capitationsandlandtaxes.Seeid.,at175;id.,at177(opinionofPaterson,J.);id.,at183(opinionofIredell,J.).Thatnarrowviewofwhatadirecttaxmightbepersistedforacentury.In1880,forexample,weexplainedthatdirecttaxes,withinthemeaningoftheConstitution,areonlycapitationtaxes,asexpressedinthatinstrument,

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andtaxesonrealestate.Springer,supra,at602.In1895,weexpandedourinterpretationtoincludetaxesonpersonalpropertyandincomefrompersonalproperty,inthecourseofstrikingdownaspectsofthefederalincometax.Pollockv.FarmersLoan&TrustCo.,158U.S.601,618(1895).ThatresultwasoverturnedbytheSixteenthAmendment,althoughwecontinuedtoconsidertaxesonpersonalpropertytobedirecttaxes.SeeEisnerv.Macomber,252U.S.189,218219(1920).Ataxongoingwithouthealthinsurancedoesnotfallwithinanyrecognizedcategoryofdirecttax.Itisnotacapitation.Capitationsaretaxespaidbyeveryperson,withoutregardtoproperty,profession,oranyothercircumstance.Hylton,sura,at175(opinionofChase,J.)(emphasisaltered).Thewholepointofthesharedresponsibilitypaymentisthatitistriggeredbyspecificcircumstancesearningacertainamountofincomebutnotobtaininghealthinsurance.Thepaymentisalsoplainlynotataxontheownershipoflandorpersonalproperty.ThesharedresponsibilitypaymentisthusnotadirecttaxthatmustbeapportionedamongtheseveralStates.Theremay,however,beamorefundamentalobjectiontoataxonthosewholackhealthinsurance.Evenifonlyatax,thepaymentunder5000A(b)remainsaburdenthattheFederalGovernmentimposesforanomission,notanact.IfitistroublingtointerprettheCommerceClauseasauthorizingCongresstoregulatethosewhoabstainfromcommerce,perhapsitshouldbesimilarlytroublingtopermitCongresstoimposeataxfornotdoingsomething.Threeconside

rationsallaythisconcern.First,andmostimportantly,itisabundantlycleartheConstitutiondoesnotguaranteethatindividualsmayavoidtaxationthroughinactivity.Acapitation,afterall,isataxthateveryonemustpaysimplyforexisting,andcapitationsareexpresslycontemplatedbytheConstitution.TheCourttodayholdsthatourConstitutionprotectsusfromfederal

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regulationundertheCommerceClausesolongasweabstainfromtheregulatedactivity.Butfromitscreation,theConstitutionhasmadenosuchpromisewithrespecttotaxes.SeeLetterfromBenjaminFranklintoM.LeRoy(Nov.13,1789)(OurnewConstitutionisnowestablished...butinthisworldnothingcanbesaidtobecertain,exceptdeathandtaxes).WhetherthemandatecanbeupheldundertheCommerceClauseisaquestionaboutthescopeoffederalauthority.ItsanswerdependsonwhetherCongresscanexercisewhatallacknowledgetobethenovelcourseofdirectingindividualstopurchaseinsurance.CongresssuseoftheTaxingClausetoencouragebuyingsomethingis,bycontrast,notnew.Taxincentivesalreadypromote,forexample,purchasinghomesandprofessionaleducations.See26U.S.C.163(h),25A.SustainingthemandateasataxdependsonlyonwhetherCongresshasproperlyexerciseditstaxingpowertoencouragepurchasinghealthinsurance,notwhetheritcan.UpholdingtheindividualmandateundertheTaxingClausethusdoesnotrecognizeanynewfederalpower.ItdeterminesthatCongresshasusedanexistingone.Second,Congresssabilitytouseitstaxingpowertoinfluenceconductisnotwithoutlimits.Afewofourcasespolicedtheselimitsaggressively,invalidatingpunitiveexactionsobviouslydesignedtoregulatebehaviorotherwiseregardedatthetimeasbeyondfederalauthority.See,e.g.,UnitedStatesv.Butler,297U.S.1(1936);DrexelFurniture,259U.S.20.Moreo

ftenandmorerecentlywehavedeclinedtocloselyexaminetheregulatorymotiveoreffectofrevenue-raisingmeasures.SeeKahriger,345U.S.,at2731(collectingcases).Wehavenonethelessmaintainedthattherecomesatimeintheextensionofthepenalizingfeaturesoftheso-calledtaxwhenitlosesitscharacterassuchandbecomesamerepenaltywiththecharacteristicsofregulationandpunishment.Kurth

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ofataxnonethelessleavesanindividualwithalawfulchoicetodoornotdoacertainact,solongasheiswillingtopayataxleviedonthatchoice.11TheAffordableCareActsrequirementthatcertainindividualspayafinancialpenaltyfornotobtaininghealthinsurancemayreasonablybecharacterizedasatax.BecausetheConstitutionpermitssuchatax,itisnotourroletoforbidit,ortopassuponitswisdomorfairness.DJUSTICEGINSBURGquestionsthenecessityofrejectingtheGovernmentscommercepowerargument,giventhat5000Acanbeupheldunderthetaxingpower.Post,at37.Butthestatutereadsmorenaturallyasacommandtobuyinsurancethanasatax,andIwouldupholditasacommandiftheConstitutionallowedit.ItisonlybecausetheCommerceClausedoesnotauthorizesuchacommandthatitisnecessarytoreachthetaxingpowerquestion.Anditisonlybecausewehaveadutytoconstrueastatutetosaveit,iffairlypossible,that5000Acanbeinterpretedasatax.WithoutdecidingtheCommerceClausequestion,Iwouldfindnobasistoadoptsuchasavingconstruction.TheFederalGovernmentdoesnothavethepowertoorderpeopletobuyhealthinsurance.Section5000Awouldthereforebeunconstitutionalifreadasacommand.TheFederalGovernmentdoeshavethepowertoimposeataxonthosewithouthealthinsurance.Section5000Ais

11Ofcourse,individualsdonothavealawfulchoicenottopayataxdue,andmaysometimesfaceprosecutionforfailingtodoso(althoughnotfordecliningtomakethesharedresponsibilitypayment,see26U.S.C.5000A(g)(2)).Butthatdoesnotshowthatthetaxrestrictsthelawfulchoicewhethertoundertakeorforgotheactivityonwhichthetaxispredicated.Thosesubjecttotheindividualmandatemaylawfullyforgohealthinsuranceandpayhighertaxes,orbuyhealthinsuranceandpaylowertaxes.Theonlythingtheymaynotlawfullydoisnotbuyhealthinsuranceandnotpaytheresultingtax.

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505U.S.,at178.ThatistruewhetherCongressdirectlycommandsaStatetoregulateorindirectlycoercesaStatetoadoptafederalregulatorysystemasitsown.PermittingtheFederalGovernmenttoforcetheStatestoimplementafederalprogramwouldthreatenthepoliticalaccountabilitykeytoourfederalsystem.[W]heretheFederalGovernmentdirectstheStatestoregulate,itmaybestateofficialswhowillbearthebruntofpublicdisapproval,whilethefederalofficialswhodevisedtheregulatoryprogrammayremaininsulatedfromtheelectoralramificationsoftheirdecision.Id.,at169.SpendingClauseprogramsdonotposethisdangerwhenaStatehasalegitimatechoicewhethertoacceptthefederalconditionsinexchangeforfederalfunds.Insuchasituation,stateofficialscanfairlybeheldpoliticallyaccountableforchoosingtoacceptorrefusethefederaloffer.ButwhentheStatehasnochoice,theFederalGovernmentcanachieveitsobjectiveswithoutaccountability,justasinNewYorkandPrintz.Indeed,thisdangerisheightenedwhenCongressactsundertheSpendingClause,becauseCongresscanusethatpowertoimplementfederalpolicyitcouldnotimposedirectlyunderitsenumeratedpowers.WeaddressedsuchconcernsinStewardMachine.Thatcaseinvolvedafederaltaxonemployersthatwasabatedifthebusinessespaidintoastateunemploymentplanthatmetcertainfederallyspecifiedconditions.Anemployersued,allegingthatthetaxwasimpermissiblydriv[ing]thesta

telegislaturesunderthewhipofeconomicpressureintotheenactmentofunemploymentcompensationlawsatthebiddingofthecentralgovernment.301U.S.,at587.WeacknowledgedthedangerthattheFederalGovernmentmightemployitstaxingpowertoexertapowerakintoundueinfluenceupontheStates.Id.,at590.ButweobservedthatCongressadoptedthechallengedtaxandabatementprogramtochannelmoneytotheStatesthatwouldotherwisehavegoneintotheFederalTreasuryfor

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thisthreatservesnopurposeotherthantoforceunwillingStatestosignupforthedramaticexpansioninhealthcarecoverageeffectedbytheAct.Giventhenatureofthethreatandtheprogramsatissuehere,wemustagree.WehaveupheldCongresssauthoritytoconditionthereceiptoffundsontheStatescomplyingwihrestrictionsontheuseofthosefunds,becausethatisthemeansbywhichCongressensuresthatthefundsarespentaccordingtoitsviewofthegeneralWelfare.Conditionsthatdonotheregoverntheuseofthefunds,however,cannotbejustifiedonthatbasis.When,forexample,suchconditionstaketheformofthreatstoterminateothersignificantindependentgrants,theconditionsareproperlyviewedasameansofpressuringtheStatestoacceptpolicychanges.InSouthDakotav.Dole,weconsideredachallengetoafederallawthatthreatenedtowithholdfivepercentofaStatesfederalhighwayfundsiftheStatedidnotraiseitsdrinkingageto21.TheCourtfoundthattheconditionwasdirectlyrelatedtooneofthemainpurposesforwhichhighwayfundsareexpendedsafeinterstatetravel.483U.S.,at208.Atthesametime,theconditionwasnotarestrictiononhowthehighwayfundssetasideforspecifichighwayimprovementandmaintenanceeffortsweretobeused.Weaccordinglyaskedwhetherthefinancialinducementofferedbyongresswassocoerciveastopassthepointatwhichpressureturnsintocompuls,at211(quotingStewardMachine,supra,at590).ByfinancialinducementtheCour

meantthethreatoflosingfivepercentofhighwayfunds;nonewmoneywasofferedtotheStatestoraisetheirdrinkingages.Wefoundthattheinducementwasnotimpermissiblycoercive,becauseCongresswasofferingonlyrelativelymildencouragementtotheStates.Dole,483U.S.,at211.WeobservedthatallSouthDakoawouldloseifsheadherestoherchosen

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prerogativetorejectCongresssdesiredpolicy,notmerelyintheorybutinfac.,at211212.Thethreatenedlossofover10percentofaStatesoverallbudget,incontrast,iseconomicdragooningthatleavestheStateswithnorealoptionbuttoacquiesceintheMedicaidexpansion.12JUSTICEGINSBURGclaimsthatDoleisdistinguishablebecausehereCongresshasnotthreatenedtowithholdfundsearmarkedforanyotherprogram.Post,at47.Butthatbegsthequestion:TheStatescontendthattheexpansionisinrealityanewprogramandthatCongressisforcingthemtoacceptitbythreateningthefundsfortheexistingMedicaidprogram.WecannotagreethatexistingMedicaidandtheexpansiondictatedbytheAffordableCareActarealloneprogramsimplybecauseCongressstyledthemassuch.Post,at49.IftheexpansionisnotproperlyviewedasamodificationoftheexistingMedicaidprogram,Congresssdecisiontosotitleitisirrelevant.13GINSBURGobservesthatstateMedicaidspendingwillincreasebyonly0.8pexpansion.Post,at43.Thatnotonlyignoresincreasedstateadministrativeexpenses,butalsoassumesthattheFederalGovernmentwillcontinuetofundtheexpansionatthecurrentstatutorilyspecifiedlevels.Itisnotunheardof,however,fortheFederalGovernmenttoincreaserequirementsinsuchamannerastoimposeunfundedmandatesontheStates.Moreimportantly,thesizeofthenewfinancialburdenimposedonaStateisirrelevantinanalyzingwhethertheStateha

sbeencoercedintoacceptingthatburden.Yourmoneyoryourlifeisacoerciveprposition,whetheryouhaveasingledollarinyourpocketor$500.13Nor,ofcourse,canthenumberofpagestheamendmentoccupies,ortheextenttowhichthechangepreservesandworkswithintheexistingprogram,bedispositive.Cf.post,at4950(opinionofGINSBURG,J.).Take,forexample,thefollowinghypotheticalamendment:AllofaStatescitizensarenoweligibleforMedicaid.Thatchangetakeupasinglelineandwouldnotalteranyoperationalaspect[]oftheprogrambeyondtheeligibilityrequirements.Post,at49.YetitcouldhardlybearguedthatsuchanamendmentwasapermissiblemodificationofMedicaid,ratherthananattempttofoistanentirelynewhealthcaresystemupontheStates.12JUSTICE

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nodifferentfromthepreviouschangestoMedicaid,suchthataStatewouldbehardputtocomplainthatitlackedfairnotice.Post,at56.Butthepriorchangeshediscussespresumablythemostdramaticalterationshecouldfinddoesnotcomeclostoworkingthetransformationtheexpansionaccomplishes.ShehighlightsanamendmentrequiringStatestocoverpregnantwomenandincreasingthenumberofeligiblechildren.Ibid.Butthismodificationcanhardlybedescribedasamajorchangeinaprogramthatfromitsinceptionprovidedhealthcareforfamilieswithdentchildren.PreviousMedicaidamendmentssimplydonotfallintothesamecategoryastheoneatstakehere.TheCourtinStewardMachinedidnotattempttofixtheoutermostlinewherepersuasiongiveswaytocoercion.301U.S.,at591.TheCourtfoundit[e]noughforpresentpurposesthatwhereverthelinemaybe,thisstatuteiswithinit.Ibid.Wehavenoneedtofixalineeither.Itisenoughfortodaythatwhereverthatlinemaybe,thisstatuteissurelybeyondit.Congressmaynotsimplyconscriptstate[agencies]intothenationalbureaucraticarmy,FERCv.Mississippi,456U.S.742,775(1982)(OConnor,J.,concurringinjudgmentinpartanddissentinginpart),andthatiswhatitisattemptingtodowiththeMedicaidexpansion.BNothinginouropinionprecludesCongressfromofferingfundsundertheAffordableCareActtoexpandtheavailabilityofhealthcare,andrequiringthatStatesacceptingsuchfundscomplywiththeconditionsontheiruse.WhatCongressisnotfreetodoistopenalizeStatesthatchoosenottopar

ticipateinthatnewprogrambytakingawaytheirexistingMedicaidfunding.Section1396cgivestheSecretaryofHealthandHumanServicestheauthorityto

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dojustthat.Itallowshertowithholdallfurther[Medicaid]payments...totheStateifshedeterminesthattheStateisoutofcompliancewithanyMedicaidrequirement,includingthosecontainedintheexpansion.42U.S.C.1396c.InlightoftheCourtsholding,theSecretarycannotapply1396ctowithdrawexistingMedicaidfundsforfailuretocomplywiththerequirementssetoutintheexpansion.Thatfullyremediestheconstitutionalviolationwehaveidentified.ThechapteroftheUnitedStatesCodethatcontains1396cincludesaseverabilityclauseconfirmingthatweneedgonofurther.Thatclausespecifiesthat[i]fanyprovisionofthischapter,ortheapplicationthereoftoanypersonorcircumstance,isheldinvalid,theremainderofthechapter,andtheapplicationofsuchprovisiontootherpersonsorcircumstancesshallnotbeaffectedthereby.1303.Todayshongdoesnotaffectthecontinuedapplicationof1396ctotheexistingMedicaidprogram.NordoesitaffecttheSecretarysabilitytowithdrawfundsprovidedundertheAffordableCareActifaStatethathaschosentoparticipateintheexpansionfailstocomplywiththerequirementsofthatAct.Thisisnottosay,asthejointdissentsuggests,thatwearerewritingtheMedicaidExpansion.Post,at48Instead,wedetermine,first,that1396cisunconstitutionalwhenappliedtowithdrawexistingMedicaidfundsfromStatesthatdeclinetocomplywiththeexpansion.WethenfollowCongresssexplicittextualinstructiontoleaveunaffectedther

mainderofthechapter,andtheapplicationof[thechallenged]provisiontootherpersonsorcircumstances.1303.Whenweinvalidateanapplicationofastatutebecausethatapplicationisunconstitutional,wearenotrewritingthestatute;weaemerelyenforcingtheConstitution.ThequestionremainswhethertodaysholdingaffectsotherprovisionsoftheAffordableCareAct.Inconsidering

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NATIONALFEDERATIONOFINDEPENDENTBUSINESSv.SEBELIUSOpinionofGINSBURG,J.

tively,thattheCommerceClauseauthorizesCongresstoenacttheminimumcoverageprovision.IwouldalsoholdthattheSpendingClausepermitstheMedicaidexpansionexactlyasCongressenactedit.ITheprovisionofhealthcareistodayaconcernofnationaldimension,justastheprovisionofold-ageandsurvivorsbenefitswasinthe1930s.IntheSocialSecurityAct,Congressinstalledafederalsystemtoprovidemonthlybenefitstoretiredwageearnersand,eventually,totheirsurvivors.Beyondquestion,Congresscouldhaveadoptedasimilarschemeforhealthcare.Congresschose,instead,topreserveacentralroleforprivateinsurersandstategovernments.AccordingtoTHECHIEFJUSTICE,theCommerceClausedoesnotpermitthatpreservation.ThisrigidreadingoftheClausemakesscantsenseandisstunninglyretrogressive.Since1937,ourprecedenthasrecognizedCongresslargeauthoritytosettheNationscourseintheeconomicandsocialwefarerealm.SeeUnitedStatesv.Darby,312U.S.100,115(1941)(overrulingHammerv.Dagenhart,247U.S.251(1918),andrecognizingthatregulationsofcommercewhichdonotinfringesomeconstitutionalprohibitionarewithintheplenarypowerconferredonCongressbytheCommerceClause);NLRBv.Jones&LaughlinSteelCorp.,301U.S.1,37(1937)([Thecommerce]powerisplenaryandmaybeexertedtoprotectinterstatecommercenomatterwhatthesourceofthedangerswhichthreatenit.(inte

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