SCOTUS Slip Opinion On Obama Care

l (SII OInIon) OCTOII! TI!
M, 20ll
SyIInbus
OTI: Whoro If Is fonsIbIo, n syIInbus (hondnofo) wIII bo roIonsod, ns Is
boIng dono In connocfIon wIfh fhIs cnso, nf fho fImo fho oInIon Is Issuod.
Tho syIInbus consfIfufos no nrf of fho oInIon of fho Courf buf hns boon
ronrod by fho !oorfor of ocIsIons for fho convonIonco of fho rondor.
Soo Ini/eJ S/o/ee v. De/roi/ TinIer & LunIer Co., 200 !. S. 32l, 33?.
SUPREME COURT OF THE UNITED STATES
SyIInbus
ATIOA! III!ATIO OI IIIIIT
I!SIISS IT A!. t. SIII!I!S, SIC!ITA!Y OI
HIA!TH A H!MA SI!VICIS, IT A!.
CI!TIO!A!I TO THI !ITI STATIS CO!!T OI AIIIA!S IO!
THI I!IVITH CI!C!IT
o. ll393. Arguod Mnrch 26, 2?, 28, 20l2ocIdod Juno 28, 20l2*
In 20l0, Congross onncfod fho InfIonf IrofocfIon nnd AffordnbIo Cnro
Acf In ordor fo Incronso fho numbor of AmorIcnns covorod by honIfh
Insurnnco nnd docronso fho cosf of honIfh cnro. Ono koy rovIsIon Is
fho IndIvIdunI mnndnfo, whIch roquIros mosf AmorIcnns fo mnInfnIn
mInImum ossonfInI honIfh Insurnnco covorngo. 26 !. S. C. 5000A.
Ior IndIvIdunIs who nro nof oxomf, nnd who do nof rocoIvo honIfh
Insurnnco fhrough nn omIoyor or govornmonf rogrnm, fho monns of
snfIsfyIng fho roquIromonf Is fo urchnso Insurnnco from n rIvnfo
comnny. IogInnIng In 20l4, fhoso who do nof comIy wIfh fho
mnndnfo musf mnko n |s]hnrod rosonsIbIIIfy nymonf fo fho Iod-
ornI Covornmonf. 5000A(b)(l). Tho Acf rovIdos fhnf fhIs onnIfy
wIII bo nId fo fho InfornnI !ovonuo SorvIco wIfh nn IndIvIdunI`s fnx-
os, nnd shnII bo nssossod nnd coIIocfod In fho snmo mnnnor ns fnx
onnIfIos. 5000A(c), (g)(l).
Anofhor koy rovIsIon of fho Acf Is fho ModIcnId oxnnsIon. Tho
curronf ModIcnId rogrnm offors fodornI fundIng fo Sfnfos fo nssIsf
rognnnf womon, chIIdron, noody fnmIIIos, fho bIInd, fho oIdorIy, nnd
fho dIsnbIod In obfnInIng modIcnI cnro. 42 !. S. C. l396d(n). Tho
AffordnbIo Cnro Acf oxnnds fho scoo of fho ModIcnId rogrnm nnd
Incronsos fho numbor of IndIvIdunIs fho Sfnfos musf covor. Ior ox-

*Togofhor wIfh o. ll398, Depor/nen/ of Heol/l onJ Hunon Ser-
ticee e/ ol. v. IloriJo e/ ol., nnd o. ll400, IloriJo e/ ol. v. Depor/nen/
of Heol/l onJ Hunon Serticee e/ ol., nIso on corfIornrI fo fho snmo
courf.

2 ATIOA! III!ATIO OI IIIIIT
I!SIISS t. SIII!I!S
SyIInbus
nmIo, fho Acf roquIros sfnfo rogrnms fo rovIdo ModIcnId covorngo
by 20l4 fo nduIfs wIfh Incomos u fo l33 orconf of fho fodornI ov-
orfy IovoI, whorons mnny Sfnfos now covor nduIfs wIfh chIIdron onIy
If fhoIr Incomo Is consIdornbIy Iowor, nnd do nof covor chIIdIoss nduIfs
nf nII. l396n(n)(l0)(A)(I)(VIII). Tho Acf Incronsos fodornI fundIng fo
covor fho Sfnfos` cosfs In oxnndIng ModIcnId covorngo. l396d(y)(l).
Iuf If n Sfnfo doos nof comIy wIfh fho Acf`s now covorngo roquIro-
monfs, If mny Ioso nof onIy fho fodornI fundIng for fhoso roquIro-
monfs, buf nII of Ifs fodornI ModIcnId funds. l396c.
Twonfy-sIx Sfnfos, sovornI IndIvIdunIs, nnd fho nfIonnI Iodorn-
fIon of Indoondonf IusInoss broughf suIf In IodornI IsfrIcf Courf,
chnIIongIng fho consfIfufIonnIIfy of fho IndIvIdunI mnndnfo nnd fho
ModIcnId oxnnsIon. Tho Courf of AonIs for fho IIovonfh CIrcuIf
uhoId fho ModIcnId oxnnsIon ns n vnIId oxorcIso of Congross`s
sondIng owor, buf concIudod fhnf Congross Inckod nufhorIfy fo on-
ncf fho IndIvIdunI mnndnfo. IIndIng fho mnndnfo sovornbIo from fho
Acf`s ofhor rovIsIons, fho IIovonfh CIrcuIf Ioff fho rosf of fho Acf In-
fncf.
HelJ. Tho judgmonf Is nffIrmod In nrf nnd rovorsod In nrf.
648 I. 3d l235, nffIrmod In nrf nnd rovorsod In nrf.
l. CHIII J!STICI !OII!TS doIIvorod fho oInIon of fho Courf wIfh
rosocf fo Inrf II, concIudIng fhnf fho AnfI-InjuncfIon Acf doos nof
bnr fhIs suIf.
Tho AnfI-InjuncfIon Acf rovIdos fhnf no suIf for fho uroso of
rosfrnInIng fho nssossmonf or coIIocfIon of nny fnx shnII bo mnIn-
fnInod In nny courf by nny orson, 26 !. S. C. ?42l(n), so fhnf fhoso
subjocf fo n fnx musf fIrsf ny If nnd fhon suo for n rofund. Tho ro-
sonf chnIIongo sooks fo rosfrnIn fho coIIocfIon of fho shnrod rosonsI-
bIIIfy nymonf from fhoso who do nof comIy wIfh fho IndIvIdunI
mnndnfo. Iuf Congross dId nof Infond fho nymonf fo bo fronfod ns
n fnx for urosos of fho AnfI-InjuncfIon Acf. Tho AffordnbIo Cnro
Acf doscrIbos fho nymonf ns n onnIfy, nof n fnx. Thnf InboI
cnnnof confroI whofhor fho nymonf Is n fnx for urosos of fho Con-
sfIfufIon, buf If doos doformIno fho nIIcnfIon of fho AnfI-InjuncfIon
Acf. Tho AnfI-InjuncfIon Acf fhoroforo doos nof bnr fhIs suIf. I. ll
l5.
2. CHIII J!STICI !OII!TS concIudod In Inrf IIIA fhnf fho IndI-
vIdunI mnndnfo Is nof n vnIId oxorcIso of Congross`s owor undor fho
Commorco CInuso nnd fho ocossnry nnd Iroor CInuso. I. l630.
(n) Tho ConsfIfufIon grnnfs Congross fho owor fo regulo/e
Commorco. Arf. I, 8, cI. 3 (omhnsIs nddod). Tho owor fo regulo/e
commorco rosuosos fho oxIsfonco of commorcInI ncfIvIfy fo bo rog-
uInfod. ThIs Courf`s rocodonf rofIocfs fhIs undorsfnndIng: As ox-
nnsIvo ns fhIs Courf`s cnsos consfruIng fho scoo of fho commorco

3 CIfo ns: 56? !. S. ____ (20l2)
SyIInbus
owor hnvo boon, fhoy unIformIy doscrIbo fho owor ns ronchIng nc-
fIvIfy. 1.g., Ini/eJ S/o/ee v. Lopec, 5l4 !. S. 549, 560. Tho IndIvId-
unI mnndnfo, howovor, doos nof roguInfo oxIsfIng commorcInI ncfIvI-
fy. If Insfond comoIs IndIvIdunIs fo Iecone ncfIvo In commorco by
urchnsIng n roducf, on fho ground fhnf fhoIr fnIIuro fo do so nffocfs
Inforsfnfo commorco.
ConsfruIng fho Commorco CInuso fo ormIf Congross fo roguInfo
IndIvIdunIs rocIsoIy Iecouee fhoy nro doIng nofhIng wouId oon n
now nnd ofonfInIIy vnsf domnIn fo congrossIonnI nufhorIfy. Con-
gross nIrondy ossossos oxnnsIvo owor fo roguInfo whnf ooIo do.
!hoIdIng fho AffordnbIo Cnro Acf undor fho Commorco CInuso
wouId gIvo Congross fho snmo IIconso fo roguInfo whnf ooIo do nof
do. Tho Irnmors know fho dIfforonco bofwoon doIng somofhIng nnd
doIng nofhIng. Thoy gnvo Congross fho owor fo regulo/e commorco,
nof fo conpel If. IgnorIng fhnf dIsfIncfIon wouId undormIno fho rIn-
cIIo fhnf fho IodornI Covornmonf Is n govornmonf of IImIfod nnd
onumornfod owors. Tho IndIvIdunI mnndnfo fhus cnnnof bo sus-
fnInod undor Congross`s owor fo roguInfo Commorco. I. l62?.
(b) or cnn fho IndIvIdunI mnndnfo bo susfnInod undor fho oc-
ossnry nnd Iroor CInuso ns nn InfogrnI nrf of fho AffordnbIo Cnro
Acf`s ofhor roforms. Inch of fhIs Courf`s rIor cnsos uhoIdIng Inws
undor fhnf CInuso InvoIvod oxorcIsos of nufhorIfy dorIvnfIvo of, nnd
In sorvIco fo, n grnnfod owor. 1.g., Ini/eJ S/o/ee v. Cone/oc/, 560
!. S. ___. Tho IndIvIdunI mnndnfo, by confrnsf, vosfs Congross wIfh
fho oxfrnordInnry nbIIIfy fo cronfo fho nocossnry rodIcnfo fo fho ox-
orcIso of nn onumornfod owor nnd drnw wIfhIn Ifs roguInfory scoo
fhoso who wouId ofhorwIso bo oufsIdo of If. Ivon If fho IndIvIdunI
mnndnfo Is nocossnry fo fho AffordnbIo Cnro Acf`s ofhor roforms,
such nn oxnnsIon of fodornI owor Is nof n roor monns for mnk-
Ing fhoso roforms offocfIvo. I. 2?30.
3. CHIII J!STICI !OII!TS concIudod In Inrf IIII fhnf fho IndIvId-
unI mnndnfo musf bo consfruod ns ImosIng n fnx on fhoso who do
nof hnvo honIfh Insurnnco, If such n consfrucfIon Is ronsonnbIo.
Tho mosf sfrnIghfforwnrd rondIng of fho IndIvIdunI mnndnfo Is fhnf
If commnnds IndIvIdunIs fo urchnso Insurnnco. Iuf, for fho ronsons
oxInInod, fho Commorco CInuso doos nof gIvo Congross fhnf owor.
If Is fhoroforo nocossnry fo furn fo fho Covornmonf`s nIfornnfIvo nr-
gumonf: fhnf fho mnndnfo mny bo uhoId ns wIfhIn Congross`s owor
fo Iny nnd coIIocf Tnxos. Arf. I, 8, cI. l. In rossIng Ifs fnxIng
owor nrgumonf, fho Covornmonf nsks fho Courf fo vIow fho mnn-
dnfo ns ImosIng n fnx on fhoso who do nof buy fhnf roducf. Io-
cnuso ovory ronsonnbIo consfrucfIon musf bo rosorfod fo, In ordor fo
snvo n sfnfufo from unconsfIfufIonnIIfy, Hooper v. Colifornio, l55
!. S. 648, 65?, fho quosfIon Is whofhor If Is fnIrIy ossIbIo fo Infor-

I!SIISS t. SIII!I!S
SyIInbus
rof fho mnndnfo ns ImosIng such n fnx, Crouell v. Beneon, 285
!. S. 22, 62. I. 3l32.
4. CHIII J!STICI !OII!TS doIIvorod fho oInIon of fho Courf wIfh
rosocf fo Inrf IIIC, concIudIng fhnf fho IndIvIdunI mnndnfo mny bo
uhoId ns wIfhIn Congross`s owor undor fho TnxIng CInuso. I. 33
44.
(n) Tho AffordnbIo Cnro Acf doscrIbos fho |s]hnrod rosonsIbIIIfy
nymonf ns n onnIfy, nof n fnx. Thnf InboI Is fnfnI fo fho nII-
cnfIon of fho AnfI-InjuncfIon Acf. If doos nof, howovor, confroI
whofhor nn oxncfIon Is wIfhIn Congross`s owor fo fnx. In nnsworIng
fhnf consfIfufIonnI quosfIon, fhIs Courf foIIows n funcfIonnI nronch,
|d]IsrognrdIng fho dosIgnnfIon of fho oxncfIon, nnd vIowIng Ifs sub-
sfnnco nnd nIIcnfIon. Ini/eJ S/o/ee v. Cone/on/ine, 296 !. S. 28?,
294. I. 3335.
(b) Such nn nnnIysIs suggosfs fhnf fho shnrod rosonsIbIIIfy
nymonf mny for consfIfufIonnI urosos bo consIdorod n fnx. Tho
nymonf Is nof so hIgh fhnf fhoro Is ronIIy no choIco buf fo buy honIfh
Insurnnco; fho nymonf Is nof IImIfod fo wIIIfuI vIoInfIons, ns onnI-
fIos for unInwfuI ncfs offon nro; nnd fho nymonf Is coIIocfod soIoIy by
fho I!S fhrough fho normnI monns of fnxnfIon. Cf. Boile, v. Drexel
Iurni/ure Co., 259 !. S. 20, 363?. ono of fhIs Is fo sny fhnf ny-
monf Is nof Infondod fo Induco fho urchnso of honIfh Insurnnco. Iuf
fho mnndnfo nood nof bo rond fo docInro fhnf fnIIIng fo do so Is un-
InwfuI. oIfhor fho AffordnbIo Cnro Acf nor nny ofhor Inw nffnchos
nognfIvo IognI consoquoncos fo nof buyIng honIfh Insurnnco, boyond
roquIrIng n nymonf fo fho I!S. And Congross`s choIco of Inngungo
sfnfIng fhnf IndIvIdunIs shnII obfnIn Insurnnco or ny n onnIfy
doos nof roquIro rondIng 5000A ns unIshIng unInwfuI conducf. If
mny nIso bo rond ns ImosIng n fnx on fhoso who go wIfhouf Insur-
nnco. Soo Aeu Yor/ v. Ini/eJ S/o/ee, 505 !. S. l44, l69l?4.
I. 3540.
(c) Ivon If fho mnndnfo mny ronsonnbIy bo chnrncforIzod ns n
fnx, If musf sfIII comIy wIfh fho Irocf Tnx CInuso, whIch rovIdos:
o CnIfnfIon, or ofhor dIrocf, Tnx shnII bo InId, unIoss In IroorfIon
fo fho Consus or InumornfIon horoIn boforo dIrocfod fo bo fnkon.
Arf. I, 9, cI. 4. A fnx on goIng wIfhouf honIfh Insurnnco Is nof IIko n
cnIfnfIon or ofhor dIrocf fnx undor fhIs Courf`s rocodonfs. If fhoro-
foro nood nof bo norfIonod so fhnf onch Sfnfo nys In roorfIon fo
Ifs ouInfIon. I. 404l.
5. CHIII J!STICI !OII!TS, joInod by J!STICI I!IYI! nnd J!STICI
KACA, concIudod In Inrf IV fhnf fho ModIcnId oxnnsIon vIoInfos
fho ConsfIfufIon by fhronfonIng Sfnfos wIfh fho Ioss of fhoIr oxIsfIng
ModIcnId fundIng If fhoy docIIno fo comIy wIfh fho oxnnsIon.
I. 4558.

5 CIfo ns: 56? !. S. ____ (20l2)
SyIInbus
(n) Tho SondIng CInuso grnnfs Congross fho owor fo ny fho
obfs nnd rovIdo for fho . . . gonornI WoIfnro of fho !nIfod Sfnfos.
Arf. I, 8, cI. l. Congross mny uso fhIs owor fo osfnbIIsh cooornfIvo
sfnfo-fodornI SondIng CInuso rogrnms. Tho IogIfImncy of SondIng
CInuso IogIsInfIon, howovor, doonds on whofhor n Sfnfo voIunfnrIIy
nnd knowIngIy nccofs fho forms of such rogrnms. Pennlure/ S/o/e
Sclool onJ Hoepi/ol v. HolJernon, 45l !. S. l, l?. |T]ho ConsfIfu-
fIon sImIy doos nof gIvo Congross fho nufhorIfy fo roquIro fho Sfnfos
fo roguInfo. Aeu Yor/ v. Ini/eJ S/o/ee, 505 !. S. l44, l?8. Whon
Congross fhronfons fo formInnfo ofhor grnnfs ns n monns of rossur-
Ing fho Sfnfos fo nccof n SondIng CInuso rogrnm, fho IogIsInfIon
runs counfor fo fhIs nfIon`s sysfom of fodornIIsm. Cf. Sou/l Do/o/o
v. Dole, 483 !. S. 203, 2ll. I. 455l.
(b) SocfIon l396c gIvos fho Socrofnry of HonIfh nnd Humnn Sor-
vIcos fho nufhorIfy fo onnIIzo Sfnfos fhnf chooso nof fo nrfIcInfo In
fho ModIcnId oxnnsIon by fnkIng nwny fhoIr oxIsfIng ModIcnId fund-
Ing. 42 !. S. C. l396c. Tho fhronfonod Ioss of ovor l0 orconf of n
Sfnfo`s ovornII budgof Is oconomIc drngoonIng fhnf Ionvos fho Sfnfos
wIfh no ronI ofIon buf fo ncquIosco In fho ModIcnId oxnnsIon. Tho
Covornmonf cInIms fhnf fho oxnnsIon Is roorIy vIowod ns onIy n
modIfIcnfIon of fho oxIsfIng rogrnm, nnd fhnf fhIs modIfIcnfIon Is
ormIssIbIo bocnuso Congross rosorvod fho rIghf fo nIfor, nmond, or
roonI nny rovIsIon of ModIcnId. l304. Iuf fho oxnnsIon nccom-
IIshos n shIff In kInd, nof moroIy dogroo. Tho orIgInnI rogrnm wns
dosIgnod fo covor modIcnI sorvIcos for nrfIcuInr cnfogorIos of vuInor-
nbIo IndIvIdunIs. !ndor fho AffordnbIo Cnro Acf, ModIcnId Is frnns-
formod Info n rogrnm fo moof fho honIfh cnro noods of fho onfIro
nonoIdorIy ouInfIon wIfh Incomo boIow l33 orconf of fho ovorfy
IovoI. A Sfnfo couId hnrdIy nnfIcInfo fhnf Congross`s rosorvnfIon of
fho rIghf fo nIfor or nmond fho ModIcnId rogrnm IncIudod fho
owor fo frnnsform If so drnmnfIcnIIy. Tho ModIcnId oxnnsIon fhus
vIoInfos fho ConsfIfufIon by fhronfonIng Sfnfos wIfh fho Ioss of fhoIr
oxIsfIng ModIcnId fundIng If fhoy docIIno fo comIy wIfh fho oxnn-
sIon. I. 5l55.
(c) Tho consfIfufIonnI vIoInfIon Is fuIIy romodIod by rocIudIng
fho Socrofnry from nIyIng l396c fo wIfhdrnw oxIsfIng ModIcnId
funds for fnIIuro fo comIy wIfh fho roquIromonfs sof ouf In fho ox-
nnsIon. Soo l303. Tho ofhor rovIsIons of fho AffordnbIo Cnro Acf
nro nof nffocfod. Congross wouId hnvo wnnfod fho rosf of fho Acf fo
sfnnd, hnd If known fhnf Sfnfos wouId hnvo n gonuIno choIco whofhor
fo nrfIcInfo In fho ModIcnId oxnnsIon. I. 5558.
6. J!STICI CISI!!C, joInod by J!STICI SOTOMAYO!, Is of fho vIow
fhnf fho SondIng CInuso doos nof rocIudo fho Socrofnry from wIfh-
hoIdIng ModIcnId funds bnsod on n Sfnfo`s rofusnI fo comIy wIfh fho

I!SIISS t. SIII!I!S
SyIInbus
oxnndod ModIcnId rogrnm. Iuf gIvon fho mnjorIfy vIow, sho
ngroos wIfh THI CHIII J!STICI`s concIusIon In Inrf IVI fhnf fho
ModIcnId Acf`s sovornbIIIfy cInuso, 42 !. S. C. l303, doformInos fho
nrorInfo romody. Iocnuso THI CHIII J!STICI fInds fho wIfhhoId-
Ingnof fho grnnfIngof fodornI funds IncomnfIbIo wIfh fho Sond-
Ing CInuso, Congross` oxfonsIon of ModIcnId romnIns nvnIInbIo fo nny
Sfnfo fhnf nffIrms Ifs wIIIIngnoss fo nrfIcInfo. Ivon nbsonf l303`s
commnnd, fho Courf wouId hnvo no wnrrnnf fo InvnIIdnfo fho fundIng
offorod by fho ModIcnId oxnnsIon, nnd suroIy no bnsIs fo fonr down
fho ACA In Ifs onfIrofy. Whon n courf confronfs nn unconsfIfufIonnI
sfnfufo, Ifs ondonvor musf bo fo consorvo, nof dosfroy, fho IogIsInfIon.
Soo, e.g., A,o//e v. PlonneJ Poren/looJ of Aor/lern Aeu 1ng., 546
!. S. 320, 328330. I. 606l.
!OII!TS, C. J., nnnouncod fho judgmonf of fho Courf nnd doIIvorod
fho oInIon of fho Courf wIfh rosocf fo Inrfs I, II, nnd IIIC, In whIch
CISI!!C, I!IYI!, SOTOMAYO!, nnd KACA, JJ., joInod; nn oInIon wIfh
rosocf fo Inrf IV, In whIch I!IYI! nnd KACA, JJ., joInod; nnd nn
oInIon wIfh rosocf fo Inrfs IIIA, IIII, nnd III. CISI!!C, J.,
fIIod nn oInIon concurrIng In nrf, concurrIng In fho judgmonf In nrf,
nnd dIssonfIng In nrf, In whIch SOTOMAYO!, J., joInod, nnd In whIch
I!IYI! nnd KACA, JJ., joInod ns fo Inrfs I, II, III, nnd IV. SCA!IA,
KIIY, THOMAS, nnd A!ITO, JJ., fIIod n dIssonfIng oInIon. THOMAS,
J., fIIod n dIssonfIng oInIon.

_________________

_________________

l CIfo ns: 56? !. S. ____ (20l2)
OInIon of !OII!TS, C. J.
OTICI: ThIs oInIon Is subjocf fo formnI rovIsIon boforo ubIIcnfIon In fho
roIImInnry rInf of fho !nIfod Sfnfos !oorfs. !ondors nro roquosfod fo
nofIfy fho !oorfor of ocIsIons, Suromo Courf of fho !nIfod Sfnfos, Wnsh-
Ingfon, . C. 20543, of nny fyogrnhIcnI or ofhor formnI orrors, In ordor
fhnf corrocfIons mny bo mndo boforo fho roIImInnry rInf goos fo ross.
os. ll393, ll398 nnd ll400
I!SIISS, IT A!., IITITIOI!S
ll393 t.
KATH!II SIII!I!S, SIC!ITA!Y OI HIA!TH
A H!MA SI!VICIS, IT A!.
IIA!TMIT OI HIA!TH A H!MA
SI!VICIS, IT A!., IITITIOI!S
ll398 t.
I!O!IA IT A!.
I!O!IA, IT A!., IITITIOI!S
ll400 t.
IIA!TMIT OI HIA!TH A
H!MA SI!VICIS IT A!.
O W!ITS OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI I!IVITH CI!C!IT
|Juno 28, 20l2]
CHIII J!STICI !OII!TS nnnouncod fho judgmonf of fho
Courf nnd doIIvorod fho oInIon of fho Courf wIfh rosocf
fo Inrfs I, II, nnd IIIC, nn oInIon wIfh rosocf fo Inrf
IV, In whIch J!STICI I!IYI! nnd J!STICI KACA joIn,
nnd nn oInIon wIfh rosocf fo Inrfs IIIA, IIII, nnd
III.
Todny wo rosoIvo consfIfufIonnI chnIIongos fo fwo rovI-
sIons of fho InfIonf IrofocfIon nnd AffordnbIo Cnro Acf of

I!SIISS t. SIII!I!S
20l0: fho IndIvIdunI mnndnfo, whIch roquIros IndIvIdunIs
fo urchnso n honIfh Insurnnco oIIcy rovIdIng n mInI-
mum IovoI of covorngo; nnd fho ModIcnId oxnnsIon, whIch
gIvos funds fo fho Sfnfos on fho condIfIon fhnf fhoy ro-
vIdo socIfIod honIfh cnro fo nII cIfIzons whoso Incomo fnIIs
boIow n corfnIn fhroshoId. Wo do nof consIdor whofhor fho
Acf ombodIos sound oIIcIos. Thnf judgmonf Is onfrusfod
fo fho nfIon`s oIocfod Iondors. Wo nsk onIy whofhor
Congross hns fho owor undor fho ConsfIfufIon fo onncf
fho chnIIongod rovIsIons.
In our fodornI sysfom, fho nfIonnI Covornmonf os-
sossos onIy IImIfod owors; fho Sfnfos nnd fho ooIo
rofnIn fho romnIndor. onrIy fwo confurIos ngo, ChIof
JusfIco MnrshnII obsorvod fhnf fho quosfIon rosocfIng
fho oxfonf of fho owors ncfunIIy grnnfod fo fho IodornI
Covornmonf Is orofunIIy nrIsIng, nnd wIII robnbIy
confInuo fo nrIso, ns Iong ns our sysfom shnII oxIsf.
McCullocl v. Mor,lonJ, 4 Whonf. 3l6, 405 (l8l9). In fhIs
cnso wo musf ngnIn doformIno whofhor fho ConsfIfufIon
grnnfs Congross owors If now nssorfs, buf whIch mnny
Sfnfos nnd IndIvIdunIs boIIovo If doos nof ossoss. !osoIv-
Ing fhIs confrovorsy roquIros us fo oxnmIno bofh fho IImIfs
of fho Covornmonf`s owor, nnd our own IImIfod roIo In
oIIcIng fhoso boundnrIos.
Tho IodornI Covornmonf Is ncknowIodgod by nII fo
bo ono of onumornfod owors. 1IiJ. Thnf Is, rnfhor
fhnn grnnfIng gonornI nufhorIfy fo orform nII fho concoIv-
nbIo funcfIons of govornmonf, fho ConsfIfufIon IIsfs, or
onumornfos, fho IodornI Covornmonf`s owors. Congross
mny, for oxnmIo, coIn Monoy, osfnbIIsh Iosf OffIcos,
nnd rnIso nnd suorf ArmIos. Arf. I, 8, cIs. 5, ?, l2.
Tho onumornfIon of owors Is nIso n IImIfnfIon of ow-
ors, bocnuso |f]ho onumornfIon rosuosos somofhIng nof
onumornfod. GiIIone v. OgJen, 9 Whonf. l, l95 (l824).
Tho ConsfIfufIon`s oxross conforrnI of somo owors
mnkos cIonr fhnf If doos nof grnnf ofhors. And fho IodornI

3 CIfo ns: 56? !. S. ____ (20l2)
Covornmonf cnn oxorcIso onIy fho owors grnnfod fo If.
McCullocl, eupro, nf 405.
Todny, fho rosfrIcfIons on govornmonf owor foromosf In
mnny AmorIcnns` mInds nro IIkoIy fo bo nffIrmnfIvo ro-
hIbIfIons, such ns confnInod In fho IIII of !Ighfs. Thoso
nffIrmnfIvo rohIbIfIons como Info Iny, howovor, onIy whoro
fho Covornmonf ossossos nufhorIfy fo ncf In fho fIrsf
Inco. If no onumornfod owor nufhorIzos Congross fo
nss n corfnIn Inw, fhnf Inw mny nof bo onncfod, ovon If If
wouId nof vIoInfo nny of fho oxross rohIbIfIons In fho
IIII of !Ighfs or oIsowhoro In fho ConsfIfufIon.
Indood, fho ConsfIfufIon dId nof InIfInIIy IncIudo n IIII
of !Ighfs nf Ionsf nrfIy bocnuso fho Irnmors foIf fho onu-
mornfIon of owors suffIcod fo rosfrnIn fho Covornmonf.
As AIoxnndor HnmIIfon uf If, fho ConsfIfufIon Is IfsoIf,
In ovory rnfIonnI sonso, nnd fo ovory usofuI uroso,
A II!! OI !ICHTS. Tho IodornIIsf o. 84, . 5l5 (C. !os-
sIfor od. l96l). And whon fho IIII of !Ighfs wns rnfIfIod,
If mndo oxross whnf fho onumornfIon of owors nocos-
snrIIy ImIIod: Tho owors nof doIognfod fo fho !nIfod
Sfnfos by fho ConsfIfufIon . . . nro rosorvod fo fho Sfnfos
rosocfIvoIy, or fo fho ooIo. !. S. Consf., Amdf. l0.
Tho IodornI Covornmonf hns oxnndod drnmnfIcnIIy ovor
fho nsf fwo confurIos, buf If sfIII musf show fhnf n consfI-
fufIonnI grnnf of owor nufhorIzos onch of Ifs ncfIons. Soo,
e.g., Ini/eJ S/o/ee v. Cone/oc/, 560 !. S. ___ (20l0).
Tho snmo doos nof nIy fo fho Sfnfos, bocnuso fho Con-
sfIfufIon Is nof fho sourco of fhoIr owor. Tho ConsfI-
fufIon mny rosfrIcf sfnfo govornmonfsns If doos, for
oxnmIo, by forbIddIng fhom fo dony nny orson fho oqunI
rofocfIon of fho Inws. Iuf whoro such rohIbIfIons do
nof nIy, sfnfo govornmonfs do nof nood consfIfufIonnI nu-
fhorIznfIon fo ncf. Tho Sfnfos fhus cnn nnd do orform
mnny of fho vIfnI funcfIons of modorn govornmonf
unIshIng sfroof crImo, runnIng ubIIc schooIs, nnd zonIng
roorfy for dovoIomonf, fo nnmo buf n fowovon fhough

I!SIISS t. SIII!I!S
fho ConsfIfufIon`s foxf doos nof nufhorIzo nny govornmonf
fo do so. Our cnsos rofor fo fhIs gonornI owor of govorn-
Ing, ossossod by fho Sfnfos buf nof by fho IodornI Cov-
ornmonf, ns fho oIIco owor. Soo, e.g., Ini/eJ S/o/ee v.
Morrieon, 529 !. S. 598, 6l86l9 (2000).
Sfnfo sovoroIgnfy Is nof jusf nn ond In IfsoIf: !nfhor,
fodornIIsm socuros fo cIfIzons fho IIborfIos fhnf dorIvo from
fho dIffusIon of sovoroIgn owor. Aeu Yor/ v. Ini/eJ
S/o/ee, 505 !. S. l44, l8l (l992) (InfornnI quofnfIon
mnrks omIffod). Iocnuso fho oIIco owor Is confroIIod by
50 dIfforonf Sfnfos Insfond of ono nnfIonnI sovoroIgn, fho
fncofs of govornIng fhnf fouch on cIfIzons` dnIIy IIvos nro
normnIIy ndmInIsforod by smnIIor govornmonfs cIosor fo
fho govornod. Tho Irnmors fhus onsurod fhnf owors
whIch In fho ordInnry courso of nffnIrs, concorn fho IIvos,
IIborfIos, nnd roorfIos of fho ooIo woro hoId by gov-
ornmonfs moro IocnI nnd moro nccounfnbIo fhnn n dIs-
fnnf fodornI buronucrncy. Tho IodornIIsf o. 45, nf 293
(J. MndIson). Tho Indoondonf owor of fho Sfnfos nIso
sorvos ns n chock on fho owor of fho IodornI Covornmonf:
Iy donyIng nny ono govornmonf comIofo jurIsdIcfIon
ovor nII fho concorns of ubIIc IIfo, fodornIIsm rofocfs fho
IIborfy of fho IndIvIdunI from nrbIfrnry owor. BonJ v.
Ini/eJ S/o/ee, 564 !. S. ___, ___ (20ll) (sII o., nf 9l0).
ThIs cnso concorns fwo owors fhnf fho ConsfIfufIon
doos grnnf fho IodornI Covornmonf, buf whIch musf bo
rond cnrofuIIy fo nvoId cronfIng n gonornI fodornI nufhorIfy
nkIn fo fho oIIco owor. Tho ConsfIfufIon nufhorIzos
Congross fo roguInfo Commorco wIfh foroIgn nfIons, nnd
nmong fho sovornI Sfnfos, nnd wIfh fho IndInn TrIbos.
Arf. I, 8, cI. 3. Our rocodonfs rond fhnf fo monn fhnf
Congross mny roguInfo fho chnnnoIs of Inforsfnfo com-
morco, orsons or fhIngs In Inforsfnfo commorco, nnd
fhoso ncfIvIfIos fhnf subsfnnfInIIy nffocf Inforsfnfo com-
morco. Morrieon, eupro, nf 609 (InfornnI quofnfIon mnrks
omIffod). Tho owor ovor ncfIvIfIos fhnf subsfnnfInIIy

5 CIfo ns: 56? !. S. ____ (20l2)
nffocf Inforsfnfo commorco cnn bo oxnnsIvo. Thnf owor
hns boon hoId fo nufhorIzo fodornI roguInfIon of such soom-
IngIy IocnI mnffors ns n fnrmor`s docIsIon fo grow whonf
for hImsoIf nnd hIs IIvosfock, nnd n Ionn shnrk`s oxfor-
fIonnfo coIIocfIons from n noIghborhood bufchor sho.
Soo Wic/orJ v. IilIurn, 3l? !. S. lll (l942); Perec v.
Ini/eJ S/o/ee, 402 !. S. l46 (l9?l).
Congross mny nIso Iny nnd coIIocf Tnxos, ufIos, Im-
osfs nnd IxcIsos, fo ny fho obfs nnd rovIdo for fho
common ofonco nnd gonornI WoIfnro of fho !nIfod
Sfnfos. !. S. Consf., Arf. I, 8, cI. l. Iuf sImIy, Con-
gross mny fnx nnd sond. ThIs grnnf gIvos fho IodornI
Covornmonf consIdornbIo InfIuonco ovon In nrons whoro
If cnnnof dIrocfIy roguInfo. Tho IodornI Covornmonf mny
onncf n fnx on nn ncfIvIfy fhnf If cnnnof nufhorIzo, forbId,
or ofhorwIso confroI. Soo, e.g., Licenee Tox Coeee, 5 WnII.
462, 4?l (l86?). And In oxorcIsIng Ifs sondIng owor,
Congross mny offor funds fo fho Sfnfos, nnd mny condIfIon
fhoso offors on comIInnco wIfh socIfIod condIfIons. Soo,
e.g., College Sotinge Bon/ v. IloriJo PrepoiJ Poe/eeconJ-
or, 1J. 1xpenee BJ., 52? !. S. 666, 686 (l999). Thoso
offors mny woII Induco fho Sfnfos fo ndof oIIcIos fhnf
fho IodornI Covornmonf IfsoIf couId nof Imoso. Soo, e.g.,
Sou/l Do/o/o v. Dole, 483 !. S. 203, 205206 (l98?) (con-
dIfIonIng fodornI hIghwny funds on Sfnfos rnIsIng fhoIr
drInkIng ngo fo 2l).
Tho ronch of fho IodornI Covornmonf`s onumornfod
owors Is brondor sfIII bocnuso fho ConsfIfufIon nufhorIzos
Congross fo mnko nII !nws whIch shnII bo nocossnry nnd
roor for cnrryIng Info IxocufIon fho forogoIng Iowors.
Arf. I, 8, cI. l8. Wo hnvo Iong rond fhIs rovIsIon fo gIvo
Congross gronf InfIfudo In oxorcIsIng Ifs owors: !of fho
ond bo IogIfImnfo, Iof If bo wIfhIn fho scoo of fho consfIfu-
fIon, nnd nII monns whIch nro nrorInfo, whIch nro
InInIy ndnfod fo fhnf ond, whIch nro nof rohIbIfod, buf
consIsf wIfh fho Ioffor nnd sIrIf of fho consfIfufIon, nro

I!SIISS t. SIII!I!S
consfIfufIonnI. McCullocl, 4 Whonf., nf 42l.
Our ormIssIvo rondIng of fhoso owors Is oxInInod In
nrf by n gonornI rofIconco fo InvnIIdnfo fho ncfs of fho
nfIon`s oIocfod Iondors. Iroor rosocf for n co-ordInnfo
brnnch of fho govornmonf roquIros fhnf wo sfrIko down
nn Acf of Congross onIy If fho Inck of consfIfufIonnI
nufhorIfy fo nss |fho] ncf In quosfIon Is cIonrIy domon-
sfrnfod. Ini/eJ S/o/ee v. Horrie, l06 !. S. 629, 635 (l883).
Mombors of fhIs Courf nro vosfod wIfh fho nufhorIfy fo
Inforrof fho Inw; wo ossoss noIfhor fho oxorfIso nor
fho rorognfIvo fo mnko oIIcy judgmonfs. Thoso docIsIons
nro onfrusfod fo our nfIon`s oIocfod Iondors, who cnn bo
fhrown ouf of offIco If fho ooIo dIsngroo wIfh fhom. If Is
nof our job fo rofocf fho ooIo from fho consoquoncos of
fhoIr oIIfIcnI choIcos.
Our doforonco In mnffors of oIIcy cnnnof, howovor,
bocomo nbdIcnfIon In mnffors of Inw. Tho owors of fho
IogIsInfuro nro dofInod nnd IImIfod; nnd fhnf fhoso IIm-
Ifs mny nof bo mIsfnkon, or forgoffon, fho consfIfufIon Is
wrIffon. MorIur, v. MoJieon, l Crnnch l3?, l?6 (l803).
Our rosocf for Congross`s oIIcy judgmonfs fhus cnn
novor oxfond so fnr ns fo dIsnvow rosfrnInfs on fodornI
owor fhnf fho ConsfIfufIon cnrofuIIy consfrucfod. Tho
ocuIInr cIrcumsfnncos of fho momonf mny rondor n
monsuro moro or Ioss wIso, buf cnnnof rondor If moro or
Ioss consfIfufIonnI. ChIof JusfIco John MnrshnII, A
IrIond of fho ConsfIfufIon o. V, AIoxnndrIn Cnzoffo, JuIy
5, l8l9, In John MnrshnII`s ofonso of McCullocl v. Mor,-
lonJ l90l9l (C. Cunfhor od. l969). And fhoro cnn bo no
quosfIon fhnf If Is fho rosonsIbIIIfy of fhIs Courf fo on-
forco fho IImIfs on fodornI owor by sfrIkIng down ncfs of
Congross fhnf frnnsgross fhoso IImIfs. MorIur, v. MoJi-
eon, eupro, nf l?5l?6.
Tho quosfIons boforo us musf bo consIdorod ngnInsf fho
bnckground of fhoso bnsIc rIncIIos.


? CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
I
In 20l0, Congross onncfod fho InfIonf IrofocfIon nnd
AffordnbIo Cnro Acf, l24 Sfnf. ll9. Tho Acf nIms fo In-
cronso fho numbor of AmorIcnns covorod by honIfh In-
surnnco nnd docronso fho cosf of honIfh cnro. Tho Acf`s l0
fIfIos sfrofch ovor 900 ngos nnd confnIn hundrods of
rovIsIons. ThIs cnso concorns consfIfufIonnI chnIIongos fo
fwo koy rovIsIons, commonIy roforrod fo ns fho IndIvIdunI
mnndnfo nnd fho ModIcnId oxnnsIon.
Tho IndIvIdunI mnndnfo roquIros mosf AmorIcnns fo
mnInfnIn mInImum ossonfInI honIfh Insurnnco covorngo.
26 !. S. C. 5000A. Tho mnndnfo doos nof nIy fo somo
IndIvIdunIs, such ns rIsonors nnd undocumonfod nIIons.
5000A(d). Mnny IndIvIdunIs wIII rocoIvo fho roquIrod cov-
orngo fhrough fhoIr omIoyor, or from n govornmonf ro-
grnm such ns ModIcnId or ModIcnro. Soo 5000A(f). Iuf
for IndIvIdunIs who nro nof oxomf nnd do nof rocoIvo
honIfh Insurnnco fhrough n fhIrd nrfy, fho monns of
snfIsfyIng fho roquIromonf Is fo urchnso Insurnnco from n
rIvnfo comnny.
IogInnIng In 20l4, fhoso who do nof comIy wIfh fho
mnndnfo musf mnko n |s]hnrod rosonsIbIIIfy nymonf
fo fho IodornI Covornmonf. 5000A(b)(l). Thnf nymonf,
whIch fho Acf doscrIbos ns n onnIfy, Is cnIcuInfod ns n
orconfngo of housohoId Incomo, subjocf fo n fIoor bnsod on
n socIfIod doIInr nmounf nnd n coIIIng bnsod on fho nvor-
ngo nnnunI romIum fho IndIvIdunI wouId hnvo fo ny for
qunIIfyIng rIvnfo honIfh Insurnnco. 5000A(c). In 20l6,
for oxnmIo, fho onnIfy wIII bo 2.5 orconf of nn IndIvId-
unI`s housohoId Incomo, buf no Ioss fhnn $695 nnd no moro
fhnn fho nvorngo yonrIy romIum for Insurnnco fhnf co-
vors 60 orconf of fho cosf of l0 socIfIod sorvIcos (e.g.,
roscrIfIon drugs nnd hosIfnIIznfIon). 1IiJ.; 42 !. S. C.
l8022. Tho Acf rovIdos fhnf fho onnIfy wIII bo nId fo
fho InfornnI !ovonuo SorvIco wIfh nn IndIvIdunI`s fnxos,
nnd shnII bo nssossod nnd coIIocfod In fho snmo mnnnor


I!SIISS t. SIII!I!S
OInIon of fho Courf
ns fnx onnIfIos, such ns fho onnIfy for cInImIng foo
Inrgo nn Incomo fnx rofund. 26 !. S. C. 5000A(g)(l). Tho
Acf, howovor, bnrs fho I!S from usIng sovornI of Ifs nor-
mnI onforcomonf fooIs, such ns crImInnI rosocufIons nnd
IovIos. 5000A(g)(2). And somo IndIvIdunIs who nro sub-
jocf fo fho mnndnfo nro nonofhoIoss oxomf from fho
onnIfyfor oxnmIo, fhoso wIfh Incomo boIow n corfnIn
fhroshoId nnd mombors of IndInn frIbos. 5000A(o).
On fho dny fho IrosIdonf sIgnod fho Acf Info Inw, IIor-
Idn nnd l2 ofhor Sfnfos fIIod n comInInf In fho IodornI
IsfrIcf Courf for fho orfhorn IsfrIcf of IIorIdn. Thoso
InInfIffswho nro bofh rosondonfs nnd ofIfIonors horo,
doondIng on fho Issuoworo subsoquonfIy joInod by l3
moro Sfnfos, sovornI IndIvIdunIs, nnd fho nfIonnI Iod-
ornfIon of Indoondonf IusInoss. Tho InInfIffs nIIogod,
nmong ofhor fhIngs, fhnf fho IndIvIdunI mnndnfo rovI-
sIons of fho Acf oxcoodod Congross`s owors undor ArfIcIo
I of fho ConsfIfufIon. Tho IsfrIcf Courf ngrood, hoIdIng
fhnf Congross Inckod consfIfufIonnI owor fo onncf fho
IndIvIdunI mnndnfo. ?80 I. Su. 2d l256 ( IIn. 20ll).
Tho IsfrIcf Courf doformInod fhnf fho IndIvIdunI mnn-
dnfo couId nof bo sovorod from fho romnIndor of fho Acf,
nnd fhoroforo sfruck down fho Acf In Ifs onfIrofy. 1J., nf
l305l306.
Tho Courf of AonIs for fho IIovonfh CIrcuIf nffIrmod
In nrf nnd rovorsod In nrf. Tho courf nffIrmod fho Is-
frIcf Courf`s hoIdIng fhnf fho IndIvIdunI mnndnfo oxcoods
Congross`s owor. 648 I. 3d l235 (20ll). Tho nnoI
unnnImousIy ngrood fhnf fho IndIvIdunI mnndnfo dId nof
Imoso n fnx, nnd fhus couId nof bo nufhorIzod by Con-
gross`s owor fo Iny nnd coIIocf Tnxos. !. S. Consf.,
Arf. I, 8, cI. l. A mnjorIfy nIso hoId fhnf fho IndIvIdunI
mnndnfo wns nof suorfod by Congross`s owor fo rogu-
Info Commorco . . . nmong fho sovornI Sfnfos. 1J., cI. 3.
AccordIng fo fho mnjorIfy, fho Commorco CInuso doos nof
omowor fho IodornI Covornmonf fo ordor IndIvIdunIs fo


9 CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
ongngo In commorco, nnd fho Covornmonf`s offorfs fo cnsf
fho IndIvIdunI mnndnfo In n dIfforonf IIghf woro unorsun-
sIvo. Judgo Mnrcus dIssonfod, ronsonIng fhnf fho IndIvId-
unI mnndnfo roguInfos oconomIc ncfIvIfy fhnf hns n cIonr
offocf on Inforsfnfo commorco.
HnvIng hoId fho IndIvIdunI mnndnfo fo bo unconsfIfu-
fIonnI, fho mnjorIfy oxnmInod whofhor fhnf rovIsIon
couId bo sovorod from fho romnIndor of fho Acf. Tho mn-
jorIfy doformInod fhnf, confrnry fo fho IsfrIcf Courf`s
vIow, If couId. Tho courf fhus sfruck down onIy fho IndI-
vIdunI mnndnfo, IonvIng fho Acf`s ofhor rovIsIons Infncf.
648 I. 3d, nf l328.
Ofhor Courfs of AonIs hnvo nIso honrd chnIIongos fo
fho IndIvIdunI mnndnfo. Tho SIxfh CIrcuIf nnd fho . C.
CIrcuIf uhoId fho mnndnfo ns n vnIId oxorcIso of Con-
gross`s commorco owor. Soo Tlonoe More Lou Cen/er v.
OIono, 65l I. 3d 529 (CA6 20ll); Seten-S/, v. HolJer,
66l I. 3d l (CAC 20ll). Tho Iourfh CIrcuIf doformInod
fhnf fho AnfI-InjuncfIon Acf rovonfs courfs from consId-
orIng fho morIfs of fhnf quosfIon. Soo LiIer/, Init., 1nc.
v. Gei/lner, 6?l I. 3d 39l (20ll). Thnf sfnfufo bnrs suIfs
for fho uroso of rosfrnInIng fho nssossmonf or coIIocfIon
of nny fnx. 26 !. S. C. ?42l(n). A mnjorIfy of fho Iourfh
CIrcuIf nnoI ronsonod fhnf fho IndIvIdunI mnndnfo`s
onnIfy Is n fnx wIfhIn fho monnIng of fho AnfI-InjuncfIon
Acf, bocnuso If Is n fInnncInI nssossmonf coIIocfod by fho
I!S fhrough fho normnI monns of fnxnfIon. Tho mnjorIfy
fhoroforo doformInod fhnf fho InInfIffs couId nof chnI-
Iongo fho IndIvIdunI mnndnfo unfII nffor fhoy nId fho
onnIfy.
l

l
Tho IIovonfh CIrcuIf dId nof consIdor whofhor fho AnfI-InjuncfIon
Acf bnrs chnIIongos fo fho IndIvIdunI mnndnfo. Tho IsfrIcf Courf hnd
doformInod fhnf If dId nof, nnd noIfhor sIdo chnIIongod fhnf hoIdIng on
nonI. Tho snmo wns fruo In fho Iourfh CIrcuIf, buf fhnf courf
oxnmInod fho quosfIon euo epon/e bocnuso If vIowod fho AnfI-InjuncfIon
Acf ns n IImIf on Ifs subjocf mnffor jurIsdIcfIon. Soo LiIer/, Init., 6?l


l0 ATIOA! III!ATIO OI IIIIIT
I!SIISS t. SIII!I!S
OInIon of fho Courf
Tho socond rovIsIon of fho AffordnbIo Cnro Acf dIrocfIy
chnIIongod horo Is fho ModIcnId oxnnsIon. Inncfod In
l965, ModIcnId offors fodornI fundIng fo Sfnfos fo nssIsf
rognnnf womon, chIIdron, noody fnmIIIos, fho bIInd, fho
oIdorIy, nnd fho dIsnbIod In obfnInIng modIcnI cnro. Soo 42
!. S. C. l396n(n)(l0). In ordor fo rocoIvo fhnf fundIng,
Sfnfos musf comIy wIfh fodornI crIforIn govornIng mnf-
fors such ns who rocoIvos cnro nnd whnf sorvIcos nro ro-
vIdod nf whnf cosf. Iy l982 ovory Sfnfo hnd choson fo
nrfIcInfo In ModIcnId. IodornI funds rocoIvod fhrough
fho ModIcnId rogrnm hnvo bocomo n subsfnnfInI nrf of
sfnfo budgofs, now consfIfufIng ovor l0 orconf of mosf
Sfnfos` fofnI rovonuo.
Tho AffordnbIo Cnro Acf oxnnds fho scoo of fho ModI-
cnId rogrnm nnd Incronsos fho numbor of IndIvIdunIs fho
Sfnfos musf covor. Ior oxnmIo, fho Acf roquIros sfnfo
rogrnms fo rovIdo ModIcnId covorngo fo nduIfs wIfh
Incomos u fo l33 orconf of fho fodornI ovorfy IovoI,
whorons mnny Sfnfos now covor nduIfs wIfh chIIdron onIy
If fhoIr Incomo Is consIdornbIy Iowor, nnd do nof covor
chIIdIoss nduIfs nf nII. Soo l396n(n)(l0)(A)(I)(VIII). Tho
Acf Incronsos fodornI fundIng fo covor fho Sfnfos` cosfs In
oxnndIng ModIcnId covorngo, nIfhough Sfnfos wIII bonr n
orfIon of fho cosfs on fhoIr own. l396d(y)(l). If n Sfnfo
doos nof comIy wIfh fho Acf`s now covorngo roquIro-
monfs, If mny Ioso nof onIy fho fodornI fundIng for fhoso
roquIromonfs, buf nII of Ifs fodornI ModIcnId funds. Soo
l396c.
AIong wIfh fhoIr chnIIongo fo fho IndIvIdunI mnndnfo,
fho sfnfo InInfIffs In fho IIovonfh CIrcuIf nrguod fhnf fho
ModIcnId oxnnsIon oxcoods Congross`s consfIfufIonnI

I. 3d, nf 40040l. Tho SIxfh CIrcuIf nnd fho . C. CIrcuIf consIdorod
fho quosfIon buf doformInod fhnf fho AnfI-InjuncfIon Acf dId nof nIy.
Soo Tlonoe More, 65l I. 3d, nf 539540 (CA6); Seten-S/,, 66l I. 3d,
nf 5l4 (CAC).


ll CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
owors. Tho Courf of AonIs unnnImousIy hoId fhnf fho
ModIcnId oxnnsIon Is n vnIId oxorcIso of Congross`s owor
undor fho SondIng CInuso. !. S. Consf., Arf. I, 8, cI. l.
And fho courf rojocfod fho Sfnfos` cInIm fhnf fho fhronf-
onod Ioss of nII fodornI ModIcnId fundIng vIoInfos fho
Tonfh Amondmonf by coorcIng fhom Info comIyIng wIfh
fho ModIcnId oxnnsIon. 648 I. 3d, nf l264, l268.
Wo grnnfod corfIornrI fo rovIow fho judgmonf of fho
Courf of AonIs for fho IIovonfh CIrcuIf wIfh rosocf fo
bofh fho IndIvIdunI mnndnfo nnd fho ModIcnId oxnnsIon.
565 !. S. ___ (20ll). Iocnuso no nrfy suorfs fho IIov-
onfh CIrcuIf`s hoIdIng fhnf fho IndIvIdunI mnndnfo cnn
bo comIofoIy sovorod from fho romnIndor of fho AffordnbIo
Cnro Acf, wo noInfod nn onicue curioe fo dofond fhnf
nsocf of fho judgmonf boIow. And bocnuso fhoro Is n
ronsonnbIo nrgumonf fhnf fho AnfI-InjuncfIon Acf do-
rIvos us of jurIsdIcfIon fo honr chnIIongos fo fho IndIvId-
unI mnndnfo, buf no nrfy suorfs fhnf roosIfIon, wo
noInfod nn onicue curioe fo ndvnnco If.
2
II
Ioforo furnIng fo fho morIfs, wo nood fo bo suro wo hnvo
fho nufhorIfy fo do so. Tho AnfI-InjuncfIon Acf rovIdos
fhnf no suIf for fho uroso of rosfrnInIng fho nssossmonf
or coIIocfIon of nny fnx shnII bo mnInfnInod In nny courf
by nny orson, whofhor or nof such orson Is fho or-
son ngnInsf whom such fnx wns nssossod. 26 !. S. C.
?42l(n). ThIs sfnfufo rofocfs fho Covornmonf`s nbIIIfy
fo coIIocf n consIsfonf sfronm of rovonuo, by bnrrIng IIfIgn-
fIon fo onjoIn or ofhorwIso obsfrucf fho coIIocfIon of fnxos.
Iocnuso of fho AnfI-InjuncfIon Acf, fnxos cnn ordInnrIIy bo

2
Wo noInfod H. Inrfow Inrr III fo brIof nnd nrguo In suorf of fho
IIovonfh CIrcuIf`s judgmonf wIfh rosocf fo sovornbIIIfy, nnd !oborf A.
!ong fo brIof nnd nrguo fho roosIfIon fhnf fho AnfI-InjuncfIon Acf
bnrs fho curronf chnIIongos fo fho IndIvIdunI mnndnfo. 565 !. S. ___
(20ll). Iofh onici hnvo nbIy dIschnrgod fhoIr nssIgnod rosonsIbIIIfIos.


OInIon of fho Courf
I!SIISS t. SIII!I!S
OInIon of fho Courf
chnIIongod onIy nffor fhoy nro nId, by suIng for n rofund.
Soo 1nocle v. Willione Poc/ing & Aot. Co., 3?0 !. S. l,
?8 (l962).
Tho onnIfy for nof comIyIng wIfh fho AffordnbIo Cnro
Acf`s IndIvIdunI mnndnfo fIrsf bocomos onforconbIo In
20l4. Tho rosonf chnIIongo fo fho mnndnfo fhus sooks fo
rosfrnIn fho onnIfy`s fufuro coIIocfIon. Anicue confonds
fhnf fho InfornnI !ovonuo Codo fronfs fho onnIfy ns n
fnx, nnd fhnf fho AnfI-InjuncfIon Acf fhoroforo bnrs fhIs
suIf.
Tho foxf of fho orfInonf sfnfufos suggosfs ofhorwIso.
Tho AnfI-InjuncfIon Acf nIIos fo suIfs for fho uroso
of rosfrnInIng fho nssossmonf or coIIocfIon of nny /ox.
?42l(n) (omhnsIs nddod). Congross, howovor, choso fo
doscrIbo fho |s]hnrod rosonsIbIIIfy nymonf Imosod on
fhoso who forgo honIfh Insurnnco nof ns n fnx, buf ns n
onnIfy. 5000A(b), (g)(2). Thoro Is no ImmodInfo
ronson fo fhInk fhnf n sfnfufo nIyIng fo nny fnx wouId
nIy fo n onnIfy.
Congross`s docIsIon fo InboI fhIs oxncfIon n onnIfy
rnfhor fhnn n fnx Is sIgnIfIcnnf bocnuso fho AffordnbIo
Cnro Acf doscrIbos mnny ofhor oxncfIons If cronfos ns
fnxos. Soo Tlonoe More, 65l I. 3d, nf 55l. Whoro
Congross usos corfnIn Inngungo In ono nrf of n sfnfufo
nnd dIfforonf Inngungo In nnofhor, If Is gonornIIy ro-
sumod fhnf Congross ncfs InfonfIonnIIy. Soo Iueeello v.
Ini/eJ S/o/ee, 464 !. S. l6, 23 (l983).
Anicue nrguos fhnf ovon fhough Congross dId nof InboI
fho shnrod rosonsIbIIIfy nymonf n fnx, wo shouId fronf If
ns such undor fho AnfI-InjuncfIon Acf bocnuso If funcfIons
IIko n fnx. If Is fruo fhnf Congross cnnnof chnngo whofhor
nn oxncfIon Is n fnx or n onnIfy for cone/i/u/ionol ur-
osos sImIy by doscrIbIng If ns ono or fho ofhor. Congross
mny nof, for oxnmIo, oxnnd Ifs owor undor fho TnxIng
CInuso, or oscno fho oubIo Joonrdy CInuso`s consfrnInf
on crImInnI snncfIons, by InboIIng n sovoro fInnncInI un-
CIfo ns: 56? !. S. ____ (20l2) l3

Ishmonf n fnx. Soo !"#$%& v. '(%)%$ +,(-#.,(% /01, 259
!. S. 20, 363? (l922); '%2"(.3%-. 04 5%6%-,% 04 70-.1 v.
8,(.9 5"-:9, 5ll !. S. ?6?, ??9 (l994).
Tho AnfI-InjuncfIon Acf nnd fho AffordnbIo Cnro Acf,
howovor, nro cronfuros of Congross`s own cronfIon. How
fhoy roInfo fo onch ofhor Is u fo Congross, nnd fho bosf
ovIdonco of Congross`s Infonf Is fho sfnfufory foxf. Wo
hnvo fhus nIIod fho AnfI-InjuncfIon Acf fo sfnfuforIIy
doscrIbod fnxos ovon whoro fhnf InboI wns Innccurnfo.
Soo !"#$%& v. ;%0(<%, 259 !. S. l6 (l922) (AnfI-InjuncfIon
Acf nIIos fo ChIId !nbor Tnx sfruck down ns oxcoodIng
Congross`s fnxIng owor In '(%)%$ +,(-#.,(%).
Congross cnn, of courso, doscrIbo somofhIng ns n onnIfy
buf dIrocf fhnf If nonofhoIoss bo fronfod ns n fnx for ur-
osos of fho AnfI-InjuncfIon Acf. Ior oxnmIo, 26 !. S. C.
66?l(n) rovIdos fhnf nny roforonco In fhIs fIfIo fo 'fnx`
Imosod by fhIs fIfIo shnII bo doomod nIso fo rofor fo fho
onnIfIos nnd IInbIIIfIos rovIdod by subchnfor 68I of
fho InfornnI !ovonuo Codo. IonnIfIos In subchnfor 68I
nro fhus fronfod ns fnxos undor TIfIo 26, whIch IncIudos
fho AnfI-InjuncfIon Acf. Tho IndIvIdunI mnndnfo, how-
ovor, Is nof In subchnfor 68I of fho Codo. or doos nny
ofhor rovIsIon sfnfo fhnf roforoncos fo fnxos In TIfIo 26
shnII nIso bo doomod fo nIy fo fho IndIvIdunI mnndnfo.
=3#:,> nffomfs fo show fhnf Congross dId rondor fho
AnfI-InjuncfIon Acf nIIcnbIo fo fho IndIvIdunI mnndnfo,
nIboIf by n moro cIrcuIfous roufo. SocfIon 5000A(g)(l) soc-
IfIos fhnf fho onnIfy for nof comIyIng wIfh fho mnn-
dnfo shnII bo nssossod nnd coIIocfod In fho snmo mnnnor
ns nn nssossnbIo onnIfy undor subchnfor I of chnfor
68. AssossnbIo onnIfIos In subchnfor 68I, In furn,
shnII bo nssossod nnd coIIocfod In fho snmo mnnnor ns
fnxos. 66?l(n). AccordIng fo "3#:,>, by dIrocfIng fhnf
fho onnIfy bo nssossod nnd coIIocfod In fho snmo mnn-
nor ns fnxos, 5000A(g)(l) mndo fho AnfI-InjuncfIon Acf
nIIcnbIo fo fhIs onnIfy.
OInIon of fho Courf


I!SIISS t. SIII!I!S
OInIon of fho Courf
Tho Covornmonf dIsngroos. If nrguos fhnf 5000A(g)(l)
doos nof dIrocf courfs fo nIy fho AnfI-InjuncfIon Acf,
bocnuso 5000A(g) Is n dIrocfIvo onIy fo fho Socrofnry of
fho Tronsury fo uso fho snmo 'mofhodoIogy nnd roco-
duros` fo coIIocf fho onnIfy fhnf ho usos fo coIIocf fnxos.
IrIof for !nIfod Sfnfos 3233 (quofIng Seten-S/,, 66l
I. 3d, nf ll).
Wo fhInk fho Covornmonf hns fho boffor rondIng. As
If obsorvos, Assossmonf nnd CoIIocfIon nro chnfors of
fho InfornnI !ovonuo Codo rovIdIng fho Socrofnry nufhor-
Ify fo nssoss nnd coIIocf fnxos, nnd gonornIIy socIfyIng
fho monns by whIch ho shnII do so. Soo 620l (nssoss-
monf nufhorIfy); 630l (coIIocfIon nufhorIfy). SocfIon
5000A(g)(l)`s commnnd fhnf fho onnIfy bo nssossod nnd
coIIocfod In fho snmo mnnnor ns fnxos Is bosf rond ns
roforrIng fo fhoso chnfors nnd gIvIng fho Socrofnry fho
snmo nufhorIfy nnd guIdnnco wIfh rosocf fo fho onnIfy.
Thnf InforrofnfIon Is consIsfonf wIfh fho romnIndor of
5000A(g), whIch Insfrucfs fho Socrofnry on fho fooIs ho
mny uso fo coIIocf fho onnIfy. Soo 5000A(g)(2)(A) (bnr-
rIng crImInnI rosocufIons); 5000A(g)(2)(I) (rohIbIfIng
fho Socrofnry from usIng nofIcos of IIon nnd IovIos). Tho
AnfI-InjuncfIon Acf, by confrnsf, snys nofhIng nbouf fho
rocoduros fo bo usod In nssossIng nnd coIIocfIng fnxos.
Anicue nrguos In fho nIfornnfIvo fhnf n dIfforonf socfIon
of fho InfornnI !ovonuo Codo roquIros courfs fo fronf fho
onnIfy ns n fnx undor fho AnfI-InjuncfIon Acf. SocfIon
620l(n) nufhorIzos fho Socrofnry fo mnko nssossmonfs of
nII fnxos (IncIudIng Inforosf, nddIfIonnI nmounfs, nddIfIons
fo fho fnx, nnd oeeeeeoIle penol/iee). (ImhnsIs nddod.)
Anicue confonds fhnf fho onnIfy musf bo n fnx, bocnuso
If Is nn nssossnbIo onnIfy nnd 620l(n) snys fhnf fnxos
IncIudo nssossnbIo onnIfIos.
Thnf nrgumonf hns forco onIy If 620l(n) Is rond In
IsoInfIon. Tho Codo confnIns mnny rovIsIons fronfIng
fnxos nnd nssossnbIo onnIfIos ns dIsfIncf forms. Soo, e.g.,

l5 CIfo ns: 56? !. S. ____ (20l2)
860(h)(l), 6324A(n), 660l(o)(l)(2), 6602, ?l22(b). Thoro
wouId, for oxnmIo, bo no nood for 66?l(n) fo doom fnx
fo rofor fo corfnIn nssossnbIo onnIfIos If fho Codo nI-
rondy IncIudod nII such onnIfIos In fho form fnx. In-
dood, onicue`s onrIIor obsorvnfIon fhnf fho Codo roquIros
nssossnbIo onnIfIos fo bo nssossod nnd coIIocfod In fho
snmo mnnnor ns fnxos mnkos IIffIo sonso If nssossnbIo
onnIfIos nro fhomsoIvos fnxos. In IIghf of fho Codo`s
consIsfonf dIsfIncfIon bofwoon fho forms fnx nnd ns-
sossnbIo onnIfy, wo musf nccof fho Covornmonf`s In-
forrofnfIon: 620l(n) Insfrucfs fho Socrofnry fhnf hIs
nufhorIfy fo nssoss fnxos IncIudos fho nufhorIfy fo nssoss
onnIfIos, buf If doos nof oqunfo nssossnbIo onnIfIos fo
fnxos for ofhor urosos.
Tho AffordnbIo Cnro Acf doos nof roquIro fhnf fho on-
nIfy for fnIIIng fo comIy wIfh fho IndIvIdunI mnndnfo bo
fronfod ns n fnx for urosos of fho AnfI-InjuncfIon Acf.
Tho AnfI-InjuncfIon Acf fhoroforo doos nof nIy fo fhIs
suIf, nnd wo mny rocood fo fho morIfs.
III
Tho Covornmonf ndvnncos fwo fhoorIos for fho roosI-
fIon fhnf Congross hnd consfIfufIonnI nufhorIfy fo onncf
fho IndIvIdunI mnndnfo. IIrsf, fho Covornmonf nrguos
fhnf Congross hnd fho owor fo onncf fho mnndnfo undor
fho Commorco CInuso. !ndor fhnf fhoory, Congross mny
ordor IndIvIdunIs fo buy honIfh Insurnnco bocnuso fho
fnIIuro fo do so nffocfs Inforsfnfo commorco, nnd couId un-
dorcuf fho AffordnbIo Cnro Acf`s ofhor roforms. Socond,
fho Covornmonf nrguos fhnf If fho commorco owor doos
nof suorf fho mnndnfo, wo shouId nonofhoIoss uhoId If
ns nn oxorcIso of Congross`s owor fo fnx. AccordIng fo fho
Covornmonf, ovon If Congross Incks fho owor fo dIrocf
IndIvIdunIs fo buy Insurnnco, fho onIy offocf of fho IndI-
vIdunI mnndnfo Is fo rnIso fnxos on fhoso who do nof do so,
nnd fhus fho Inw mny bo uhoId ns n fnx.

I!SIISS t. SIII!I!S
A
Tho Covornmonf`s fIrsf nrgumonf Is fhnf fho IndIvIdunI
mnndnfo Is n vnIId oxorcIso of Congross`s owor undor fho
Commorco CInuso nnd fho ocossnry nnd Iroor CInuso.
AccordIng fo fho Covornmonf, fho honIfh cnro mnrkof Is
chnrncforIzod by n sIgnIfIcnnf cosf-shIffIng robIom. Ivory-
ono wIII ovonfunIIy nood honIfh cnro nf n fImo nnd fo nn
oxfonf fhoy cnnnof rodIcf, buf If fhoy do nof hnvo Insur-
nnco, fhoy offon wIII nof bo nbIo fo ny for If. Iocnuso
sfnfo nnd fodornI Inws nonofhoIoss roquIro hosIfnIs fo
rovIdo n corfnIn dogroo of cnro fo IndIvIdunIs wIfhouf
rognrd fo fhoIr nbIIIfy fo ny, soo, e.g., 42 !. S. C. l395dd;
IIn. Sfnf. Ann. 395.l04l, hosIfnIs ond u rocoIvIng
comonsnfIon for onIy n orfIon of fho sorvIcos fhoy ro-
vIdo. To rocou fho Iossos, hosIfnIs nss on fho cosf fo
Insurors fhrough hIghor rnfos, nnd Insurors, In furn, nss
on fho cosf fo oIIcy hoIdors In fho form of hIghor ro-
mIums. Congross osfImnfod fhnf fho cosf of uncomon-
snfod cnro rnIsos fnmIIy honIfh Insurnnco romIums, on
nvorngo, by ovor $l,000 or yonr. 42 !. S. C. l809l(2)(I).
In fho AffordnbIo Cnro Acf, Congross nddrossod fho
robIom of fhoso who cnnnof obfnIn Insurnnco covorngo
bocnuso of rooxIsfIng condIfIons or ofhor honIfh Issuos. If
dId so fhrough fho Acf`s gunrnnfood-Issuo nnd communIfy-
rnfIng rovIsIons. Thoso rovIsIons fogofhor rohIbIf In-
surnnco comnnIos from donyIng covorngo fo fhoso wIfh
such condIfIons or chnrgIng unhonIfhy IndIvIdunIs hIghor
romIums fhnn honIfhy IndIvIdunIs. Soo 300gg, 300ggl,
300gg3, 300gg4.
Tho gunrnnfood-Issuo nnd communIfy-rnfIng roforms do
nof, howovor, nddross fho Issuo of honIfhy IndIvIdunIs who
chooso nof fo urchnso Insurnnco fo covor ofonfInI honIfh
cnro noods. In fncf, fho roforms shnrIy oxncorbnfo fhnf
robIom, by rovIdIng nn InconfIvo for IndIvIdunIs fo doIny
urchnsIng honIfh Insurnnco unfII fhoy bocomo sIck, roIy-
Ing on fho romIso of gunrnnfood nnd nffordnbIo covorngo.

l? CIfo ns: 56? !. S. ____ (20l2)
Tho roforms nIso fhronfon fo Imoso mnssIvo now cosfs on
Insurors, who nro roquIrod fo nccof unhonIfhy IndIvIdunIs
buf rohIbIfod from chnrgIng fhom rnfos nocossnry fo ny
for fhoIr covorngo. ThIs wIII Iond Insurors fo sIgnIfIcnnfIy
Incronso romIums on ovoryono. Soo IrIof for AmorIcn`s
HonIfh Insurnnco IInns of nI. ns Anici Curioe In o. ll
393 ofc. 89.
Tho IndIvIdunI mnndnfo wns Congross`s soIufIon fo
fhoso robIoms. Iy roquIrIng fhnf IndIvIdunIs urchnso
honIfh Insurnnco, fho mnndnfo rovonfs cosf-shIffIng by
fhoso who wouId ofhorwIso go wIfhouf If. In nddIfIon, fho
mnndnfo forcos Info fho Insurnnco rIsk ooI moro honIfhy
IndIvIdunIs, whoso romIums on nvorngo wIII bo hIghor
fhnn fhoIr honIfh cnro oxonsos. ThIs nIIows Insurors fo
subsIdIzo fho cosfs of covorIng fho unhonIfhy IndIvIdunIs
fho roforms roquIro fhom fo nccof. Tho Covornmonf
cInIms fhnf Congross hns owor undor fho Commorco nnd
ocossnry nnd Iroor CInusos fo onncf fhIs soIufIon.
l
Tho Covornmonf confonds fhnf fho IndIvIdunI mnndnfo
Is wIfhIn Congross`s owor bocnuso fho fnIIuro fo ur-
chnso Insurnnco hns n subsfnnfInI nnd doIoforIous offocf
on Inforsfnfo commorco by cronfIng fho cosf-shIffIng rob-
Iom. IrIof for !nIfod Sfnfos 34. Tho nfh of our Com-
morco CInuso docIsIons hns nof nIwnys run smoofh, soo
Ini/eJ S/o/ee v. Lopec, 5l4 !. S. 549, 552559 (l995), buf
If Is now woII osfnbIIshod fhnf Congross hns brond nufhor-
Ify undor fho CInuso. Wo hnvo rocognIzod, for oxnmIo,
fhnf |f]ho owor of Congross ovor Inforsfnfo commorco Is
nof confInod fo fho roguInfIon of commorco nmong fho
sfnfos, buf oxfonds fo ncfIvIfIos fhnf hnvo n subsfnnfInI
offocf on Inforsfnfo commorco. Ini/eJ S/o/ee v. DorI,,
3l2 !. S. l00, ll8ll9 (l94l). Congross`s owor, moro-
ovor, Is nof IImIfod fo roguInfIon of nn ncfIvIfy fhnf by IfsoIf
subsfnnfInIIy nffocfs Inforsfnfo commorco, buf nIso oxfonds

I!SIISS t. SIII!I!S
fo ncfIvIfIos fhnf do so onIy whon nggrognfod wIfh sImIInr
ncfIvIfIos of ofhors. Soo Wic/orJ, 3l? !. S., nf l2?l28.
CIvon Ifs oxnnsIvo scoo, If Is no surrIso fhnf Con-
gross hns omIoyod fho commorco owor In n wIdo vnrIofy
of wnys fo nddross fho rossIng noods of fho fImo. Iuf
Congross hns novor nffomfod fo roIy on fhnf owor fo
comoI IndIvIdunIs nof ongngod In commorco fo urchnso
nn unwnnfod roducf.
3
!ogIsInfIvo novoIfy Is nof noc-
ossnrIIy fnfnI; fhoro Is n fIrsf fImo for ovoryfhIng. Iuf
somofImos fho mosf foIIIng IndIcnfIon of |n] sovoro con-
sfIfufIonnI robIom . . . Is fho Inck of hIsforIcnI rocodonf
for Congross`s ncfIon. Iree 1n/erpriee IunJ v. PuIlic Con-
pon, Accoun/ing Otereigl/ BJ., 56l !. S. ___, ___ (20l0)
(sII o., nf 25) (InfornnI quofnfIon mnrks omIffod). Af fho
vory Ionsf, wo shouId nuso fo consIdor fho ImIIcnfIons of
fho Covornmonf`s nrgumonfs whon confronfod wIfh such
now concofIons of fodornI owor. Lopec, eupro, nf 564.
Tho ConsfIfufIon grnnfs Congross fho owor fo regulo/e
Commorco. Arf. I, 8, cI. 3 (omhnsIs nddod). Tho owor
fo regulo/e commorco rosuosos fho oxIsfonco of com-
morcInI ncfIvIfy fo bo roguInfod. If fho owor fo roguInfo
somofhIng IncIudod fho owor fo cronfo If, mnny of fho
rovIsIons In fho ConsfIfufIon wouId bo suorfIuous. Ior
oxnmIo, fho ConsfIfufIon gIvos Congross fho owor fo
coIn Monoy, In nddIfIon fo fho owor fo roguInfo fho
VnIuo fhoroof. 1J., cI. 5. And If gIvos Congross fho owor

3
Tho oxnmIos of ofhor congrossIonnI mnndnfos cIfod by J!STICI
CISI!!C, poe/, nf 35, n. l0 (oInIon concurrIng In nrf, concurrIng In
judgmonf In nrf, nnd dIssonfIng In nrf), nro nof fo fho confrnry. Inch
of fhoso mnndnfosfo roorf for jury dufy, fo rogIsfor for fho drnff, fo
urchnso fIronrms In nnfIcInfIon of mIIIfIn sorvIco, fo oxchnngo goId
curroncy for nor curroncy, nnd fo fIIo n fnx rofurnnro bnsod on
consfIfufIonnI rovIsIons ofhor fhnn fho Commorco CInuso. Soo Arf. I,
8, cI. 9 (fo consfIfufo TrIbunnIs InforIor fo fho suromo Courf); iJ.,
cI. l2 (fo rnIso nnd suorf ArmIos); iJ., cI. l6 (fo rovIdo for orgnnIz-
Ing, nrmIng, nnd dIscIIInIng, fho MIIIfIn); iJ., cI. 5 (fo coIn Monoy);
iJ., cI. l (fo Iny nnd coIIocf Tnxos).

l9 CIfo ns: 56? !. S. ____ (20l2)
fo rnIso nnd suorf ArmIos nnd fo rovIdo nnd mnIn-
fnIn n nvy, In nddIfIon fo fho owor fo mnko !uIos
for fho Covornmonf nnd !oguInfIon of fho Innd nnd nnvnI
Iorcos. 1J., cIs. l2l4. If fho owor fo roguInfo fho
nrmod forcos or fho vnIuo of monoy IncIudod fho owor fo
brIng fho subjocf of fho roguInfIon Info oxIsfonco, fho
socIfIc grnnf of such owors wouId hnvo boon unnocos-
snry. Tho Inngungo of fho ConsfIfufIon rofIocfs fho nnfu-
rnI undorsfnndIng fhnf fho owor fo roguInfo nssumos
fhoro Is nIrondy somofhIng fo bo roguInfod. Soo GiIIone, 9
Whonf., nf l88 (|T]ho onIIghfonod nfrIofs who frnmod
our consfIfufIon, nnd fho ooIo who ndofod If, musf bo
undorsfood fo hnvo omIoyod words In fhoIr nnfurnI sonso,
nnd fo hnvo Infondod whnf fhoy hnvo snId).
4
Our rocodonf nIso rofIocfs fhIs undorsfnndIng. As
oxnnsIvo ns our cnsos consfruIng fho scoo of fho com-
morco owor hnvo boon, fhoy nII hnvo ono fhIng In com-
mon: Thoy unIformIy doscrIbo fho owor ns ronchIng
ncfIvIfy. If Is nonrIy ImossIbIo fo nvoId fho word whon
quofIng fhom. Soo, e.g., Lopec, eupro, nf 560 (Whoro
oconomIc ncfIvIfy subsfnnfInIIy nffocfs Inforsfnfo com-
morco, IogIsInfIon roguInfIng fhnf ncfIvIfy wIII bo sus-

4
J!STICI CISI!!C suggosfs fhnf nf fho fImo fho ConsfIfufIon wns
frnmod, fo 'roguInfo` monnf, nmong ofhor fhIngs, fo roquIro ncfIon.
Poe/, nf 23 (cIfIng Seten-S/, v. HolJer, 66l I. 3d l, l6 (CAC 20ll);
brnckofs nnd somo InfornnI quofnfIon mnrks omIffod). Iuf fo ronch
fhIs concIusIon, fho cnso cIfod by J!STICI CISI!!C roIIod on n dIcfIon-
nry In whIch |f]o ordor; fo commnnd wns fho fIffh-nIfornnfIvo dofInI-
fIon of fo dIrocf, whIch wns IfsoIf fho socond-nIfornnfIvo dofInIfIon of
fo roguInfo. Soo Seten-S/,, eupro, nf l6 (cIfIng S. Johnson, IcfIon-
nry of fho IngIIsh !nngungo (4fh od. l??3) (rorInfod l9?8)). If Is
unIIkoIy fhnf fho Irnmors hnd such nn obscuro monnIng In mInd whon
fhoy usod fho word roguInfo. Inr moro commonIy, |f]o roguInfo
monnf |f]o ndjusf by ruIo or mofhod, whIch rosuosos somofhIng fo
ndjusf. 2 Johnson, eupro, nf l6l9; soo nIso GiIIone, 9 Whonf., nf l96
(dofInIng fho commorco owor ns fho owor fo roscrIbo fho ruIo by
whIch commorco Is fo bo govornod).

I!SIISS t. SIII!I!S
fnInod); Perec, 402 !. S., nf l54 (Whoro fho cloee of
oc/iti/iee Is roguInfod nnd fhnf cloee Is wIfhIn fho ronch of
fodornI owor, fho courfs hnvo no owor fo oxcIso, ns frIv-
InI, IndIvIdunI Insfnncos of fho cInss (omhnsIs In orIgInnI;
InfornnI quofnfIon mnrks omIffod)); Wic/orJ, eupro, nf
l25 (|I]von If noIIoo`s ncfIvIfy bo IocnI nnd fhough If
mny nof bo rognrdod ns commorco, If mny sfIII, whnfovor
Ifs nnfuro, bo ronchod by Congross If If oxorfs n subsfnn-
fInI oconomIc offocf on Inforsfnfo commorco); ALIB v.
Jonee & Lougllin S/eel Corp., 30l !. S. l, 3? (l93?) (AI-
fhough ncfIvIfIos mny bo Infrnsfnfo In chnrncfor whon
sonrnfoIy consIdorod, If fhoy hnvo such n cIoso nnd sub-
sfnnfInI roInfIon fo Inforsfnfo commorco fhnf fhoIr confroI
Is ossonfInI or nrorInfo fo rofocf fhnf commorco from
burdons nnd obsfrucfIons, Congross cnnnof bo donIod fho
owor fo oxorcIso fhnf confroI); soo nIso poe/, nf l5, 2526,
28, 32 (CISI!!C, J., concurrIng In nrf, concurrIng In
judgmonf In nrf, nnd dIssonfIng In nrf).
5
Tho IndIvIdunI mnndnfo, howovor, doos nof roguInfo
oxIsfIng commorcInI ncfIvIfy. If Insfond comoIs IndIvId-
unIs fo Iecone ncfIvo In commorco by urchnsIng n roducf,
on fho ground fhnf fhoIr fnIIuro fo do so nffocfs Inforsfnfo
commorco. ConsfruIng fho Commorco CInuso fo ormIf Con-
gross fo roguInfo IndIvIdunIs rocIsoIy Iecouee fhoy nro
doIng nofhIng wouId oon n now nnd ofonfInIIy vnsf do-
mnIn fo congrossIonnI nufhorIfy. Ivory dny IndIvIdunIs do
nof do nn InfInIfo numbor of fhIngs. In somo cnsos fhoy

5
J!STICI CISI!!C cIfos fwo omInonf domnIn cnsos from fho l890s fo
suorf fho roosIfIon fhnf our cnso Inw doos nof foo fho ncfIvIfy
vorsus InncfIvIfy IIno. Poe/, nf 2425 (cIfIng Monongolelo Aot. Co. v.
Ini/eJ S/o/ee, l48 !. S. 3l2, 33533? (l893), nnd Clero/ee Ao/ion v.
Sou/lern Koneoe I. Co., l35 !. S. 64l, 65?659 (l890)). Tho fncf fhnf
fho IIffh Amondmonf roquIros fho nymonf of jusf comonsnfIon
whon fho Covornmonf oxorcIsos Ifs owor of omInonf domnIn doos nof
furn fho fnkIng Info n commorcInI frnnsncfIon bofwoon fho Inndownor
nnd fho Covornmonf, Iof nIono n govornmonf-comoIIod frnnsncfIon
bofwoon fho Inndownor nnd n fhIrd nrfy.

2l CIfo ns: 56? !. S. ____ (20l2)
docIdo nof fo do somofhIng; In ofhors fhoy sImIy fnII fo
do If. AIIowIng Congross fo jusfIfy fodornI roguInfIon by
oInfIng fo fho offocf of InncfIon on commorco wouId brIng
counfIoss docIsIons nn IndIvIdunI couId po/en/ioll, mnko
wIfhIn fho scoo of fodornI roguInfIon, nndundor fho
Covornmonf`s fhooryomowor Congross fo mnko fhoso
docIsIons for hIm.
AIyIng fho Covornmonf`s IogIc fo fho fnmIIInr cnso of
Wic/orJ v. IilIurn shows how fnr fhnf IogIc wouId cnrry
us from fho nofIon of n govornmonf of IImIfod owors. In
Wic/orJ, fho Courf fnmousIy uhoId n fodornI onnIfy Im-
osod on n fnrmor for growIng whonf for consumfIon
on hIs own fnrm. 3l? !. S., nf ll4ll5, l28l29. Thnf
nmounf of whonf cnusod fho fnrmor fo oxcood hIs quofn
undor n rogrnm dosIgnod fo suorf fho rIco of whonf by
IImIfIng suIy. Tho Courf rojocfod fho fnrmor`s nrgumonf
fhnf growIng whonf for homo consumfIon wns boyond fho
ronch of fho commorco owor. If dId so on fho ground fhnf
fho fnrmor`s docIsIon fo grow whonf for hIs own uso nI-
Iowod hIm fo nvoId urchnsIng whonf In fho mnrkof. Thnf
docIsIon, whon consIdorod In fho nggrognfo nIong wIfh sIm-
IInr docIsIons of ofhors, wouId hnvo hnd n subsfnnfInI of-
focf on fho Inforsfnfo mnrkof for whonf. 1J., nf l2?l29.
Wic/orJ hns Iong boon rognrdod ns orhns fho mosf
fnr ronchIng oxnmIo of Commorco CInuso nufhorIfy ovor
Infrnsfnfo ncfIvIfy, Lopec, 5l4 !. S., nf 560, buf fho Cov-
ornmonf`s fhoory In fhIs cnso wouId go much furfhor.
!ndor Wic/orJ If Is wIfhIn Congross`s owor fo roguInfo
fho mnrkof for whonf by suorfIng Ifs rIco. Iuf rIco
cnn bo suorfod by IncronsIng domnnd ns woII ns by
docronsIng suIy. Tho nggrognfod docIsIons of somo
consumors nof fo urchnso whonf hnvo n subsfnnfInI offocf
on fho rIco of whonf, jusf ns docIsIons nof fo urchnso
honIfh Insurnnco hnvo on fho rIco of Insurnnco. Congross
cnn fhoroforo commnnd fhnf fhoso nof buyIng whonf do so,
jusf ns If nrguos horo fhnf If mny commnnd fhnf fhoso nof

I!SIISS t. SIII!I!S
buyIng honIfh Insurnnco do so. Tho fnrmor In Wic/orJ
wns nf Ionsf ncfIvoIy ongngod In fho roducfIon of whonf,
nnd fho Covornmonf couId roguInfo fhnf ncfIvIfy bocnuso
of Ifs offocf on commorco. Tho Covornmonf`s fhoory horo
wouId offocfIvoIy ovorrIdo fhnf IImIfnfIon, by osfnbIIshIng
fhnf IndIvIdunIs mny bo roguInfod undor fho Commorco
CInuso whonovor onough of fhom nro nof doIng somofhIng
fho Covornmonf wouId hnvo fhom do.
Indood, fho Covornmonf`s IogIc wouId jusfIfy n mnndn-
fory urchnso fo soIvo nImosf nny robIom. Soo Seten-S/,,
66l I. 3d, nf l4l5 (nofIng fho Covornmonf`s InnbIIIfy
fo IdonfIfy nny mnndnfo fo urchnso n roducf or sor-
vIco In Inforsfnfo commorco fhnf wouId bo unconsfIfu-
fIonnI undor Ifs fhoory of fho commorco owor). To
consIdor n dIfforonf oxnmIo In fho honIfh cnro mnrkof, mnny
AmorIcnns do nof onf n bnInncod dIof. Thnf grou mnkos
u n Inrgor orconfngo of fho fofnI ouInfIon fhnn fhoso
wIfhouf honIfh Insurnnco. Soo, e.g., of. of AgrIcuIfuro
nnd of. of HonIfh nnd Humnn SorvIcos, Iofnry CuIdo-
IInos for AmorIcnns l (20l0). Tho fnIIuro of fhnf grou
fo hnvo n honIfhy dIof Incronsos honIfh cnro cosfs, fo n
gronfor oxfonf fhnn fho fnIIuro of fho unInsurod fo ur-
chnso Insurnnco. Soo, e.g., IInkoIsfoIn, Trogdon, Cohon, &
Iofz, AnnunI ModIcnI SondIng AffrIbufnbIo fo ObosIfy:
Inyor- nnd SorvIco-SocIfIc IsfImnfos, 28 HonIfh AffnIrs
w822 (2009) (dofnIIIng fho undonInbIo IInk bofwoon rIs-
Ing rnfos of obosIfy nnd rIsIng modIcnI sondIng, nnd osfI-
mnfIng fhnf fho nnnunI modIcnI burdon of obosIfy hns
rIson fo nImosf l0 orconf of nII modIcnI sondIng nnd
couId nmounf fo $l4? bIIIIon or yonr In 2008). Thoso In-
cronsod cosfs nro borno In nrf by ofhor AmorIcnns who
musf ny moro, jusf ns fho unInsurod shIff cosfs fo fho
Insurod. Soo Confor for AIIod IfhIcs, VoIunfnry HonIfh
!Isks: Who ShouId Iny, 6 Issuos In IfhIcs 6 (l993) (nof-
Ing ovorwhoImIng ovIdonco fhnf IndIvIdunIs wIfh un-
honIfhy hnbIfs ny onIy n frncfIon of fho cosfs nssocInfod

23 CIfo ns: 56? !. S. ____ (20l2)
wIfh fhoIr bohnvIors; mosf of fho oxonso Is borno by fho
rosf of socIofy In fho form of hIghor Insurnnco romIums,
govornmonf oxondIfuros for honIfh cnro, nnd dIsnbIIIfy
bonofIfs). Congross nddrossod fho Insurnnco robIom by
ordorIng ovoryono fo buy Insurnnco. !ndor fho Cov-
ornmonf`s fhoory, Congross couId nddross fho dIof robIom
by ordorIng ovoryono fo buy vogofnbIos. Soo Iofnry
CuIdoIInos, eupro, nf l9 (Imrovod nufrIfIon, nrorInfo
onfIng bohnvIors, nnd Incronsod hysIcnI ncfIvIfy hnvo fro-
mondous ofonfInI fo . . . roduco honIfh cnro cosfs).
IooIo, for ronsons of fhoIr own, offon fnII fo do fhIngs
fhnf wouId bo good for fhom or good for socIofy. Thoso
fnIIurosjoInod wIfh fho sImIInr fnIIuros of ofhorscnn
rondIIy hnvo n subsfnnfInI offocf on Inforsfnfo commorco.
!ndor fho Covornmonf`s IogIc, fhnf nufhorIzos Congross fo
uso Ifs commorco owor fo comoI cIfIzons fo ncf ns fho
Covornmonf wouId hnvo fhom ncf.
Thnf Is nof fho counfry fho Irnmors of our ConsfIfufIon
onvIsIonod. Jnmos MndIson oxInInod fhnf fho Commorco
CInuso wns nn nddIfIon whIch fow ooso nnd from whIch
no nrohonsIons nro onforfnInod. Tho IodornIIsf o. 45,
nf 293. WhIIo Congross`s nufhorIfy undor fho Commorco
CInuso hns of courso oxnndod wIfh fho growfh of fho
nnfIonnI oconomy, our cnsos hnvo nIwnys rocognIzod fhnf
fho owor fo roguInfo commorco, fhough brond Indood, hns
IImIfs. Mor,lonJ v. Wir/c, 392 !. S. l83, l96 (l968). Tho
Covornmonf`s fhoory wouId orodo fhoso IImIfs, ormIffIng
Congross fo ronch boyond fho nnfurnI oxfonf of Ifs nufhor-
Ify, ovorywhoro oxfondIng fho shoro of Ifs ncfIvIfy nnd
drnwIng nII owor Info Ifs Imofuous vorfox. Tho Iodor-
nIIsf o. 48, nf 309 (J. MndIson). Congross nIrondy onjoys
vnsf owor fo roguInfo much of whnf wo do. AccofIng
fho Covornmonf`s fhoory wouId gIvo Congross fho snmo
IIconso fo roguInfo whnf wo do nof do, fundnmonfnIIy
chnngIng fho roInfIon bofwoon fho cIfIzon nnd fho IodornI

I!SIISS t. SIII!I!S
Covornmonf.
6
To nn oconomIsf, orhns, fhoro Is no dIfforonco bofwoon
ncfIvIfy nnd InncfIvIfy; bofh hnvo monsurnbIo oconomIc
offocfs on commorco. Iuf fho dIsfIncfIon bofwoon doIng
somofhIng nnd doIng nofhIng wouId nof hnvo boon Iosf on
fho Irnmors, who woro rncfIcnI sfnfosmon, nof mofn-
hysIcnI hIIosohors. 1nJue/riol Inion Dep/., AILC1O
v. Anericon Pe/roleun 1ne/i/u/e, 448 !. S. 60?, 6?3 (l980)
(!ohnquIsf, J., concurrIng In judgmonf). As wo hnvo ox-
InInod, fho frnmors of fho ConsfIfufIon woro nof moro
vIsIonnrIos, foyIng wIfh socuInfIons or fhoorIos, buf
rncfIcnI mon, donIIng wIfh fho fncfs of oIIfIcnI IIfo ns
fhoy undorsfood fhom, uffIng Info form fho govornmonf
fhoy woro cronfIng, nnd roscrIbIng In Inngungo cIonr
nnd InfoIIIgIbIo fho owors fhnf govornmonf wns fo fnko.
Sou/l Corolino v. Ini/eJ S/o/ee, l99 !. S. 43?, 449 (l905).
Tho Irnmors gnvo Congross fho owor fo regulo/e com-
morco, nof fo conpel If, nnd for ovor 200 yonrs bofh our
docIsIons nnd Congross`s ncfIons hnvo rofIocfod fhIs un-
dorsfnndIng. Thoro Is no ronson fo donrf from fhnf un-
dorsfnndIng now.
Tho Covornmonf soos fhIngs dIfforonfIy. If nrguos fhnf
bocnuso sIcknoss nnd Injury nro unrodIcfnbIo buf unn-
voIdnbIo, fho unInsurod ns n cInss nro ncfIvo In fho mnr-
kof for honIfh cnro, whIch fhoy roguInrIy sook nnd obfnIn.
IrIof for !nIfod Sfnfos 50. Tho IndIvIdunI mnndnfo
moroIy roguInfos how IndIvIdunIs fInnnco nnd ny for fhnf

6
In nn nffomf fo rocnsf fho IndIvIdunI mnndnfo ns n roguInfIon of
commorcInI ncfIvIfy, J!STICI CISI!!C suggosfs fhnf |n]n IndIvIdunI
who ofs nof fo urchnso Insurnnco from n rIvnfo Insuror cnn bo soon
ns ncfIvoIy soIocfIng nnofhor form of Insurnnco: soIf-Insurnnco. Poe/, nf
26. Iuf soIf-Insurnnco Is, In fhIs confoxf, nofhIng moro fhnn n do-
scrIfIon of fho fnIIuro fo urchnso Insurnnco. IndIvIdunIs nro no moro
ncfIv|o] In fho soIf-Insurnnco mnrkof whon fhoy fnII fo urchnso
Insurnnco, iIiJ., fhnn fhoy nro ncfIvo In fho rosf mnrkof whon doIng
nofhIng.

25 CIfo ns: 56? !. S. ____ (20l2)
ncfIvo nrfIcInfIonroquIrIng fhnf fhoy do so fhrough
Insurnnco, rnfhor fhnn fhrough nffomfod soIf-Insurnnco
wIfh fho bnck-sfo of shIffIng cosfs fo ofhors. 1IiJ.
Tho Covornmonf roonfs fho hrnso ncfIvo In fho mnr-
kof for honIfh cnro fhroughouf Ifs brIof, soo iJ., nf ?, l8,
34, 50, buf fhnf concof hns no consfIfufIonnI sIgnIfIcnnco.
An IndIvIdunI who boughf n cnr fwo yonrs ngo nnd mny
buy nnofhor In fho fufuro Is nof ncfIvo In fho cnr mnrkof
In nny orfInonf sonso. Tho hrnso ncfIvo In fho mnrkof
cnnnof obscuro fho fncf fhnf mosf of fhoso roguInfod by
fho IndIvIdunI mnndnfo nro nof curronfIy ongngod In nny
commorcInI ncfIvIfy InvoIvIng honIfh cnro, nnd fhnf fncf Is
fnfnI fo fho Covornmonf`s offorf fo roguInfo fho unInsurod
ns n cInss. 1J., nf 42. Our rocodonfs rocognIzo Con-
gross`s owor fo roguInfo cInss|os] of oc/iti/iee, Goncolee
v. Ioicl, 545 !. S. l, l? (2005) (omhnsIs nddod), nof
cInssos of inJitiJuole, nnrf from nny ncfIvIfy In whIch
fhoy nro ongngod, soo, e.g., Perec, 402 !. S., nf l53 (IofI-
fIonor Is cIonrIy n mombor of fho cInss whIch ongngos In
'oxforfIonnfo crodIf frnnsncfIons` . . . (omhnsIs doIofod)).
Tho IndIvIdunI mnndnfo`s roguInfIon of fho unInsurod ns
n cInss Is, In fncf, nrfIcuInrIy dIvorcod from nny IInk fo
oxIsfIng commorcInI ncfIvIfy. Tho mnndnfo rImnrIIy
nffocfs honIfhy, offon young nduIfs who nro Ioss IIkoIy fo
nood sIgnIfIcnnf honIfh cnro nnd hnvo ofhor rIorIfIos for
sondIng fhoIr monoy. If Is rocIsoIy bocnuso fhoso IndI-
vIdunIs, ns nn ncfunrInI cInss, Incur roInfIvoIy Iow honIfh
cnro cosfs fhnf fho mnndnfo hoIs counfor fho offocf of
forcIng Insurnnco comnnIos fo covor ofhors who Imoso
gronfor cosfs fhnn fhoIr romIums nro nIIowod fo rofIocf.
Soo 42 !. S. C. l809l(2)(I) (rocognIzIng fhnf fho mnndnfo
wouId brondon fho honIfh Insurnnco rIsk ooI fo IncIudo
honIfhy IndIvIdunIs, whIch wIII Iowor honIfh Insurnnco
romIums). If fho IndIvIdunI mnndnfo Is fnrgofod nf n
cInss, If Is n cInss whoso commorcInI InncfIvIfy rnfhor fhnn
ncfIvIfy Is Ifs dofInIng fonfuro.

I!SIISS t. SIII!I!S
Tho Covornmonf, howovor, cInIms fhnf fhIs doos nof
mnffor. Tho Covornmonf rognrds If ns suffIcIonf fo frIggor
Congross`s nufhorIfy fhnf nImosf nII fhoso who nro unIn-
surod wIII, nf somo unknown oInf In fho fufuro, ongngo
In n honIfh cnro frnnsncfIon. AssorfIng fhnf |f]horo Is no
fomornI IImIfnfIon In fho Commorco CInuso, fho Cov-
ornmonf nrguos fhnf bocnuso |o]voryono subjocf fo fhIs
roguInfIon Is In or wIII bo In fho honIfh cnro mnrkof, fhoy
cnn bo roguInfod In ndvnnco. Tr. of OrnI Arg. l09 (Mnr.
2?, 20l2).
Tho roosIfIon fhnf Congross mny dIcfnfo fho conducf
of nn IndIvIdunI fodny bocnuso of rohosIod fufuro nc-
fIvIfy fInds no suorf In our rocodonf. Wo hnvo snId fhnf
Congross cnn nnfIcInfo fho effec/e on commorco of nn oco-
nomIc ncfIvIfy. Soo, e.g., ConeoliJo/eJ 1Jieon Co. v. ALIB,
305 !. S. l9? (l938) (roguInfIng fho Inbor rncfIcos of
ufIIIfy comnnIos); Heor/ of A/lon/o Mo/el, 1nc. v. Ini/eJ
S/o/ee, 3?9 !. S. 24l (l964) (rohIbIfIng dIscrImInnfIon by
hofoI oornfors); Ko/cenIocl v. McClung, 3?9 !. S. 294
(l964) (rohIbIfIng dIscrImInnfIon by rosfnurnnf ownors).
Iuf wo hnvo novor ormIffod Congross fo nnfIcInfo fhnf
ncfIvIfy IfsoIf In ordor fo roguInfo IndIvIdunIs nof curronfIy
ongngod In commorco. Inch ono of our cnsos, IncIudIng
fhoso cIfod by J!STICI CISI!!C, poe/, nf 202l, InvoIvod
rooxIsfIng oconomIc ncfIvIfy. Soo, e.g., Wic/orJ, 3l?
!. S., nf l2?l29 (roducIng whonf); Ioicl, eupro, nf 25
(growIng mnrIjunnn).
Ivoryono wIII IIkoIy nrfIcInfo In fho mnrkofs for food,
cIofhIng, frnnsorfnfIon, shoIfor, or onorgy; fhnf doos nof
nufhorIzo Congross fo dIrocf fhom fo urchnso nrfIcuInr
roducfs In fhoso or ofhor mnrkofs fodny. Tho Commorco
CInuso Is nof n gonornI IIconso fo roguInfo nn IndIvIdunI
from crndIo fo grnvo, sImIy bocnuso ho wIII rodIcfnbIy
ongngo In nrfIcuInr frnnsncfIons. Any oIIco owor fo
roguInfo IndIvIdunIs ns such, ns oosod fo fhoIr ncfIvIfIos,
romnIns vosfod In fho Sfnfos.

2? CIfo ns: 56? !. S. ____ (20l2)
Tho Covornmonf nrguos fhnf fho IndIvIdunI mnndnfo
cnn bo susfnInod ns n sorf of oxcofIon fo fhIs ruIo, bocnuso
honIfh Insurnnco Is n unIquo roducf. AccordIng fo fho
Covornmonf, uhoIdIng fho IndIvIdunI mnndnfo wouId
nof jusfIfy mnndnfory urchnsos of Ifoms such ns cnrs or
broccoII bocnuso, ns fho Covornmonf ufs If, |h]onIfh In-
surnnco Is nof urchnsod for Ifs own snko IIko n cnr or
broccoII; If Is n monns of fInnncIng honIfh-cnro consum-
fIon nnd covorIng unIvorsnI rIsks. !oIy IrIof for !nIfod
Sfnfos l9. Iuf cnrs nnd broccoII nro no moro urchnsod
for fhoIr own snko fhnn honIfh Insurnnco. Thoy nro
urchnsod fo covor fho nood for frnnsorfnfIon nnd food.
Tho Covornmonf snys fhnf honIfh Insurnnco nnd honIfh
cnro fInnncIng nro InhoronfIy Infogrnfod. IrIof for !nIfod
Sfnfos 4l. Iuf fhnf doos nof monn fho comoIIod urchnso
of fho fIrsf Is roorIy rognrdod ns n roguInfIon of fho
socond. o mnffor how InhoronfIy Infogrnfod honIfh
Insurnnco nnd honIfh cnro consumfIon mny bo, fhoy nro
nof fho snmo fhIng: Thoy InvoIvo dIfforonf frnnsncfIons,
onforod Info nf dIfforonf fImos, wIfh dIfforonf rovIdors.
And for mosf of fhoso fnrgofod by fho mnndnfo, sIgnIfIcnnf
honIfh cnro noods wIII bo yonrs, or ovon docndos, nwny.
Tho roxImIfy nnd dogroo of connocfIon bofwoon fho
mnndnfo nnd fho subsoquonf commorcInI ncfIvIfy Is foo Inck-
Ing fo jusfIfy nn oxcofIon of fho sorf urgod by fho Cov-
ornmonf. Tho IndIvIdunI mnndnfo forcos IndIvIdunIs
Info commorco rocIsoIy bocnuso fhoy oIocfod fo rofrnIn
from commorcInI ncfIvIfy. Such n Inw cnnnof bo sus-
fnInod undor n cInuso nufhorIzIng Congross fo roguInfo
Commorco.
2
Tho Covornmonf noxf confonds fhnf Congross hns fho
owor undor fho ocossnry nnd Iroor CInuso fo onncf fho
IndIvIdunI mnndnfo bocnuso fho mnndnfo Is nn InfogrnI
nrf of n comrohonsIvo schomo of oconomIc roguInfIon

I!SIISS t. SIII!I!S
fho gunrnnfood-Issuo nnd communIfy-rnfIng Insurnnco
roforms. IrIof for !nIfod Sfnfos 24. !ndor fhIs nrgu-
monf, If Is nof nocossnry fo consIdor fho offocf fhnf nn
IndIvIdunI`s InncfIvIfy mny hnvo on Inforsfnfo commorco; If
Is onough fhnf Congross roguInfo commorcInI ncfIvIfy In n
wny fhnf roquIros roguInfIon of InncfIvIfy fo bo offocfIvo.
Tho owor fo mnko nII !nws whIch shnII bo nocossnry
nnd roor for cnrryIng Info IxocufIon fho owors onu-
mornfod In fho ConsfIfufIon, Arf. I, 8, cI. l8, vosfs Con-
gross wIfh nufhorIfy fo onncf rovIsIons IncIdonfnI fo fho
|onumornfod] owor, nnd conducIvo fo Ifs bonofIcInI oxor-
cIso, McCullocl, 4 Whonf., nf 4l8. AIfhough fho CInuso
gIvos Congross nufhorIfy fo IogIsInfo on fhnf vnsf mnss
of IncIdonfnI owors whIch musf bo InvoIvod In fho con-
sfIfufIon, If doos nof IIconso fho oxorcIso of nny gronf
subsfnnfIvo nnd Indoondonf owor|s] boyond fhoso socIfI-
cnIIy onumornfod. 1J., nf 4ll, 42l. Insfond, fho CInuso Is
'moroIy n docInrnfIon, for fho romovnI of nII uncorfnInfy,
fhnf fho monns of cnrryIng Info oxocufIon fhoso |owors]
ofhorwIso grnnfod nro IncIudod In fho grnnf.` Kineello v.
Ini/eJ S/o/ee ex rel. Single/on, 36l !. S. 234, 24? (l960)
(quofIng VI WrIfIngs of Jnmos MndIson 383 (C. Hunf od.
l906)).
As our jurIsrudonco undor fho ocossnry nnd Iroor
CInuso hns dovoIood, wo hnvo boon vory doforonfInI fo
Congross`s doformInnfIon fhnf n roguInfIon Is nocossnry.
Wo hnvo fhus uhoId Inws fhnf nro 'convonIonf, or uso-
fuI` or 'conducIvo` fo fho nufhorIfy`s 'bonofIcInI oxorcIso.`
Cone/oc/, 560 !. S., nf ___ (sII o., nf 5) (quofIng McCul-
locl, eupro, nf 4l3, 4l8). Iuf wo hnvo nIso cnrrIod ouf our
rosonsIbIIIfy fo docInro unconsfIfufIonnI fhoso Inws fhnf
undormIno fho sfrucfuro of govornmonf osfnbIIshod by fho
ConsfIfufIon. Such Inws, whIch nro nof consIsf|onf] wIfh
fho Ioffor nnd sIrIf of fho consfIfufIon, McCullocl, eupro,
nf 42l, nro nof proper |monns] for cnrryIng Info Ixocu-
fIon Congross`s onumornfod owors. !nfhor, fhoy nro, In

29 CIfo ns: 56? !. S. ____ (20l2)
fho words of Tho IodornIIsf, 'moroIy ncfs of usurnfIon`
whIch 'dosorvo fo bo fronfod ns such.` Prin/c v. Ini/eJ
S/o/ee, 52l !. S. 898, 924 (l99?) (nIfornfIons omIffod)
(quofIng Tho IodornIIsf o. 33, nf 204 (A. HnmIIfon)); soo
nIso Aeu Yor/, 505 !. S., nf l??; Cone/oc/, eupro, nf ___
(sII o., nf 5) (KIIY, J., concurrIng In judgmonf) (If
Is of fundnmonfnI Imorfnnco fo consIdor whofhor osson-
fInI nffrIbufos of sfnfo sovoroIgnfy nro comromIsod by fho
nssorfIon of fodornI owor undor fho ocossnry nnd Iroor
CInuso . . .).
AIyIng fhoso rIncIIos, fho IndIvIdunI mnndnfo cnn-
nof bo susfnInod undor fho ocossnry nnd Iroor CInuso
ns nn ossonfInI comononf of fho Insurnnco roforms. Inch
of our rIor cnsos uhoIdIng Inws undor fhnf CInuso In-
voIvod oxorcIsos of nufhorIfy dorIvnfIvo of, nnd In sorvIco
fo, n grnnfod owor. Ior oxnmIo, wo hnvo uhoId rovI-
sIons ormIffIng confInuod confInomonf of fhoso olreoJ,
in feJerol cue/oJ, whon fhoy couId nof bo snfoIy roIonsod,
Cone/oc/, eupro, nf ___ (sII o., nf l2); crImInnIIz-
Ing brIbos InvoIvIng orgnnIznfIons receiting feJerol funJe,
SoIri v. Ini/eJ S/o/ee, 54l !. S. 600, 602, 605 (2004); nnd
foIIIng sfnfo sfnfufos of IImIfnfIons whIIo cnsos nro penJ-
ing in feJerol cour/, Jin/e v. IicllonJ Coun/,, 538
!. S. 456, 459, 462 (2003). Tho IndIvIdunI mnndnfo, by con-
frnsf, vosfs Congross wIfh fho oxfrnordInnry nbIIIfy fo
cronfo fho nocossnry rodIcnfo fo fho oxorcIso of nn onu-
mornfod owor.
ThIs Is In no wny nn nufhorIfy fhnf Is nnrrow In scoo,
Cone/oc/, eupro, nf ___ (sII o., nf 20), or IncIdonfnI fo
fho oxorcIso of fho commorco owor, McCullocl, eupro, nf
4l8. !nfhor, such n concofIon of fho ocossnry nnd
Iroor CInuso wouId work n subsfnnfInI oxnnsIon of
fodornI nufhorIfy. o Iongor wouId Congross bo IImIfod fo
roguInfIng undor fho Commorco CInuso fhoso who by somo
rooxIsfIng ncfIvIfy brIng fhomsoIvos wIfhIn fho shoro of
fodornI roguInfIon. Insfond, Congross couId ronch boyond

I!SIISS t. SIII!I!S
fho nnfurnI IImIf of Ifs nufhorIfy nnd drnw wIfhIn Ifs
roguInfory scoo fhoso who ofhorwIso wouId bo oufsIdo of
If. Ivon If fho IndIvIdunI mnndnfo Is nocossnry fo fho
Acf`s Insurnnco roforms, such nn oxnnsIon of fodornI
owor Is nof n roor monns for mnkIng fhoso roforms
offocfIvo.
Tho Covornmonf roIIos rImnrIIy on our docIsIon In
Goncolee v. Ioicl. In Ioicl, wo consIdorod comrohon-
sIvo IogIsInfIon fo roguInfo fho Inforsfnfo mnrkof In mnrI-
junnn. 545 !. S., nf 22. CorfnIn IndIvIdunIs soughf nn
oxomfIon from fhnf roguInfIon on fho ground fhnf fhoy
ongngod In onIy Infrnsfnfo ossossIon nnd consumfIon.
Wo donIod nny oxomfIon, on fho ground fhnf mnrIjunnn
Is n fungIbIo commodIfy, so fhnf nny mnrIjunnn couId
bo rondIIy dIvorfod Info fho Inforsfnfo mnrkof. Congross`s
nffomf fo roguInfo fho Inforsfnfo mnrkof for mnrIjunnn
wouId fhoroforo hnvo boon subsfnnfInIIy undorcuf If If
couId nof nIso roguInfo Infrnsfnfo ossossIon nnd con-
sumfIon. 1J., nf l9. AccordIngIy, wo rocognIzod fhnf
Congross wns ncfIng woII wIfhIn Ifs nufhorIfy undor fho
ocossnry nnd Iroor CInuso ovon fhough Ifs roguInfIon
onsnnro|d] somo uroIy Infrnsfnfo ncfIvIfy. 1J., nf 22; soo
nIso Perec, 402 !. S., nf l54. Ioicl fhus dId nof InvoIvo
fho oxorcIso of nny gronf subsfnnfIvo nnd Indoondonf
owor, McCullocl, eupro, nf 4ll, of fho sorf nf Issuo horo.
Insfond, If concornod onIy fho consfIfufIonnIIfy of IndI-
vIdunI opplico/ione of n concododIy vnIId sfnfufory
schomo. Ioicl, eupro, nf 23 (omhnsIs nddod).
Jusf ns fho IndIvIdunI mnndnfo cnnnof bo susfnInod ns
n Inw roguInfIng fho subsfnnfInI offocfs of fho fnIIuro fo
urchnso honIfh Insurnnco, noIfhor cnn If bo uhoId ns
n nocossnry nnd roor comononf of fho Insurnnco ro-
forms. Tho commorco owor fhus doos nof nufhorIzo fho
mnndnfo. Accord, poe/, nf 4l6 (joInf oInIon of SCA!IA,
KIIY, THOMAS, nnd A!ITO, JJ., dIssonfIng).

3l CIfo ns: 56? !. S. ____ (20l2)
I
Thnf Is nof fho ond of fho mnffor. Iocnuso fho Com-
morco CInuso doos nof suorf fho IndIvIdunI mnndnfo, If
Is nocossnry fo furn fo fho Covornmonf`s socond nrgumonf:
fhnf fho mnndnfo mny bo uhoId ns wIfhIn Congross`s
onumornfod owor fo Iny nnd coIIocf Tnxos. Arf. I, 8,
cI. l.
Tho Covornmonf`s fnx owor nrgumonf nsks us fo vIow
fho sfnfufo dIfforonfIy fhnn wo dId In consIdorIng Ifs com-
morco owor fhoory. In mnkIng Ifs Commorco CInuso
nrgumonf, fho Covornmonf dofondod fho mnndnfo ns n
roguInfIon roquIrIng IndIvIdunIs fo urchnso honIfh In-
surnnco. Tho Covornmonf doos nof cInIm fhnf fho fnxIng
owor nIIows Congross fo Issuo such n commnnd. Insfond,
fho Covornmonf nsks us fo rond fho mnndnfo nof ns ordor-
Ing IndIvIdunIs fo buy Insurnnco, buf rnfhor ns ImosIng n
fnx on fhoso who do nof buy fhnf roducf.
Tho foxf of n sfnfufo cnn somofImos hnvo moro fhnn ono
ossIbIo monnIng. To fnko n fnmIIInr oxnmIo, n Inw fhnf
ronds no vohIcIos In fho nrk mIghf, or mIghf nof, bnn
bIcycIos In fho nrk. And If Is woII osfnbIIshod fhnf If
n sfnfufo hns fwo ossIbIo monnIngs, ono of whIch vIoInfos
fho ConsfIfufIon, courfs shouId ndof fho monnIng fhnf
doos nof do so. JusfIco Sfory snId fhnf l80 yonrs ngo: o
courf oughf, unIoss fho forms of nn ncf rondorod If unn-
voIdnbIo, fo gIvo n consfrucfIon fo If whIch shouId InvoIvo
n vIoInfIon, howovor unInfonfIonnI, of fho consfIfufIon.
Poreone v. BeJforJ, 3 Iof. 433, 448449 (l830). JusfIco
HoImos mndo fho snmo oInf n confury Infor: |T]ho ruIo Is
soffIod fhnf ns bofwoon fwo ossIbIo InforrofnfIons of n
sfnfufo, by ono of whIch If wouId bo unconsfIfufIonnI nnd
by fho ofhor vnIId, our InIn dufy Is fo ndof fhnf whIch
wIII snvo fho Acf. BloJge// v. HolJen, 2?5 !. S. l42, l48
(l92?) (concurrIng oInIon).
Tho mosf sfrnIghfforwnrd rondIng of fho mnndnfo Is
fhnf If commnnds IndIvIdunIs fo urchnso Insurnnco.

I!SIISS t. SIII!I!S
Affor nII, If sfnfos fhnf IndIvIdunIs shnII mnInfnIn honIfh
Insurnnco. 26 !. S. C. 5000A(n). Congross fhoughf If
couId onncf such n commnnd undor fho Commorco CInuso,
nnd fho Covornmonf rImnrIIy dofondod fho Inw on fhnf
bnsIs. Iuf, for fho ronsons oxInInod nbovo, fho Com-
morco CInuso doos nof gIvo Congross fhnf owor. !ndor
our rocodonf, If Is fhoroforo nocossnry fo nsk whofhor fho
Covornmonf`s nIfornnfIvo rondIng of fho sfnfufofhnf If
onIy Imosos n fnx on fhoso wIfhouf InsurnncoIs n ron-
sonnbIo ono.
!ndor fho mnndnfo, If nn IndIvIdunI doos nof mnInfnIn
honIfh Insurnnco, fho onIy consoquonco Is fhnf ho musf
mnko nn nddIfIonnI nymonf fo fho I!S whon ho nys hIs
fnxos. Soo 5000A(b). Thnf, nccordIng fo fho Covornmonf,
monns fho mnndnfo cnn bo rognrdod ns osfnbIIshIng n
condIfIonnof ownIng honIfh Insurnncofhnf frIggors n
fnxfho roquIrod nymonf fo fho I!S. !ndor fhnf fhoory,
fho mnndnfo Is nof n IognI commnnd fo buy Insurnnco.
!nfhor, If mnkos goIng wIfhouf Insurnnco jusf nnofhor
fhIng fho Covornmonf fnxos, IIko buyIng gnsoIIno or onrn-
Ing Incomo. And If fho mnndnfo Is In offocf jusf n fnx hIko
on corfnIn fnxnyors who do nof hnvo honIfh Insurnnco, If
mny bo wIfhIn Congross`s consfIfufIonnI owor fo fnx.
Tho quosfIon Is nof whofhor fhnf Is fho mosf nnfurnI
InforrofnfIon of fho mnndnfo, buf onIy whofhor If Is n
fnIrIy ossIbIo ono. Crouell v. Beneon, 285 !. S. 22, 62
(l932). As wo hnvo oxInInod, ovory ronsonnbIo consfruc-
fIon musf bo rosorfod fo, In ordor fo snvo n sfnfufo from
unconsfIfufIonnIIfy. Hooper v. Colifornio, l55 !. S. 648,
65? (l895). Tho Covornmonf nsks us fo Inforrof fho
mnndnfo ns ImosIng n fnx, If If wouId ofhorwIso vIoInfo
fho ConsfIfufIon. CrnnfIng fho Acf fho fuII monsuro of
doforonco owod fo fodornI sfnfufos, If cnn bo so rond, for
fho ronsons sof forfh boIow.


33 CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
C
Tho oxncfIon fho AffordnbIo Cnro Acf Imosos on fhoso
wIfhouf honIfh Insurnnco Iooks IIko n fnx In mnny ro-
socfs. Tho |s]hnrod rosonsIbIIIfy nymonf, ns fho
sfnfufo onfIfIos If, Is nId Info fho Tronsury by fnx-
nyor|s] whon fhoy fIIo fhoIr fnx rofurns. 26 !. S. C.
5000A(b). If doos nof nIy fo IndIvIdunIs who do nof
ny fodornI Incomo fnxos bocnuso fhoIr housohoId Incomo
Is Ioss fhnn fho fIIIng fhroshoId In fho InfornnI !ovonuo
Codo. 5000A(o)(2). Ior fnxnyors who do owo fho ny-
monf, Ifs nmounf Is doformInod by such fnmIIInr fncfors ns
fnxnbIo Incomo, numbor of doondonfs, nnd joInf fIIIng
sfnfus. 5000A(b)(3), (c)(2), (c)(4). Tho roquIromonf fo
ny Is found In fho InfornnI !ovonuo Codo nnd onforcod by
fho I!S, whIchns wo rovIousIy oxInInodmusf nssoss
nnd coIIocf If In fho snmo mnnnor ns fnxos. Supro, nf
l3l4. ThIs rocoss yIoIds fho ossonfInI fonfuro of nny fnx:
If roducos nf Ionsf somo rovonuo for fho Covornmonf.
Ini/eJ S/o/ee v. Kolriger, 345 !. S. 22, 28, n. 4 (l953).
Indood, fho nymonf Is oxocfod fo rnIso nbouf $4 bIIIIon
or yonr by 20l?. CongrossIonnI Iudgof OffIco, Inymonfs
of IonnIfIos for IoIng !nInsurod !ndor fho InfIonf Iro-
focfIon nnd AffordnbIo Cnro Acf (Ar. 30, 20l0), In SoIocfod
CIO IubIIcnfIons !oInfod fo HonIfh Cnro !ogIsInfIon,
200920l0, . ?l (rov. 20l0).
If Is of courso fruo fhnf fho Acf doscrIbos fho nymonf ns
n onnIfy, nof n fnx. Iuf whIIo fhnf InboI Is fnfnI fo fho
nIIcnfIon of fho AnfI-InjuncfIon Acf, eupro, nf l2l3, If
doos nof doformIno whofhor fho nymonf mny bo vIowod
ns nn oxorcIso of Congross`s fnxIng owor. If Is u fo Con-
gross whofhor fo nIy fho AnfI-InjuncfIon Acf fo nny
nrfIcuInr sfnfufo, so If mnkos sonso fo bo guIdod by Con-
gross`s choIco of InboI on fhnf quosfIon. Thnf choIco doos
nof, howovor, confroI whofhor nn oxncfIon Is wIfhIn Con-
gross`s consfIfufIonnI owor fo fnx.
Our rocodonf rofIocfs fhIs: In l922, wo docIdod fwo


I!SIISS t. SIII!I!S
OInIon of fho Courf
chnIIongos fo fho ChIId !nbor Tnx on fho snmo dny. In
fho fIrsf, wo hoId fhnf n suIf fo onjoIn coIIocfIon of fho so-
cnIIod fnx wns bnrrod by fho AnfI-InjuncfIon Acf. George,
259 !. S., nf 20. Congross know fhnf suIfs fo obsfrucf
fnxos hnd fo nwnIf nymonf undor fho AnfI-InjuncfIon
Acf; Congross cnIIod fho chIId Inbor fnx n fnx; Congross
fhoroforo Infondod fho AnfI-InjuncfIon Acf fo nIy. In
fho socond cnso, howovor, wo hoId fhnf fho snmo oxncfIon,
nIfhough InboIod n fnx, wns nof In fncf nufhorIzod by Con-
gross`s fnxIng owor. Drexel Iurni/ure, 259 !. S., nf 38.
Thnf consfIfufIonnI quosfIon wns nof confroIIod by Con-
gross`s choIco of InboI.
Wo hnvo sImIInrIy hoId fhnf oxncfIons nof InboIod fnxos
nonofhoIoss woro nufhorIzod by Congross`s owor fo fnx.
In fho Licenee Tox Coeee, for oxnmIo, wo hoId fhnf fodornI
IIconsos fo soII IIquor nnd Ioffory fIckofsfor whIch fho
IIconsoo hnd fo ny n foocouId bo susfnInod ns oxorcIsos
of fho fnxIng owor. 5 WnII., nf 4?l. And In Aeu Yor/ v.
Ini/eJ S/o/ee wo uhoId ns n fnx n surchnrgo on ouf-of-
sfnfo nucIonr wnsfo shImonfs, n orfIon of whIch wns
nId fo fho IodornI Tronsury. 505 !. S., nf l?l. Wo fhus
nsk whofhor fho shnrod rosonsIbIIIfy nymonf fnIIs
wIfhIn Congross`s fnxIng owor, |d]IsrognrdIng fho dosIgnn-
fIon of fho oxncfIon, nnd vIowIng Ifs subsfnnco nnd nII-
cnfIon. Ini/eJ S/o/ee v. Cone/on/ine, 296 !. S. 28?, 294
(l935); cf. Quill Corp. v. Aor/l Do/o/o, 504 !. S. 298, 3l0
(l992) (|M]ngIc words or InboIs shouId nof dIsnbIo nn
ofhorwIso consfIfufIonnI Iovy (InfornnI quofnfIon mnrks
omIffod)); Aeleon v. Seore, IoeIuc/ & Co., 3l2 !. S. 359,
363 (l94l) (In nssIng on fho consfIfufIonnIIfy of n fnx
Inw, wo nro concornod onIy wIfh Ifs rncfIcnI oornfIon,
nof Ifs dofInIfIon or fho rocIso form of doscrIfIvo words
whIch mny bo nIIod fo If (InfornnI quofnfIon mnrks
omIffod)); Ini/eJ S/o/ee v. So/elo, 436 !. S. 268, 2?5
(l9?8) (Thnf fho funds duo nro roforrod fo ns n 'onnIfy`


35 CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
. . . doos nof nIfor fhoIr ossonfInI chnrncfor ns fnxos).
?
Our cnsos confIrm fhIs funcfIonnI nronch. Ior ox-
nmIo, In Drexel Iurni/ure, wo focusod on fhroo rncfIcnI
chnrncforIsfIcs of fho so-cnIIod fnx on omIoyIng chIId
Inborors fhnf convIncod us fho fnx wns ncfunIIy n on-
nIfy. IIrsf, fho fnx Imosod nn oxcoodIngIy honvy bur-
donl0 orconf of n comnny`s nof Incomoon fhoso who
omIoyod chIIdron, no mnffor how smnII fhoIr InfrncfIon.
Socond, If Imosod fhnf oxncfIon onIy on fhoso who know-
IngIy omIoyod undorngo Inborors. Such scIonfor roquIro-
monfs nro fyIcnI of unIfIvo sfnfufos, bocnuso Congross
offon wIshos fo unIsh onIy fhoso who InfonfIonnIIy bronk
fho Inw. ThIrd, fhIs fnx wns onforcod In nrf by fho
onrfmonf of !nbor, nn ngoncy rosonsIbIo for un-
IshIng vIoInfIons of Inbor Inws, nof coIIocfIng rovonuo. 259
!. S., nf 363?; soo nIso, e.g., Kur/l Ioncl, 5ll !. S., nf
?80?82 (consIdorIng, in/er olio, fho nmounf of fho oxnc-
fIon, nnd fho fncf fhnf If wns Imosod for vIoInfIon of n
sonrnfo crImInnI Inw); Cone/on/ine, eupro, nf 295 (snmo).
Tho snmo nnnIysIs horo suggosfs fhnf fho shnrod ro-
sonsIbIIIfy nymonf mny for consfIfufIonnI urosos bo
consIdorod n fnx, nof n onnIfy: IIrsf, for mosf AmorIcnns
fho nmounf duo wIII bo fnr Ioss fhnn fho rIco of Insur-
nnco, nnd, by sfnfufo, If cnn novor bo moro.
8
If mny offon

?
So/elo, In nrfIcuInr, wouId soom fo rofufo fho joInf dIssonf`s confon-
fIon fhnf wo hnvo novor fronfod nn oxncfIon ns n fnx If If wns donomI-
nnfod n onnIfy. Poe/, nf 20. Wo nro nof orsundod by fho dIssonf`s
nffomf fo dIsfInguIsh So/elo ns n sfnfufory consfrucfIon cnso from fho
bnnkrufcy confoxf. Poe/, nf l?, n. 5. Tho dIssonf IfsoIf fronfs fho
quosfIon horo ns ono of sfnfufory InforrofnfIon, nnd Indood nIso roIIos
on n sfnfufory InforrofnfIon cnso from fho bnnkrufcy confoxf. Poe/,
nf 23 (cIfIng Ini/eJ S/o/ee v. IeorgoniceJ CI&1 IoIrico/ore of I/ol,
1nc., 5l8 !. S. 2l3, 224 (l996)).
8
In 20l6, for oxnmIo, IndIvIdunIs mnkIng $35,000 n yonr nro ox-
ocfod fo owo fho I!S nbouf $60 for nny monfh In whIch fhoy do nof
hnvo honIfh Insurnnco. Somoono wIfh nn nnnunI Incomo of $l00,000 n
yonr wouId IIkoIy owo nbouf $200. Tho rIco of n qunIIfyIng Insurnnco


I!SIISS t. SIII!I!S
OInIon of fho Courf
bo n ronsonnbIo fInnncInI docIsIon fo mnko fho nymonf
rnfhor fhnn urchnso Insurnnco, unIIko fho rohIbIfory
fInnncInI unIshmonf In Drexel Iurni/ure. 259 !. S., nf
3?. Socond, fho IndIvIdunI mnndnfo confnIns no scIonfor
roquIromonf. ThIrd, fho nymonf Is coIIocfod soIoIy by fho
I!S fhrough fho normnI monns of fnxnfIonoxcof fhnf
fho SorvIco Is no/ nIIowod fo uso fhoso monns mosf suggos-
fIvo of n unIfIvo snncfIon, such ns crImInnI rosocufIon.
Soo 5000A(g)(2). Tho ronsons fho Courf In Drexel Iurni-
/ure hoId fhnf whnf wns cnIIod n fnx fhoro wns n onnIfy
suorf fho concIusIon fhnf whnf Is cnIIod n onnIfy horo
mny bo vIowod ns n fnx.
9
ono of fhIs Is fo sny fhnf fho nymonf Is nof Infondod
fo nffocf IndIvIdunI conducf. AIfhough fho nymonf wIII
rnIso consIdornbIo rovonuo, If Is InInIy dosIgnod fo ox-
nnd honIfh Insurnnco covorngo. Iuf fnxos fhnf sook fo
InfIuonco conducf nro nofhIng now. Somo of our onrIIosf
fodornI fnxos soughf fo dofor fho urchnso of Imorfod
mnnufncfurod goods In ordor fo fosfor fho growfh of do-
mosfIc Indusfry. Soo W. IrownIoo, IodornI TnxnfIon In
AmorIcn 22 (2d od. 2004); cf. 2 J. Sfory, CommonfnrIos on
fho ConsfIfufIon of fho !nIfod Sfnfos 962, . 434 (l833)
(fho fnxIng owor Is offon, vory offon, nIIod for ofhor
urosos, fhnn rovonuo). Todny, fodornI nnd sfnfo fnxos
cnn comoso moro fhnn hnIf fho rofnII rIco of cIgnroffos,

oIIcy Is rojocfod fo bo nround $400 or monfh. Soo . owmnn, C!S
!oorf for Congross, IndIvIdunI Mnndnfo nnd !oInfod InformnfIon !o-
quIromonfs !ndor IIACA ?, nnd n. 25 (20ll).
9
Wo do nof suggosf fhnf nny oxncfIon InckIng n scIonfor roquIromonf
nnd onforcod by fho I!S Is wIfhIn fho fnxIng owor. Soo poe/, nf 2324
(joInf oInIon of SCA!IA, KIIY, THOMAS, nnd A!ITO, JJ., dIssonfIng).
Congross couId nof, for oxnmIo, oxnnd Ifs nufhorIfy fo Imoso crImI-
nnI fInos by cronfIng sfrIcf IInbIIIfy offonsos onforcod by fho I!S rnfhor
fhnn fho III. Iuf fho fncf fho oxncfIon horo Is nId IIko n fnx, fo fho
ngoncy fhnf coIIocfs fnxosrnfhor fhnn, for oxnmIo, oxncfod by o-
nrfmonf of !nbor Insocfors nffor forrofIng ouf wIIIfuI mnIfonsnnco
suggosfs fhnf fhIs oxncfIon mny bo vIowod ns n fnx.


3? CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
nof jusf fo rnIso moro monoy, buf fo oncourngo ooIo fo
quIf smokIng. And wo hnvo uhoId such obvIousIy roguIn-
fory monsuros ns fnxos on soIIIng mnrIjunnn nnd snwod-off
shofguns. Soo Ini/eJ S/o/ee v. Sonclec, 340 !. S. 42, 44
45 (l950); Soncine/, v. Ini/eJ S/o/ee, 300 !. S. 506, 5l3
(l93?). Indood, |o]vory fnx Is In somo monsuro roguIn-
fory. To somo oxfonf If Inforosos nn oconomIc ImodImonf
fo fho ncfIvIfy fnxod ns comnrod wIfh ofhors nof fnxod.
Soncine/,, eupro, nf 5l3. Thnf 5000A sooks fo shno
docIsIons nbouf whofhor fo buy honIfh Insurnnco doos nof
monn fhnf If cnnnof bo n vnIId oxorcIso of fho fnxIng
owor.
In dIsfInguIshIng onnIfIos from fnxos, fhIs Courf hns
oxInInod fhnf If fho concof of onnIfy monns nnyfhIng,
If monns unIshmonf for nn unInwfuI ncf or omIssIon.
Ini/eJ S/o/ee v. IeorgoniceJ CI&1 IoIrico/ore of I/ol,
1nc., 5l8 !. S. 2l3, 224 (l996); soo nIso Ini/eJ S/o/ee v. Lo
Ironco, 282 !. S. 568, 5?2 (l93l) (|A] onnIfy, ns fho
word Is horo usod, Is nn oxncfIon Imosod by sfnfufo ns
unIshmonf for nn unInwfuI ncf). WhIIo fho IndIvIdunI
mnndnfo cIonrIy nIms fo Induco fho urchnso of honIfh
Insurnnco, If nood nof bo rond fo docInro fhnf fnIIIng fo do
so Is unInwfuI. oIfhor fho Acf nor nny ofhor Inw nffnchos
nognfIvo IognI consoquoncos fo nof buyIng honIfh Insur-
nnco, boyond roquIrIng n nymonf fo fho I!S. Tho Cov-
ornmonf ngroos wIfh fhnf rondIng, confIrmIng fhnf If
somoono choosos fo ny rnfhor fhnn obfnIn honIfh Insur-
nnco, fhoy hnvo fuIIy comIIod wIfh fho Inw. IrIof for
!nIfod Sfnfos 606l; Tr. of OrnI Arg. 4950 (Mnr. 26,
20l2).
Indood, If Is osfImnfod fhnf four mIIIIon ooIo onch yonr
wIII chooso fo ny fho I!S rnfhor fhnn buy Insurnnco. Soo
CongrossIonnI Iudgof OffIco, eupro, nf ?l. Wo wouId
oxocf Congross fo bo froubIod by fhnf rosocf If such
conducf woro unInwfuI. Thnf Congross nnronfIy rognrds
such oxfonsIvo fnIIuro fo comIy wIfh fho mnndnfo ns


I!SIISS t. SIII!I!S
OInIon of fho Courf
foIornbIo suggosfs fhnf Congross dId nof fhInk If wns
cronfIng four mIIIIon oufInws. If suggosfs Insfond fhnf fho
shnrod rosonsIbIIIfy nymonf moroIy Imosos n fnx cIfI-
zons mny InwfuIIy chooso fo ny In IIou of buyIng honIfh
Insurnnco.
Tho InInfIffs confond fhnf Congross`s choIco of Inn-
gungosfnfIng fhnf IndIvIdunIs shnII obfnIn Insurnnco
or ny n onnIfyroquIros rondIng 5000A ns unIshIng
unInwfuI conducf, ovon If fhnf InforrofnfIon wouId ron-
dor fho Inw unconsfIfufIonnI. Wo hnvo rojocfod n sImIInr
nrgumonf boforo. In Aeu Yor/ v. Ini/eJ S/o/ee wo oxnm-
Inod n sfnfufo rovIdIng fhnf '|o]nch Sfnfo shnII bo ro-
sonsIbIo for rovIdIng . . . for fho dIsosnI of . . . Iow-IovoI
rndIoncfIvo wnsfo.` 505 !. S., nf l69 (quofIng 42 !. S. C.
202lc(n)(l)(A)). A Sfnfo fhnf shIod Ifs wnsfo fo nnofhor
Sfnfo wns oxosod fo surchnrgos by fho rocoIvIng Sfnfo,
n orfIon of whIch wouId bo nId ovor fo fho IodornI
Covornmonf. And n Sfnfo fhnf dId nof ndhoro fo fho
sfnfufory schomo fncod |]onnIfIos for fnIIuro fo comIy,
IncIudIng Incronsos In fho surchnrgo. 202lo(o)(2); Aeu
Yor/, 505 !. S., nf l52l53. ow York urgod us fo rond
fho sfnfufo ns n fodornI commnnd fhnf fho sfnfo IogIsIn-
furo onncf IogIsInfIon fo dIsoso of Ifs wnsfo, whIch wouId
hnvo vIoInfod fho ConsfIfufIon. To nvoId fhnf oufcomo, wo
Inforrofod fho sfnfufo fo Imoso onIy n sorIos of Incon-
fIvos for fho Sfnfo fo fnko rosonsIbIIIfy for Ifs wnsfo. Wo
fhon susfnInod fho chnrgo nId fo fho IodornI Covornmonf
ns nn oxorcIso of fho fnxIng owor. 1J., nf l69l?4. Wo
soo no InsurmounfnbIo obsfncIo fo n sImIInr nronch
horo.
l0

l0
Tho joInf dIssonf nffomfs fo dIsfInguIsh Aeu Yor/ v. Ini/eJ S/o/ee
on fho ground fhnf fho soomIngIy ImornfIvo Inngungo In fhnf cnso wns
In nn Infroducfory rovIsIon fhnf hnd no IognI consoquoncos. Poe/,
nf l9. Wo dId nof roIy on fhnf ronsonIng In Aeu Yor/. Soo 505 !. S., nf
l69l?0. or couId wo hnvo. WhIIo fho Courf quofod onIy fho brond
sfnfomonf fhnf |o]nch Sfnfo shnII bo rosonsIbIo for Ifs wnsfo, fhnf


39 CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
Tho joInf dIssonfors nrguo fhnf wo cnnnof uhoId
5000A ns n fnx bocnuso Congross dId nof frnmo If ns
such. Poe/, nf l?. In offocf, fhoy confond fhnf ovon If
fho ConsfIfufIon ormIfs Congross fo do oxncfIy whnf wo
Inforrof fhIs sfnfufo fo do, fho Inw musf bo sfruck down
bocnuso Congross usod fho wrong InboIs. An oxnmIo mny
hoI IIIusfrnfo why InboIs shouId nof confroI horo. Su-
oso Congross onncfod n sfnfufo rovIdIng fhnf ovory
fnxnyor who owns n houso wIfhouf onorgy offIcIonf wIn-
dows musf ny $50 fo fho I!S. Tho nmounf duo Is ndjusfod
bnsod on fncfors such ns fnxnbIo Incomo nnd joInf fIIIng
sfnfus, nnd Is nId nIong wIfh fho fnxnyor`s Incomo fnx
rofurn. Thoso whoso Incomo Is boIow fho fIIIng fhroshoId
nood nof ny. Tho roquIrod nymonf Is nof cnIIod n fnx,
n onnIfy, or nnyfhIng oIso. o ono wouId doubf fhnf
fhIs Inw Imosod n fnx, nnd wns wIfhIn Congross`s owor
fo fnx. Thnf concIusIon shouId nof chnngo sImIy bocnuso
Congross usod fho word onnIfy fo doscrIbo fho ny-
monf. InforrofIng such n Inw fo bo n fnx wouId hnrdIy
|I]mos|o] n fnx fhrough judIcInI IogIsInfIon. Poe/, nf 25.
!nfhor, If wouId gIvo rncfIcnI offocf fo fho !ogIsInfuro`s
onncfmonf.
Our rocodonf domonsfrnfos fhnf Congross hnd fho
owor fo Imoso fho oxncfIon In 5000A undor fho fnxIng
owor, nnd fhnf 5000A nood nof bo rond fo do moro fhnn
Imoso n fnx. Thnf Is suffIcIonf fo susfnIn If. Tho quos-
fIon of fho consfIfufIonnIIfy of ncfIon fnkon by Congross
doos nof doond on rocIfnIs of fho owor whIch If undor-
fnkos fo oxorcIso. WooJe v. Clo,J W. Miller Co., 333 !. S.

Inngungo wns ImIomonfod fhrough oornfIvo rovIsIons fhnf nIso uso
fho words on whIch fho dIssonf roIIos. Soo 42 !. S. C. 202lo(o)(l)
(onfIfIod !oquIromonfs for non-sIfod comncf rogIons nnd non-mombor
Sfnfos nnd dIrocfIng fhnf fhoso onfIfIos shnII comIy wIfh fho foIIow-
Ing roquIromonfs); 202lo(o)(2) (doscrIbIng IonnIfIos for fnIIuro fo
comIy). Tho Courf uhoId fhoso rovIsIons nof ns InwfuI commnnds,
buf ns InconfIvos. Soo 505 !. S., nf l52l53, l?ll?3.


I!SIISS t. SIII!I!S
OInIon of fho Courf
l38, l44 (l948).
Ivon If fho fnxIng owor onnbIos Congross fo Imoso
n fnx on nof obfnInIng honIfh Insurnnco, nny fnx musf
sfIII comIy wIfh ofhor roquIromonfs In fho ConsfIfufIon.
IInInfIffs nrguo fhnf fho shnrod rosonsIbIIIfy nymonf
doos nof do so, cIfIng ArfIcIo I, 9, cInuso 4. Thnf cInuso
rovIdos: o CnIfnfIon, or ofhor dIrocf, Tnx shnII bo InId,
unIoss In IroorfIon fo fho Consus or InumornfIon horoIn
boforo dIrocfod fo bo fnkon. ThIs roquIromonf monns fhnf
nny dIrocf Tnx musf bo norfIonod so fhnf onch Sfnfo
nys In roorfIon fo Ifs ouInfIon. AccordIng fo fho
InInfIffs, If fho IndIvIdunI mnndnfo Imosos n fnx, If Is n
dIrocf fnx, nnd If Is unconsfIfufIonnI bocnuso Congross
mndo no offorf fo norfIon If nmong fho Sfnfos.
Ivon whon fho Irocf Tnx CInuso wns wrIffon If wns
uncIonr whnf oIso, ofhor fhnn n cnIfnfIon (nIso known ns
n hond fnx or n oII fnx), mIghf bo n dIrocf fnx. Soo
Springer v. Ini/eJ S/o/ee, l02 !. S. 586, 596598 (l88l).
Soon nffor fho frnmIng, Congross nssod n fnx on ownor-
shI of cnrrIngos, ovor Jnmos MndIson`s objocfIon fhnf If
wns nn unnorfIonod dIrocf fnx. 1J., nf 59?. ThIs Courf
uhoId fho fnx, In nrf ronsonIng fhnf norfIonIng such
n fnx wouId mnko IIffIo sonso, bocnuso If wouId hnvo ro-
quIrod fnxIng cnrrIngo ownors nf drnmnfIcnIIy dIfforonf
rnfos doondIng on how mnny cnrrIngos woro In fhoIr
homo Sfnfo. Soo H,l/on v. Ini/eJ S/o/ee, 3 nII. l?l, l?4
(l?96) (oInIon of Chnso, J.). Tho Courf wns unnnImous,
nnd fhoso JusfIcos who wrofo oInIons oIfhor dIrocfIy
nssorfod or sfrongIy suggosfod fhnf onIy fwo forms of
fnxnfIon woro dIrocf: cnIfnfIons nnd Innd fnxos. Soo iJ.,
nf l?5; iJ., nf l?? (oInIon of Inforson, J.); iJ., nf l83
(oInIon of IrodoII, J.).
Thnf nnrrow vIow of whnf n dIrocf fnx mIghf bo or-
sIsfod for n confury. In l880, for oxnmIo, wo oxInInod fhnf
Jirec/ /oxee, wIfhIn fho monnIng of fho ConsfIfufIon, nro
onIy cnIfnfIon fnxos, ns oxrossod In fhnf Insfrumonf,


4l CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
nnd fnxos on ronI osfnfo. Springer, eupro, nf 602. In
l895, wo oxnndod our InforrofnfIon fo IncIudo fnxos on
orsonnI roorfy nnd Incomo from orsonnI roorfy, In
fho courso of sfrIkIng down nsocfs of fho fodornI Incomo
fnx. Polloc/ v. Iornere` Loon & True/ Co., l58 !. S. 60l,
6l8 (l895). Thnf rosuIf wns ovorfurnod by fho SIxfoonfh
Amondmonf, nIfhough wo confInuod fo consIdor fnxos on
orsonnI roorfy fo bo dIrocf fnxos. Soo 1iener v. Mocon-
Ier, 252 !. S. l89, 2l82l9 (l920).
A fnx on goIng wIfhouf honIfh Insurnnco doos nof fnII
wIfhIn nny rocognIzod cnfogory of dIrocf fnx. If Is nof n
cnIfnfIon. CnIfnfIons nro fnxos nId by ovory orson,
wIfhouf rognrd fo roorfy, rofossIon, or on, o/ler cir-
cune/once. H,l/on, eupro, nf l?5 (oInIon of Chnso, J.)
(omhnsIs nIforod). Tho whoIo oInf of fho shnrod roson-
sIbIIIfy nymonf Is fhnf If Is frIggorod by socIfIc cIr-
cumsfnncosonrnIng n corfnIn nmounf of Incomo buf nof
obfnInIng honIfh Insurnnco. Tho nymonf Is nIso InInIy
nof n fnx on fho ownorshI of Innd or orsonnI roorfy.
Tho shnrod rosonsIbIIIfy nymonf Is fhus nof n dIrocf fnx
fhnf musf bo norfIonod nmong fho sovornI Sfnfos.
Thoro mny, howovor, bo n moro fundnmonfnI objocfIon
fo n fnx on fhoso who Inck honIfh Insurnnco. Ivon If onIy
n fnx, fho nymonf undor 5000A(b) romnIns n burdon
fhnf fho IodornI Covornmonf Imosos for nn omIssIon, nof
nn ncf. If If Is froubIIng fo Inforrof fho Commorco CInuso
ns nufhorIzIng Congross fo roguInfo fhoso who nbsfnIn
from commorco, orhns If shouId bo sImIInrIy froubIIng fo
ormIf Congross fo Imoso n fnx for nof doIng somofhIng.
Throo consIdornfIons nIIny fhIs concorn. IIrsf, nnd mosf
ImorfnnfIy, If Is nbundnnfIy cIonr fho ConsfIfufIon doos
nof gunrnnfoo fhnf IndIvIdunIs mny nvoId fnxnfIon fhrough
InncfIvIfy. A cnIfnfIon, nffor nII, Is n fnx fhnf ovory-
ono musf ny sImIy for oxIsfIng, nnd cnIfnfIons nro
oxrossIy confomInfod by fho ConsfIfufIon. Tho Courf
fodny hoIds fhnf our ConsfIfufIon rofocfs us from fodornI


I!SIISS t. SIII!I!S
OInIon of fho Courf
roguInfIon undor fho Commorco CInuso so Iong ns wo nb-
sfnIn from fho roguInfod ncfIvIfy. Iuf from Ifs cronfIon,
fho ConsfIfufIon hns mndo no such romIso wIfh rosocf fo
fnxos. Soo !offor from IonjnmIn IrnnkIIn fo M. !o !oy
(ov. l3, l?89) (Our now ConsfIfufIon Is now osfnbIIshod
. . . buf In fhIs worId nofhIng cnn bo snId fo bo corfnIn,
oxcof donfh nnd fnxos).
Whofhor fho mnndnfo cnn bo uhoId undor fho Com-
morco CInuso Is n quosfIon nbouf fho scoo of fodornI
nufhorIfy. Ifs nnswor doonds on whofhor Congross cnn
oxorcIso whnf nII ncknowIodgo fo bo fho novoI courso of
dIrocfIng IndIvIdunIs fo urchnso Insurnnco. Congross`s
uso of fho TnxIng CInuso fo oncourngo buyIng somofhIng
Is, by confrnsf, nof now. Tnx InconfIvos nIrondy romofo,
for oxnmIo, urchnsIng homos nnd rofossIonnI oducn-
fIons. Soo 26 !. S. C. l63(h), 25A. SusfnInIng fho
mnndnfo ns n fnx doonds onIy on whofhor Congross loe
roorIy oxorcIsod Ifs fnxIng owor fo oncourngo urchns-
Ing honIfh Insurnnco, nof whofhor If con. !hoIdIng fho
IndIvIdunI mnndnfo undor fho TnxIng CInuso fhus doos
nof rocognIzo nny now fodornI owor. If doformInos fhnf
Congross hns usod nn oxIsfIng ono.
Socond, Congross`s nbIIIfy fo uso Ifs fnxIng owor fo
InfIuonco conducf Is nof wIfhouf IImIfs. A fow of our cnsos
oIIcod fhoso IImIfs nggrossIvoIy, InvnIIdnfIng unIfIvo
oxncfIons obvIousIy dosIgnod fo roguInfo bohnvIor ofhor-
wIso rognrdod nf fho fImo ns boyond fodornI nufhorIfy.
Soo, e.g., Ini/eJ S/o/ee v. Bu/ler, 29? !. S. l (l936); Drexel
Iurni/ure, 259 !. S. 20. Moro offon nnd moro roconfIy
wo hnvo docIInod fo cIosoIy oxnmIno fho roguInfory mofIvo
or offocf of rovonuo-rnIsIng monsuros. Soo Kolriger, 345
!. S., nf 2?3l (coIIocfIng cnsos). Wo hnvo nonofhoIoss
mnInfnInod fhnf 'fhoro comos n fImo In fho oxfonsIon of
fho onnIIzIng fonfuros of fho so-cnIIod fnx whon If Iosos
Ifs chnrncfor ns such nnd bocomos n moro onnIfy wIfh fho
chnrncforIsfIcs of roguInfIon nnd unIshmonf.` Kur/l


43 CIfo ns: 56? !. S. ____ (20l2)
OInIon of fho Courf
Ioncl, 5ll !. S., nf ??9 (quofIng Drexel Iurni/ure, eupro,
nf 38).
Wo hnvo nIrondy oxInInod fhnf fho shnrod rosonsIbII-
Ify nymonf`s rncfIcnI chnrncforIsfIcs nss musfor ns n
fnx undor our nnrrowosf InforrofnfIons of fho fnxIng
owor. Supro, nf 3536. Iocnuso fho fnx nf hnnd Is
wIfhIn ovon fhoso sfrIcf IImIfs, wo nood nof horo docIdo fho
rocIso oInf nf whIch nn oxncfIon bocomos so unIfIvo
fhnf fho fnxIng owor doos nof nufhorIzo If. If romnIns
fruo, howovor, fhnf fho 'owor fo fnx Is nof fho owor fo
dosfroy whIIo fhIs Courf sIfs.` O/lolono Tox Conn`n v.
Texoe Co., 336 !. S. 342, 364 (l949) (quofIng PonlonJle
Oil Co. v. Mieeieeippi ex rel. Knox, 2?? !. S. 2l8, 223
(l928) (HoImos, J., dIssonfIng)).
ThIrd, nIfhough fho brondfh of Congross`s owor fo fnx
Is gronfor fhnn Ifs owor fo roguInfo commorco, fho fnxIng
owor doos nof gIvo Congross fho snmo dogroo of confroI
ovor IndIvIdunI bohnvIor. Onco wo rocognIzo fhnf Con-
gross mny roguInfo n nrfIcuInr docIsIon undor fho Com-
morco CInuso, fho IodornI Covornmonf cnn brIng Ifs fuII
woIghf fo bonr. Congross mny sImIy commnnd IndIvId-
unIs fo do ns If dIrocfs. An IndIvIdunI who dIsoboys mny
bo subjocfod fo crImInnI snncfIons. Thoso snncfIons cnn
IncIudo nof onIy fInos nnd ImrIsonmonf, buf nII fho nf-
fondnnf consoquoncos of boIng brnndod n crImInnI: dorI-
vnfIon of ofhorwIso rofocfod cIvII rIghfs, such ns fho rIghf
fo bonr nrms or vofo In oIocfIons; Ioss of omIoymonf o-
orfunIfIos; socInI sfIgmn; nnd sovoro dIsnbIIIfIos In ofhor
confrovorsIos, such ns cusfody or ImmIgrnfIon dIsufos.
Iy confrnsf, Congross`s nufhorIfy undor fho fnxIng
owor Is IImIfod fo roquIrIng nn IndIvIdunI fo ny monoy
Info fho IodornI Tronsury, no moro. If n fnx Is roorIy
nId, fho Covornmonf hns no owor fo comoI or unIsh
IndIvIdunIs subjocf fo If. Wo do nof mnko IIghf of fho so-
voro burdon fhnf fnxnfIonosocInIIy fnxnfIon mofIvnfod
by n roguInfory urosocnn Imoso. Iuf ImosIfIon

I!SIISS t. SIII!I!S
of n fnx nonofhoIoss Ionvos nn IndIvIdunI wIfh n InwfuI
choIco fo do or nof do n corfnIn ncf, so Iong ns ho Is wIIIIng
fo ny n fnx IovIod on fhnf choIco.
ll
Tho AffordnbIo Cnro Acf`s roquIromonf fhnf corfnIn In-
dIvIdunIs ny n fInnncInI onnIfy for nof obfnInIng honIfh
Insurnnco mny ronsonnbIy bo chnrncforIzod ns n fnx. Io-
cnuso fho ConsfIfufIon ormIfs such n fnx, If Is nof our roIo
fo forbId If, or fo nss uon Ifs wIsdom or fnIrnoss.

J!STICI CISI!!C quosfIons fho nocossIfy of rojocfIng
fho Covornmonf`s commorco owor nrgumonf, gIvon fhnf
5000A cnn bo uhoId undor fho fnxIng owor. Poe/, nf 3?.
Iuf fho sfnfufo ronds moro nnfurnIIy ns n commnnd fo buy
Insurnnco fhnn ns n fnx, nnd I wouId uhoId If ns n com-
mnnd If fho ConsfIfufIon nIIowod If. If Is onIy bocnuso fho
Commorco CInuso doos nof nufhorIzo such n commnnd
fhnf If Is nocossnry fo ronch fho fnxIng owor quosfIon.
And If Is onIy bocnuso wo hnvo n dufy fo consfruo n sfnf-
ufo fo snvo If, If fnIrIy ossIbIo, fhnf 5000A cnn bo Infor-
rofod ns n fnx. WIfhouf docIdIng fho Commorco CInuso
quosfIon, I wouId fInd no bnsIs fo ndof such n snvIng
consfrucfIon.
Tho IodornI Covornmonf doos nof hnvo fho owor fo
ordor ooIo fo buy honIfh Insurnnco. SocfIon 5000A
wouId fhoroforo bo unconsfIfufIonnI If rond ns n commnnd.
Tho IodornI Covornmonf doos hnvo fho owor fo Imoso n
fnx on fhoso wIfhouf honIfh Insurnnco. SocfIon 5000A Is

ll
Of courso, IndIvIdunIs do nof hnvo n InwfuI choIco nof fo ny n fnx
duo, nnd mny somofImos fnco rosocufIon for fnIIIng fo do so (nIfhough
nof for docIInIng fo mnko fho shnrod rosonsIbIIIfy nymonf, soo 26
!. S. C. 5000A(g)(2)). Iuf fhnf doos nof show fhnf fho fnx rosfrIcfs fho
InwfuI choIco whofhor fo undorfnko or forgo fho ncfIvIfy on whIch fho fnx
Is rodIcnfod. Thoso subjocf fo fho IndIvIdunI mnndnfo mny InwfuIIy
forgo honIfh Insurnnco nnd ny hIghor fnxos, or buy honIfh Insurnnco
nnd ny Iowor fnxos. Tho onIy fhIng fhoy mny nof InwfuIIy do Is nof
buy honIfh Insurnnco nnd nof ny fho rosuIfIng fnx.

45 CIfo ns: 56? !. S. ____ (20l2)
fhoroforo consfIfufIonnI, bocnuso If cnn ronsonnbIy bo rond
ns n fnx.
IV
A
Tho Sfnfos nIso confond fhnf fho ModIcnId oxnnsIon
oxcoods Congross`s nufhorIfy undor fho SondIng CInuso.
Thoy cInIm fhnf Congross Is coorcIng fho Sfnfos fo ndof
fho chnngos If wnnfs by fhronfonIng fo wIfhhoId nII of n
Sfnfo`s ModIcnId grnnfs, unIoss fho Sfnfo nccofs fho now
oxnndod fundIng nnd comIIos wIfh fho condIfIons fhnf
como wIfh If. ThIs, fhoy nrguo, vIoInfos fho bnsIc rIncIIo
fhnf fho IodornI Covornmonf mny nof comoI fho Sfnfos
fo onncf or ndmInIsfor n fodornI roguInfory rogrnm. Aeu
Yor/, 505 !. S., nf l88.
Thoro Is no doubf fhnf fho Acf drnmnfIcnIIy Incronsos
sfnfo obIIgnfIons undor ModIcnId. Tho curronf ModIcnId
rogrnm roquIros Sfnfos fo covor onIy corfnIn dIscrofo
cnfogorIos of noody IndIvIdunIsrognnnf womon, chII-
dron, noody fnmIIIos, fho bIInd, fho oIdorIy, nnd fho dIs-
nbIod. 42 !. S. C. l396n(n)(l0). Thoro Is no mnndnfory
covorngo for mosf chIIdIoss nduIfs, nnd fho Sfnfos fyIcnIIy
do nof offor nny such covorngo. Tho Sfnfos nIso onjoy
consIdornbIo fIoxIbIIIfy wIfh rosocf fo fho covorngo IovoIs
for nronfs of noody fnmIIIos. l396n(n)(l0)(A)(II). On
nvorngo Sfnfos covor onIy fhoso unomIoyod nronfs who
mnko Ioss fhnn 3? orconf of fho fodornI ovorfy IovoI, nnd
onIy fhoso omIoyod nronfs who mnko Ioss fhnn 63 or-
conf of fho ovorfy IIno. KnIsor Comm`n on ModIcnId nnd
fho !nInsurod, IorformIng !ndor Irossuro ll, nnd fIg. ll
(20l2).
Tho ModIcnId rovIsIons of fho AffordnbIo Cnro Acf, In
confrnsf, roquIro Sfnfos fo oxnnd fhoIr ModIcnId ro-
grnms by 20l4 fo covor oll IndIvIdunIs undor fho ngo of 65
wIfh Incomos boIow l33 orconf of fho fodornI ovorfy IIno.
l396n(n)(l0)(A)(I)(VIII). Tho Acf nIso osfnbIIshos n now

I!SIISS t. SIII!I!S
|o]ssonfInI honIfh bonofIfs nckngo, whIch Sfnfos musf
rovIdo fo nII now ModIcnId rocIIonfsn IovoI suffIcIonf
fo snfIsfy n rocIIonf`s obIIgnfIons undor fho IndIvIdunI mnn-
dnfo. l396n(k)(l), l396u?(b)(5), l8022(b). Tho Af-
fordnbIo Cnro Acf rovIdos fhnf fho IodornI Covornmonf
wIII ny l00 orconf of fho cosfs of covorIng fhoso nowIy
oIIgIbIo IndIvIdunIs fhrough 20l6. l396d(y)(l). In fho
foIIowIng yonrs, fho fodornI nymonf IovoI grndunIIy do-
cronsos, fo n mInImum of 90 orconf. 1IiJ. In IIghf of
fho oxnnsIon In covorngo mnndnfod by fho Acf, fho IodornI
Covornmonf osfImnfos fhnf Ifs ModIcnId sondIng wIII In-
cronso by nroxImnfoIy $l00 bIIIIon or yonr, nonrIy 40
orconf nbovo curronf IovoIs. Sfnfomonf of ougIns W.
IImondorf, CIO`s AnnIysIs of fho Mnjor HonIfh Cnro
!ogIsInfIon Inncfod In Mnrch 20l0, . l4, TnbIo 2 (Mnr.
30, 20ll).
Tho SondIng CInuso grnnfs Congross fho owor fo ny
fho obfs nnd rovIdo for fho . . . gonornI WoIfnro of fho
!nIfod Sfnfos. !. S. Consf., Arf. I, 8, cI. l. Wo hnvo
Iong rocognIzod fhnf Congross mny uso fhIs owor fo grnnf
fodornI funds fo fho Sfnfos, nnd mny condIfIon such n
grnnf uon fho Sfnfos` fnkIng corfnIn ncfIons fhnf Con-
gross couId nof roquIro fhom fo fnko. College Sotinge Bon/,
52? !. S., nf 686. Such monsuros oncourngo n Sfnfo
fo roguInfo In n nrfIcuInr wny, |nnd] InfIuonc|o] n Sfnfo`s
oIIcy choIcos. Aeu Yor/, eupro, nf l66. Tho con-
dIfIons Imosod by Congross onsuro fhnf fho funds nro
usod by fho Sfnfos fo rovIdo for fho . . . gonornI WoIfnro
In fho mnnnor Congross Infondod.
Af fho snmo fImo, our cnsos hnvo rocognIzod IImIfs on
Congross`s owor undor fho SondIng CInuso fo socuro
sfnfo comIInnco wIfh fodornI objocfIvos. Wo hnvo ro-
onfodIy chnrncforIzod . . . SondIng CInuso IogIsInfIon ns
'much In fho nnfuro of n con/roc/.` Bornee v. Gornon,
536 !. S. l8l, l86 (2002) (quofIng Pennlure/ S/o/e Sclool
onJ Hoepi/ol v. HolJernon, 45l !. S. l, l? (l98l)). Tho

4? CIfo ns: 56? !. S. ____ (20l2)
IogIfImncy of Congross`s oxorcIso of fho sondIng owor
fhus rosfs on whofhor fho Sfnfo voIunfnrIIy nnd knowIngIy
nccofs fho forms of fho 'confrncf.` Pennlure/, eupro,
nf l?. !osocfIng fhIs IImIfnfIon Is crIfIcnI fo onsurIng
fhnf SondIng CInuso IogIsInfIon doos nof undormIno fho
sfnfus of fho Sfnfos ns Indoondonf sovoroIgns In our fod-
ornI sysfom. Thnf sysfom rosfs on whnf mIghf nf fIrsf
soom n counforInfuIfIvo InsIghf, fhnf 'froodom Is onhnncod
by fho cronfIon of fwo govornmonfs, nof ono.` BonJ, 564
!. S., nf ___ (sII o., nf 8) (quofIng AlJen v. Moine, 52?
!. S. ?06, ?58 (l999)). Ior fhIs ronson, fho ConsfIfufIon
hns novor boon undorsfood fo confor uon Congross fho
nbIIIfy fo roquIro fho Sfnfos fo govorn nccordIng fo Con-
gross` InsfrucfIons. Aeu Yor/, eupro, nf l62. OfhorwIso
fho fwo-govornmonf sysfom osfnbIIshod by fho Irnmors
wouId gIvo wny fo n sysfom fhnf vosfs owor In ono confrnI
govornmonf, nnd IndIvIdunI IIborfy wouId suffor.
Thnf InsIghf hns Iod fhIs Courf fo sfrIko down fod-
ornI IogIsInfIon fhnf commnndoors n Sfnfo`s IogIsInfIvo or
ndmInIsfrnfIvo nnrnfus for fodornI urosos. Soo, e.g.,
Prin/c, 52l !. S., nf 933 (sfrIkIng down fodornI IogIsIn-
fIon comoIIIng sfnfo Inw onforcomonf offIcors fo orform
fodornIIy mnndnfod bnckground chocks on hnndgun ur-
chnsors); Aeu Yor/, eupro, nf l?4l?5 (InvnIIdnfIng rovI-
sIons of nn Acf fhnf wouId comoI n Sfnfo fo oIfhor fnko
fIfIo fo nucIonr wnsfo or onncf nrfIcuInr sfnfo wnsfo
roguInfIons). If hns nIso Iod us fo scrufInIzo SondIng
CInuso IogIsInfIon fo onsuro fhnf Congross Is nof usIng
fInnncInI Inducomonfs fo oxorf n owor nkIn fo unduo
InfIuonco. S/euorJ Mocline Co. v. Dotie, 30l !. S. 548,
590 (l93?). Congross mny uso Ifs sondIng owor fo cro-
nfo InconfIvos for Sfnfos fo ncf In nccordnnco wIfh fodornI
oIIcIos. Iuf whon rossuro furns Info comuIsIon, iIiJ.,
fho IogIsInfIon runs confrnry fo our sysfom of fodornIIsm.
|T]ho ConsfIfufIon sImIy doos nof gIvo Congross fho
nufhorIfy fo roquIro fho Sfnfos fo roguInfo. Aeu Yor/,

I!SIISS t. SIII!I!S
505 !. S., nf l?8. Thnf Is fruo whofhor Congross dIrocfIy
commnnds n Sfnfo fo roguInfo or IndIrocfIy coorcos n Sfnfo
fo ndof n fodornI roguInfory sysfom ns Ifs own.
IormIffIng fho IodornI Covornmonf fo forco fho Sfnfos
fo ImIomonf n fodornI rogrnm wouId fhronfon fho oIIfI-
cnI nccounfnbIIIfy koy fo our fodornI sysfom. |W]horo fho
IodornI Covornmonf dIrocfs fho Sfnfos fo roguInfo, If mny
bo sfnfo offIcInIs who wIII bonr fho brunf of ubIIc dIsn-
rovnI, whIIo fho fodornI offIcInIs who dovIsod fho rogu-
Infory rogrnm mny romnIn InsuInfod from fho oIocfornI
rnmIfIcnfIons of fhoIr docIsIon. 1J., nf l69. SondIng
CInuso rogrnms do nof oso fhIs dnngor whon n Sfnfo hns
n IogIfImnfo choIco whofhor fo nccof fho fodornI condI-
fIons In oxchnngo for fodornI funds. In such n sIfunfIon,
sfnfo offIcInIs cnn fnIrIy bo hoId oIIfIcnIIy nccounfnbIo for
choosIng fo nccof or rofuso fho fodornI offor. Iuf whon
fho Sfnfo hns no choIco, fho IodornI Covornmonf cnn
nchIovo Ifs objocfIvos wIfhouf nccounfnbIIIfy, jusf ns In
Aeu Yor/ nnd Prin/c. Indood, fhIs dnngor Is hoIghfonod
whon Congross ncfs undor fho SondIng CInuso, bocnuso
Congross cnn uso fhnf owor fo ImIomonf fodornI oIIcy If
couId nof Imoso dIrocfIy undor Ifs onumornfod owors.
Wo nddrossod such concorns In S/euorJ Mocline. Thnf
cnso InvoIvod n fodornI fnx on omIoyors fhnf wns nbnfod
If fho busInossos nId Info n sfnfo unomIoymonf Inn fhnf
mof corfnIn fodornIIy socIfIod condIfIons. An omIoyor
suod, nIIogIng fhnf fho fnx wns ImormIssIbIy drIv|Ing]
fho sfnfo IogIsInfuros undor fho whI of oconomIc rossuro
Info fho onncfmonf of unomIoymonf comonsnfIon Inws
nf fho bIddIng of fho confrnI govornmonf. 30l !. S., nf
58?. Wo ncknowIodgod fho dnngor fhnf fho IodornI Cov-
ornmonf mIghf omIoy Ifs fnxIng owor fo oxorf n owor
nkIn fo unduo InfIuonco uon fho Sfnfos. 1J., nf 590. Iuf
wo obsorvod fhnf Congross ndofod fho chnIIongod fnx nnd
nbnfomonf rogrnm fo chnnnoI monoy fo fho Sfnfos fhnf
wouId ofhorwIso hnvo gono Info fho IodornI Tronsury for

49 CIfo ns: 56? !. S. ____ (20l2)
uso In rovIdIng nnfIonnI unomIoymonf sorvIcos. Con-
gross wns wIIIIng fo dIrocf busInossos fo Insfond ny fho
monoy Info sfnfo rogrnms onIy on fho condIfIon fhnf fho
monoy bo usod for fho snmo urosos. IrodIcnfIng fnx
nbnfomonf on n Sfnfo`s ndofIon of n nrfIcuInr fyo of un-
omIoymonf IogIsInfIon wns fhoroforo n monns fo snfo-
gunrd |fho IodornI Covornmonf`s] own fronsury. 1J., nf
59l. Wo hoId fhnf |I]n such cIrcumsfnncos, If In no ofh-
ors, Inducomonf or orsunsIon doos nof go boyond fho
bounds of owor. 1IiJ.
In rojocfIng fho nrgumonf fhnf fho fodornI Inw wns n
wonon| ] of coorcIon, dosfroyIng or ImnIrIng fho nufon-
omy of fho sfnfos, fho Courf nofod fhnf fhoro wns no
ronson fo suoso fhnf fho Sfnfo In fhnf cnso ncfod ofhor
fhnn fhrough hor unfofforod wIII. 1J., nf 586, 590.
Indood, fho Sfnfo IfsoIf dId nof offor n suggosfIon fhnf In
nssIng fho unomIoymonf Inw sho wns nffocfod by du-
ross. 1J., nf 589.
As our docIsIon In S/euorJ Mocline confIrms, Congross
mny nffnch nrorInfo condIfIons fo fodornI fnxIng nnd
sondIng rogrnms fo rosorvo Ifs confroI ovor fho uso of
fodornI funds. In fho fyIcnI cnso wo Iook fo fho Sfnfos fo
dofond fhoIr rorognfIvos by ndofIng fho sImIo oxodI-
onf of nof yIoIdIng fo fodornI bInndIshmonfs whon fhoy
do nof wnnf fo ombrnco fho fodornI oIIcIos ns fhoIr own.
Moeeocluee//e v. Mellon, 262 !. S. 44?, 482 (l923). Tho
Sfnfos nro sonrnfo nnd Indoondonf sovoroIgns. Somo-
fImos fhoy hnvo fo ncf IIko If.
Tho Sfnfos, howovor, nrguo fhnf fho ModIcnId oxnnsIon
Is fnr from fho fyIcnI cnso. Thoy objocf fhnf Congross hns
crossod fho IIno dIsfInguIshIng oncourngomonf from
coorcIon, Aeu Yor/, eupro, nf l?5, In fho wny If hns sfruc-
furod fho fundIng: Insfond of sImIy rofusIng fo grnnf fho
now funds fo Sfnfos fhnf wIII nof nccof fho now condI-
fIons, Congross hns nIso fhronfonod fo wIfhhoId fhoso
Sfnfos` oxIsfIng ModIcnId funds. Tho Sfnfos cInIm fhnf

I!SIISS t. SIII!I!S
fhIs fhronf sorvos no uroso ofhor fhnn fo forco unwIIIIng
Sfnfos fo sIgn u for fho drnmnfIc oxnnsIon In honIfh cnro
covorngo offocfod by fho Acf.
CIvon fho nnfuro of fho fhronf nnd fho rogrnms nf
Issuo horo, wo musf ngroo. Wo hnvo uhoId Congross`s
nufhorIfy fo condIfIon fho rocoIf of funds on fho Sfnfos`
comIyIng wIfh rosfrIcfIons on fho uso of fhoso funds,
bocnuso fhnf Is fho monns by whIch Congross onsuros fhnf
fho funds nro sonf nccordIng fo Ifs vIow of fho gonornI
WoIfnro. CondIfIons fhnf do nof horo govorn fho uso
of fho funds, howovor, cnnnof bo jusfIfIod on fhnf bn-
sIs. Whon, for oxnmIo, such condIfIons fnko fho form of
fhronfs fo formInnfo ofhor sIgnIfIcnnf Indoondonf grnnfs,
fho condIfIons nro roorIy vIowod ns n monns of rossur-
Ing fho Sfnfos fo nccof oIIcy chnngos.
In Sou/l Do/o/o v. Dole, wo consIdorod n chnIIongo fo n
fodornI Inw fhnf fhronfonod fo wIfhhoId fIvo orconf of n
Sfnfo`s fodornI hIghwny funds If fho Sfnfo dId nof rnIso Ifs
drInkIng ngo fo 2l. Tho Courf found fhnf fho condIfIon
wns dIrocfIy roInfod fo ono of fho mnIn urosos for whIch
hIghwny funds nro oxondodsnfo Inforsfnfo frnvoI. 483
!. S., nf 208. Af fho snmo fImo, fho condIfIon wns nof n
rosfrIcfIon on how fho hIghwny fundssof nsIdo for soc-
IfIc hIghwny Imrovomonf nnd mnInfonnnco offorfsworo
fo bo usod.
Wo nccordIngIy nskod whofhor fho fInnncInI Induco-
monf offorod by Congross wns so coorcIvo ns fo nss fho
oInf nf whIch 'rossuro furns Info comuIsIon.` 1J., nf
2ll (quofIng S/euorJ Mocline, eupro, nf 590). Iy fInnn-
cInI Inducomonf fho Courf monnf fho fhronf of IosIng fIvo
orconf of hIghwny funds; no now monoy wns offorod fo
fho Sfnfos fo rnIso fhoIr drInkIng ngos. Wo found fhnf fho
Inducomonf wns nof ImormIssIbIy coorcIvo, bocnuso
Congross wns offorIng onIy roInfIvoIy mIId oncourngomonf
fo fho Sfnfos. Dole, 483 !. S., nf 2ll. Wo obsorvod fhnf
nII Soufh nkofn wouId Ioso If sho ndhoros fo hor choson

5l CIfo ns: 56? !. S. ____ (20l2)
courso ns fo n suIfnbIo mInImum drInkIng ngo Is 5 of
hor hIghwny funds. 1IiJ. In fncf, fho fodornI funds nf
sfnko consfIfufod Ioss fhnn hnIf of ono orconf of Soufh
nkofn`s budgof nf fho fImo. Soo nf. Assn. of Sfnfo
Iudgof OffIcors, Tho Sfnfo IxondIfuro !oorf 59 (l98?);
Sou/l Do/o/o v. Dole, ?9l I. 2d 628, 630 (CA8 l986). In
consoquonco, wo concIudo|d] fhnf |fho] oncourngomonf
fo sfnfo ncfIon |wns] n vnIId uso of fho sondIng owor.
Dole, 483 !. S., nf 2l2. Whofhor fo nccof fho drInkIng
ngo chnngo romnIn|od] fho rorognfIvo of fho Sfnfos nof
moroIy In fhoory buf In fncf. 1J., nf 2ll2l2.
In fhIs cnso, fho fInnncInI Inducomonf Congross hns
choson Is much moro fhnn roInfIvoIy mIId oncourngo-
monfIf Is n gun fo fho hond. SocfIon l396c of fho ModI-
cnId Acf rovIdos fhnf If n Sfnfo`s ModIcnId Inn doos
nof comIy wIfh fho Acf`s roquIromonfs, fho Socrofnry of
HonIfh nnd Humnn SorvIcos mny docInro fhnf furfhor
nymonfs wIII nof bo mndo fo fho Sfnfo. 42 !. S. C.
l396c. A Sfnfo fhnf ofs ouf of fho AffordnbIo Cnro Acf`s
oxnnsIon In honIfh cnro covorngo fhus sfnnds fo Ioso nof
moroIy n roInfIvoIy smnII orconfngo of Ifs oxIsfIng ModI-
cnId fundIng, buf oll of If. Dole, eupro, nf 2ll. ModIcnId
sondIng nccounfs for ovor 20 orconf of fho nvorngo
Sfnfo`s fofnI budgof, wIfh fodornI funds covorIng 50 fo 83
orconf of fhoso cosfs. Soo nf. Assn. of Sfnfo Iudgof
OffIcors, IIscnI Yonr 20l0 Sfnfo IxondIfuro !oorf, . ll,
TnbIo 5 (20ll); 42 !. S. C. l396d(b). Tho IodornI Cov-
ornmonf osfImnfos fhnf If wIII ny ouf nroxImnfoIy $3.3
frIIIIon bofwoon 20l0 nnd 20l9 In ordor fo covor fho cosfs
of pre-oxnnsIon ModIcnId. IrIof for !nIfod Sfnfos l0,
n. 6. In nddIfIon, fho Sfnfos hnvo dovoIood InfrIcnfo
sfnfufory nnd ndmInIsfrnfIvo rogImos ovor fho courso of
mnny docndos fo ImIomonf fhoIr objocfIvos undor oxIsfIng
ModIcnId. If Is onsy fo soo how fho Dole Courf couId con-
cIudo fhnf fho fhronfonod Ioss of Ioss fhnn hnIf of ono
orconf of Soufh nkofn`s budgof Ioff fhnf Sfnfo wIfh n

I!SIISS t. SIII!I!S
rorognfIvo fo rojocf Congross`s dosIrod oIIcy, nof
moroIy In fhoory buf In fncf. 483 !. S., nf 2ll2l2. Tho
fhronfonod Ioss of ovor l0 orconf of n Sfnfo`s ovornII
budgof, In confrnsf, Is oconomIc drngoonIng fhnf Ionvos fho
Sfnfos wIfh no ronI ofIon buf fo ncquIosco In fho ModIcnId
oxnnsIon.
l2
J!STICI CISI!!C cInIms fhnf Dole Is dIsfInguIshnbIo
bocnuso horo Congross hns nof fhronfonod fo wIfhhoId
funds onrmnrkod for nny ofhor rogrnm. Poe/, nf 4?. Iuf
fhnf bogs fho quosfIon: Tho Sfnfos confond fhnf fho ox-
nnsIon Is In ronIIfy n now rogrnm nnd fhnf Congross Is
forcIng fhom fo nccof If by fhronfonIng fho funds for fho
oxIsfIng ModIcnId rogrnm. Wo cnnnof ngroo fhnf oxIsfIng
ModIcnId nnd fho oxnnsIon dIcfnfod by fho AffordnbIo
Cnro Acf nro nII ono rogrnm sImIy bocnuso Congross
sfyIod fhom ns such. Poe/, nf 49. If fho oxnnsIon Is nof
roorIy vIowod ns n modIfIcnfIon of fho oxIsfIng ModIcnId
rogrnm, Congross`s docIsIon fo so fIfIo If Is IrroIovnnf.
l3

l2
J!STICI CISI!!C obsorvos fhnf sfnfo ModIcnId sondIng wIII In-
cronso by onIy 0.8 orconf nffor fho oxnnsIon. Poe/, nf 43. Thnf nof
onIy Ignoros Incronsod sfnfo ndmInIsfrnfIvo oxonsos, buf nIso nssumos
fhnf fho IodornI Covornmonf wIII confInuo fo fund fho oxnnsIon nf fho
curronf sfnfuforIIy socIfIod IovoIs. If Is nof unhonrd of, howovor, for
fho IodornI Covornmonf fo Incronso roquIromonfs In such n mnnnor ns
fo Imoso unfundod mnndnfos on fho Sfnfos. Moro ImorfnnfIy, fho
sIzo of fho now fInnncInI burdon Imosod on n Sfnfo Is IrroIovnnf In
nnnIyzIng whofhor fho Sfnfo hns boon coorcod Info nccofIng fhnf
burdon. Your monoy or your IIfo Is n coorcIvo roosIfIon, whofhor
you hnvo n sIngIo doIInr In your ockof or $500.
l3
or, of courso, cnn fho numbor of ngos fho nmondmonf occu-
Ios, or fho oxfonf fo whIch fho chnngo rosorvos nnd works wIfhIn
fho oxIsfIng rogrnm, bo dIsosIfIvo. Cf. poe/, nf 4950 (oInIon of
CISI!!C, J.). Tnko, for oxnmIo, fho foIIowIng hyofhofIcnI nmond-
monf: AII of n Sfnfo`s cIfIzons nro now oIIgIbIo for ModIcnId. Thnf
chnngo wouId fnko u n sIngIo IIno nnd wouId nof nIfor nny oornfIonnI
nsocf| ] of fho rogrnm boyond fho oIIgIbIIIfy roquIromonfs. Poe/, nf
49. Yof If couId hnrdIy bo nrguod fhnf such nn nmondmonf wns n
ormIssIbIo modIfIcnfIon of ModIcnId, rnfhor fhnn nn nffomf fo foIsf nn
onfIroIy now honIfh cnro sysfom uon fho Sfnfos.

53 CIfo ns: 56? !. S. ____ (20l2)
Horo, fho Covornmonf cInIms fhnf fho ModIcnId oxnn-
sIon Is roorIy vIowod moroIy ns n modIfIcnfIon of fho ox-
IsfIng rogrnm bocnuso fho Sfnfos ngrood fhnf Congross
couId chnngo fho forms of ModIcnId whon fhoy sIgnod on
In fho fIrsf Inco. Tho Covornmonf obsorvos fhnf fho
SocInI SocurIfy Acf, whIch IncIudos fho orIgInnI ModIcnId
rovIsIons, confnIns n cInuso oxrossIy rosorvIng |f]ho
rIghf fo nIfor, nmond, or roonI nny rovIsIon of fhnf
sfnfufo. 42 !. S. C. l304. So If doos. Iuf If Congross
Infonds fo Imoso n condIfIon on fho grnnf of fodornI mon-
oys, If musf do so unnmbIguousIy. Pennlure/, 45l !. S.,
nf l?. A Sfnfo confronfod wIfh sfnfufory Inngungo rosorv-
Ing fho rIghf fo nIfor or nmond fho orfInonf rovIsIons
of fho SocInI SocurIfy Acf mIghf ronsonnbIy nssumo fhnf
Congross wns onfIfIod fo mnko ndjusfmonfs fo fho ModI-
cnId rogrnm ns If dovoIood. Congross hns In fncf dono
so, somofImos condIfIonIng onIy fho now fundIng, ofhor
fImos bofh oId nnd now. Soo, e.g., SocInI SocurIfy Amond-
monfs of l9?2, 86 Sfnf. l38ll382, l465 (oxfondIng Mod-
IcnId oIIgIbIIIfy, buf nrfIy condIfIonIng onIy fho now
fundIng); OmnIbus Iudgof !oconcIIInfIon Acf of l990,
460l, l04 Sfnf. l388l66 (oxfondIng oIIgIbIIIfy, nnd
condIfIonIng oId nnd now funds).
Tho ModIcnId oxnnsIon, howovor, nccomIIshos n shIff
In kInd, nof moroIy dogroo. Tho orIgInnI rogrnm wns do-
sIgnod fo covor modIcnI sorvIcos for four nrfIcuInr cnf-
ogorIos of fho noody: fho dIsnbIod, fho bIInd, fho oIdorIy,
nnd noody fnmIIIos wIfh doondonf chIIdron. Soo 42
!. S. C. l396n(n)(l0). IrovIous nmondmonfs fo ModIcnId
oIIgIbIIIfy moroIy nIforod nnd oxnndod fho boundnrIos of
fhoso cnfogorIos. !ndor fho AffordnbIo Cnro Acf, ModIcnId
Is frnnsformod Info n rogrnm fo moof fho honIfh cnro
noods of fho onfIro nonoIdorIy ouInfIon wIfh Incomo
boIow l33 orconf of fho ovorfy IovoI. If Is no Iongor n
rogrnm fo cnro for fho noodIosf nmong us, buf rnfhor nn
oIomonf of n comrohonsIvo nnfIonnI Inn fo rovIdo unI-

I!SIISS t. SIII!I!S
vorsnI honIfh Insurnnco covorngo.
l4
Indood, fho mnnnor In whIch fho oxnnsIon Is sfruc-
furod IndIcnfos fhnf whIIo Congross mny hnvo sfyIod fho
oxnnsIon n moro nIfornfIon of oxIsfIng ModIcnId, If rocog-
nIzod If wns onIIsfIng fho Sfnfos In n now honIfh cnro
rogrnm. Congross cronfod n sonrnfo fundIng rovIsIon
fo covor fho cosfs of rovIdIng sorvIcos fo nny orson
mndo nowIy oIIgIbIo by fho oxnnsIon. WhIIo Congross nys
50 fo 83 orconf of fho cosfs of covorIng IndIvIdunIs cur-
ronfIy onroIIod In ModIcnId, l396d(b), onco fho oxnnsIon Is
fuIIy ImIomonfod Congross wIII ny 90 orconf of fho
cosfs for nowIy oIIgIbIo orsons, l396d(y)(l). Tho condI-
fIons on uso of fho dIfforonf funds nro nIso dIsfIncf. Con-
gross mnndnfod fhnf nowIy oIIgIbIo orsons rocoIvo n IovoI
of covorngo fhnf Is Ioss comrohonsIvo fhnn fho frndIfIonnI
ModIcnId bonofIf nckngo. l396n(k)(l); soo IrIof for
!nIfod Sfnfos 9.
As wo hnvo oxInInod, |f]hough Congross` owor fo
IogIsInfo undor fho sondIng owor Is brond, If doos nof
IncIudo surrIsIng nrfIcInfIng Sfnfos wIfh osfnc-
cofnnco or 'rofroncfIvo` condIfIons. Pennlure/, eupro, nf
25. A Sfnfo couId hnrdIy nnfIcInfo fhnf Congross`s rosor-
vnfIon of fho rIghf fo nIfor or nmond fho ModIcnId
rogrnm IncIudod fho owor fo frnnsform If so drnmnfIcnIIy.
J!STICI CISI!!C cInIms fhnf In fncf fhIs oxnnsIon Is

l4
J!STICI CISI!!C suggosfs fhnf fho Sfnfos cnn hnvo no objocfIon fo
fho ModIcnId oxnnsIon, bocnuso Congross couId hnvo roonIod ModI-
cnId |nnd,] |f]horonffor, . . . couId hnvo onncfod ModIcnId II, n now
rogrnm combInIng fho ro-20l0 covorngo wIfh fho oxnndod covorngo
roquIrod by fho ACA. Poe/, nf 5l; soo nIso poe/, nf 38. Iuf If wouId
corfnInIy nof bo fhnf onsy. IrncfIcnI consfrnInfs wouId InInIy InhIbIf,
If nof rocIudo, fho IodornI Covornmonf from roonIIng fho oxIsfIng
rogrnm nnd uffIng ovory fonfuro of ModIcnId on fho fnbIo for oIIfIcnI
roconsIdornfIon. Such n mnssIvo undorfnkIng wouId hnrdIy bo rIfunI-
IsfIc. 1IiJ. Tho snmo Is fruo of J!STICI CISI!!C`s suggosfIon fhnf
Congross couId osfnbIIsh ModIcnId ns nn oxcIusIvoIy fodornI rogrnm.
Poe/, nf 44.

55 CIfo ns: 56? !. S. ____ (20l2)
no dIfforonf from fho rovIous chnngos fo ModIcnId, such
fhnf n Sfnfo wouId bo hnrd uf fo comInIn fhnf If Inckod
fnIr nofIco. Poe/, nf 56. Iuf fho rIor chnngo sho dIs-
cussosrosumnbIy fho mosf drnmnfIc nIfornfIon sho couId
fInddoos nof como cIoso fo workIng fho frnnsformnfIon
fho oxnnsIon nccomIIshos. Sho hIghIIghfs nn nmond-
monf roquIrIng Sfnfos fo covor rognnnf womon nnd In-
cronsIng fho numbor of oIIgIbIo chIIdron. 1IiJ. Iuf fhIs
modIfIcnfIon cnn hnrdIy bo doscrIbod ns n mnjor chnngo In
n rogrnm fhnffrom Ifs IncofIonrovIdod honIfh cnro
for fnmIIIos wIfh doondonf chIIdron. IrovIous ModIcnId
nmondmonfs sImIy do nof fnII Info fho snmo cnfogory ns
fho ono nf sfnko horo.
Tho Courf In S/euorJ Mocline dId nof nffomf fo fIx
fho ouformosf IIno whoro orsunsIon gIvos wny fo coor-
cIon. 30l !. S., nf 59l. Tho Courf found If |o]nough for
rosonf urosos fhnf whorovor fho IIno mny bo, fhIs
sfnfufo Is wIfhIn If. 1IiJ. Wo hnvo no nood fo fIx n IIno
oIfhor. If Is onough for fodny fhnf whorovor fhnf IIno mny
bo, fhIs sfnfufo Is suroIy boyond If. Congross mny nof
sImIy conscrIf sfnfo |ngoncIos] Info fho nnfIonnI bu-
ronucrnfIc nrmy, I1IC v. Mieeieeippi, 456 !. S. ?42, ??5
(l982) (O`Connor, J., concurrIng In judgmonf In nrf nnd
dIssonfIng In nrf), nnd fhnf Is whnf If Is nffomfIng fo do
wIfh fho ModIcnId oxnnsIon.
I
ofhIng In our oInIon rocIudos Congross from offorIng
funds undor fho AffordnbIo Cnro Acf fo oxnnd fho nvnIIn-
bIIIfy of honIfh cnro, nnd roquIrIng fhnf Sfnfos nccofIng
such funds comIy wIfh fho condIfIons on fhoIr uso. Whnf
Congross Is nof froo fo do Is fo onnIIzo Sfnfos fhnf chooso
nof fo nrfIcInfo In fhnf now rogrnm by fnkIng nwny
fhoIr oxIsfIng ModIcnId fundIng. SocfIon l396c gIvos fho
Socrofnry of HonIfh nnd Humnn SorvIcos fho nufhorIfy fo

I!SIISS t. SIII!I!S
do jusf fhnf. If nIIows hor fo wIfhhoId oll furfhor |ModI-
cnId] nymonfs . . . fo fho Sfnfo If sho doformInos fhnf fho
Sfnfo Is ouf of comIInnco wIfh nny ModIcnId roquIromonf,
IncIudIng fhoso confnInod In fho oxnnsIon. 42 !. S. C.
l396c. In IIghf of fho Courf`s hoIdIng, fho Socrofnry
cnnnof nIy l396c fo wIfhdrnw oxIsfIng ModIcnId funds
for fnIIuro fo comIy wIfh fho roquIromonfs sof ouf In fho
oxnnsIon.
Thnf fuIIy romodIos fho consfIfufIonnI vIoInfIon wo hnvo
IdonfIfIod. Tho chnfor of fho !nIfod Sfnfos Codo fhnf
confnIns l396c IncIudos n sovornbIIIfy cInuso confIrmIng
fhnf wo nood go no furfhor. Thnf cInuso socIfIos fhnf |I]f
nny rovIsIon of fhIs chnfor, or fho nIIcnfIon fhoroof fo
nny orson or cIrcumsfnnco, Is hoId InvnIId, fho romnIndor
of fho chnfor, nnd fho nIIcnfIon of such rovIsIon fo
ofhor orsons or cIrcumsfnncos shnII nof bo nffocfod fhoroby.
l303. Todny`s hoIdIng doos nof nffocf fho confInuod n-
IIcnfIon of l396c fo fho oxIsfIng ModIcnId rogrnm. or
doos If nffocf fho Socrofnry`s nbIIIfy fo wIfhdrnw funds ro-
vIdod undor fho AffordnbIo Cnro Acf If n Sfnfo fhnf hns
choson fo nrfIcInfo In fho oxnnsIon fnIIs fo comIy wIfh
fho roquIromonfs of fhnf Acf.
ThIs Is nof fo sny, ns fho joInf dIssonf suggosfs, fhnf wo
nro rowrIfIng fho ModIcnId IxnnsIon. Poe/, nf 48.
Insfond, wo doformIno, fIrsf, fhnf l396c Is unconsfIfu-
fIonnI whon nIIod fo wIfhdrnw oxIsfIng ModIcnId funds
from Sfnfos fhnf docIIno fo comIy wIfh fho oxnnsIon.
Wo fhon foIIow Congross`s oxIIcIf foxfunI InsfrucfIon fo
Ionvo unnffocfod fho romnIndor of fho chnfor, nnd fho
nIIcnfIon of |fho chnIIongod] rovIsIon fo ofhor orsons
or cIrcumsfnncos. l303. Whon wo InvnIIdnfo nn nIIcn-
fIon of n sfnfufo bocnuso fhnf nIIcnfIon Is unconsfIfu-
fIonnI, wo nro nof rowrIfIng fho sfnfufo; wo nro moroIy
onforcIng fho ConsfIfufIon.
Tho quosfIon romnIns whofhor fodny`s hoIdIng nffocfs
ofhor rovIsIons of fho AffordnbIo Cnro Acf. In consIdorIng

5? CIfo ns: 56? !. S. ____ (20l2)
fhnf quosfIon, |w]o sook fo doformIno whnf Congross
wouId hnvo Infondod In IIghf of fho Courf`s consfIfufIonnI
hoIdIng. Ini/eJ S/o/ee v. Boo/er, 543 !. S. 220, 246
(2005) (InfornnI quofnfIon mnrks omIffod). Our fouch-
sfono for nny docIsIon nbouf romody Is IogIsInfIvo Infonf,
for n courf cnnnof uso Ifs romodInI owors fo cIrcum-
vonf fho Infonf of fho IogIsInfuro. A,o//e v. PlonneJ
Poren/looJ of Aor/lern Aeu 1ng., 546 !. S. 320, 330
(2006) (InfornnI quofnfIon mnrks omIffod). Tho quosfIon
horo Is whofhor Congross wouId hnvo wnnfod fho rosf of
fho Acf fo sfnnd, hnd If known fhnf Sfnfos wouId hnvo n
gonuIno choIco whofhor fo nrfIcInfo In fho now ModIcnId
oxnnsIon. !nIoss If Is ovIdonf fhnf fho nnswor Is no, wo
musf Ionvo fho rosf of fho Acf Infncf. Clonplin Iefining
Co. v. Corporo/ion Conn`n of O/lo., 286 !. S. 2l0, 234
(l932).
Wo nro confIdonf fhnf Congross wouId hnvo wnnfod fo
rosorvo fho rosf of fho Acf. If Is fnIr fo sny fhnf Congross
nssumod fhnf ovory Sfnfo wouId nrfIcInfo In fho ModI-
cnId oxnnsIon, gIvon fhnf Sfnfos hnd no ronI choIco buf fo
do so. Tho Sfnfos confond fhnf Congross onncfod fho rosf
of fho Acf wIfh such fuII nrfIcInfIon In mInd; fhoy oInf
ouf fhnf Congross mndo ModIcnId n monns for snfIsfyIng
fho mnndnfo, 26 !. S. C. 5000A(f)(l)(A)(II), nnd onncfod
no ofhor Inn for rovIdIng covorngo fo mnny Iow-Incomo
IndIvIdunIs. AccordIng fo fho Sfnfos, fhIs monns fhnf fho
onfIro Acf musf fnII.
Wo dIsngroo. Tho Courf fodny IImIfs fho fInnncInI ros-
suro fho Socrofnry mny nIy fo Induco Sfnfos fo nccof
fho forms of fho ModIcnId oxnnsIon. As n rncfIcnI mnf-
for, fhnf monns Sfnfos mny now chooso fo rojocf fho ox-
nnsIon; fhnf Is fho whoIo oInf. Iuf fhnf doos nof monn
nII or ovon nny wIII. Somo Sfnfos mny Indood docIIno fo
nrfIcInfo, oIfhor bocnuso fhoy nro unsuro fhoy wIII bo
nbIo fo nfford fhoIr shnro of fho now fundIng obIIgnfIons,
or bocnuso fhoy nro unwIIIIng fo commIf fho ndmInIsfrn-

I!SIISS t. SIII!I!S
fIvo rosourcos nocossnry fo suorf fho oxnnsIon. Ofhor
Sfnfos, howovor, mny voIunfnrIIy sIgn u, fIndIng fho Idon
of oxnndIng ModIcnId covorngo nffrncfIvo, nrfIcuInrIy
gIvon fho IovoI of fodornI fundIng fho Acf offors nf fho
oufsof.
Wo hnvo no wny of knowIng how mnny Sfnfos wIII nc-
cof fho forms of fho oxnnsIon, buf wo do nof boIIovo
Congross wouId hnvo wnnfod fho whoIo Acf fo fnII, sImIy
bocnuso somo mny chooso nof fo nrfIcInfo. Tho ofhor
roforms Congross onncfod, nffor nII, wIII romnIn fuIIy
oornfIvo ns n Inw, Clonplin, eupro, nf 234, nnd wIII sfIII
funcfIon In n wny consIsfonf wIfh Congross` bnsIc objoc-
fIvos In onncfIng fho sfnfufo, Boo/er, eupro, nf 259.
ConfIdonf fhnf Congross wouId nof hnvo Infondod nny-
fhIng dIfforonf, wo concIudo fhnf fho rosf of fho Acf nood
nof fnII In IIghf of our consfIfufIonnI hoIdIng.
* * *
Tho AffordnbIo Cnro Acf Is consfIfufIonnI In nrf nnd
unconsfIfufIonnI In nrf. Tho IndIvIdunI mnndnfo cnnnof
bo uhoId ns nn oxorcIso of Congross`s owor undor fho
Commorco CInuso. Thnf CInuso nufhorIzos Congross fo
roguInfo Inforsfnfo commorco, nof fo ordor IndIvIdunIs fo
ongngo In If. In fhIs cnso, howovor, If Is ronsonnbIo fo con-
sfruo whnf Congross hns dono ns IncronsIng fnxos on fhoso
who hnvo n corfnIn nmounf of Incomo, buf chooso fo go
wIfhouf honIfh Insurnnco. Such IogIsInfIon Is wIfhIn Con-
gross`s owor fo fnx.
As for fho ModIcnId oxnnsIon, fhnf orfIon of fho Af-
fordnbIo Cnro Acf vIoInfos fho ConsfIfufIon by fhronfonIng
oxIsfIng ModIcnId fundIng. Congross hns no nufhorIfy fo
ordor fho Sfnfos fo roguInfo nccordIng fo Ifs InsfrucfIons.
Congross mny offor fho Sfnfos grnnfs nnd roquIro fho
Sfnfos fo comIy wIfh nccomnnyIng condIfIons, buf fho
Sfnfos musf hnvo n gonuIno choIco whofhor fo nccof fho
offor. Tho Sfnfos nro gIvon no such choIco In fhIs cnso:

59 CIfo ns: 56? !. S. ____ (20l2)
Thoy musf oIfhor nccof n bnsIc chnngo In fho nnfuro of
ModIcnId, or rIsk IosIng nII ModIcnId fundIng. Tho romody
for fhnf consfIfufIonnI vIoInfIon Is fo rocIudo fho IodornI
Covornmonf from ImosIng such n snncfIon. Thnf romody
doos nof roquIro sfrIkIng down ofhor orfIons of fho Af-
fordnbIo Cnro Acf.
Tho Irnmors cronfod n IodornI Covornmonf of IImIfod
owors, nnd nssIgnod fo fhIs Courf fho dufy of onforcIng
fhoso IImIfs. Tho Courf doos so fodny. Iuf fho Courf doos
nof oxross nny oInIon on fho wIsdom of fho AffordnbIo
Cnro Acf. !ndor fho ConsfIfufIon, fhnf judgmonf Is ro-
sorvod fo fho ooIo.
Tho judgmonf of fho Courf of AonIs for fho IIovonfh
CIrcuIf Is nffIrmod In nrf nnd rovorsod In nrf.
1/ ie eo orJereJ.

_________________

_________________

l CIfo ns: 56? !. S. ____ (20l2)
OInIon of CISI!!C, J.
ll393 t.
ll398 t.
I!O!IA IT A!.
ll400
t.
|Juno 28, 20l2]
J!STICI CISI!!C, wIfh whom J!STICI SOTOMAYO!
joIns, nnd wIfh whom J!STICI I!IYI! nnd J!STICI
KACA joIn ns fo Inrfs I, II, III, nnd IV, concurrIng In
nrf, concurrIng In fho judgmonf In nrf, nnd dIssonfIng In
nrf.
I ngroo wIfh THI CHIII J!STICI fhnf fho AnfI-InjuncfIon
Acf doos nof bnr fho Courf`s consIdornfIon of fhIs cnso,
nnd fhnf fho mInImum covorngo rovIsIon Is n roor
oxorcIso of Congross` fnxIng owor. I fhoroforo joIn Inrfs
I, II, nnd IIIC of THI CHIII J!STICI`s oInIon.
!nIIko THI CHIII J!STICI, howovor, I wouId hoId, nIfornn-

I!SIISS t. SIII!I!S
fIvoIy, fhnf fho Commorco CInuso nufhorIzos Congross fo
onncf fho mInImum covorngo rovIsIon. I wouId nIso hoId
fhnf fho SondIng CInuso ormIfs fho ModIcnId oxnnsIon
oxncfIy ns Congross onncfod If.
I
Tho rovIsIon of honIfh cnro Is fodny n concorn of nn-
fIonnI dImonsIon, jusf ns fho rovIsIon of oId-ngo nnd
survIvors` bonofIfs wns In fho l930`s. In fho SocInI Socu-
rIfy Acf, Congross InsfnIIod n fodornI sysfom fo rovIdo
monfhIy bonofIfs fo rofIrod wngo onrnors nnd, ovonfunIIy,
fo fhoIr survIvors. Ioyond quosfIon, Congross couId hnvo
ndofod n sImIInr schomo for honIfh cnro. Congross choso,
Insfond, fo rosorvo n confrnI roIo for rIvnfo Insurors nnd
sfnfo govornmonfs. AccordIng fo THI CHIII J!STICI, fho
Commorco CInuso doos nof ormIf fhnf rosorvnfIon. ThIs
rIgId rondIng of fho CInuso mnkos scnnf sonso nnd Is
sfunnIngIy rofrogrossIvo.
SInco l93?, our rocodonf hns rocognIzod Congross`
Inrgo nufhorIfy fo sof fho nfIon`s courso In fho oconomIc
nnd socInI woIfnro ronIm. Soo Ini/eJ S/o/ee v. DorI,, 3l2
!. S. l00, ll5 (l94l) (ovorruIIng Honner v. Dogenlor/,
24? !. S. 25l (l9l8), nnd rocognIzIng fhnf roguInfIons of
commorco whIch do nof InfrIngo somo consfIfufIonnI rohIbI-
fIon nro wIfhIn fho Ionnry owor conforrod on Congross
by fho Commorco CInuso); ALIB v. Jonee & Lougllin
S/eel Corp., 30l !. S. l, 3? (l93?) (|Tho commorco]
owor Is Ionnry nnd mny bo oxorfod fo rofocf Inforsfnfo
commorco no mnffor whnf fho sourco of fho dnngors whIch
fhronfon If. (InfornnI quofnfIon mnrks omIffod)). THI
CHIII J!STICI`s crnbbod rondIng of fho Commorco CInuso
hnrks bnck fo fho orn In whIch fho Courf roufInoIy fhwnrfod
Congross` offorfs fo roguInfo fho nnfIonnI oconomy In
fho Inforosf of fhoso who Inbor fo susfnIn If. Soo, e.g.,
IoilrooJ Ie/irenen/ BJ. v. Al/on I. Co., 295 !. S. 330,
362, 368 (l935) (InvnIIdnfIng comuIsory rofIromonf nnd

3 CIfo ns: 56? !. S. ____ (20l2)
onsIon Inn for omIoyoos of cnrrIors subjocf fo fho Infor-
sfnfo Commorco Acf; Courf found Inw roInfod ossonfInIIy
fo fho socInI woIfnro of fho workor, nnd fhoroforo romofo
from nny roguInfIon of commorco ns such). If Is n rondIng
fhnf shouId nof hnvo sfnyIng owor.
A
In onncfIng fho InfIonf IrofocfIon nnd AffordnbIo Cnro
Acf (ACA), Congross comrohonsIvoIy roformod fho
nnfIonnI mnrkof for honIfh-cnro roducfs nnd sorvIcos.
Iy nny monsuro, fhnf mnrkof Is Immonso. CoIIocfIvoIy,
AmorIcnns sonf $2.5 frIIIIon on honIfh cnro In 2009,
nccounfIng for l?.6 of our nfIon`s oconomy. 42 !. S. C.
l809l(2)(I) (2006 od., Su. IV). WIfhIn fho noxf docndo,
If Is nnfIcInfod, sondIng on honIfh cnro wIII nonrIy dou-
bIo. 1IiJ.
Tho honIfh-cnro mnrkof`s sIzo Is nof Ifs onIy dIsfIncfIvo
fonfuro. !nIIko fho mnrkof for nImosf nny ofhor roducf
or sorvIco, fho mnrkof for modIcnI cnro Is ono In whIch nII
IndIvIdunIs InovIfnbIy nrfIcInfo. VIrfunIIy ovory orson
rosIdIng In fho !nIfod Sfnfos, soonor or Infor, wIII vIsIf
n docfor or ofhor honIfh-cnro rofossIonnI. Soo of. of
HonIfh nnd Humnn SorvIcos, nfIonnI Confor for HonIfh
SfnfIsfIcs, Summnry HonIfh SfnfIsfIcs for !. S. AduIfs:
nfIonnI HonIfh InforvIow Survoy 2009, Sor. l0, o. 249,
. l24, TnbIo 3? (oc. 20l0) (Ovor 99.5 of nduIfs nbovo
65 hnvo vIsIfod n honIfh-cnro rofossIonnI.). Mosf ooIo
wIII do so roonfodIy. Soo iJ., nf ll5, TnbIo 34 (In 2009
nIono, 64 of nduIfs mndo fwo or moro vIsIfs fo n docfor`s
offIco.).
Whon IndIvIdunIs mnko fhoso vIsIfs, fhoy fnco nnofhor
ronIIfy of fho curronf mnrkof for modIcnI cnro: Ifs hIgh
cosf. In 20l0, on nvorngo, nn IndIvIdunI In fho !nIfod
Sfnfos Incurrod ovor $?,000 In honIfh-cnro oxonsos.
of. of HonIfh nnd Humnn SorvIcos, Confors for ModI-
cnro nnd ModIcnId SorvIcos, HIsforIc nfIonnI HonIfh

I!SIISS t. SIII!I!S
IxondIfuro nfn, nfIonnI HonIfh IxondIfuros: So-
Iocfod CnIondnr Yonrs l96020l0 (TnbIo l). Ovor n IIfo-
fImo, cosfs mounf fo hundrods of fhousnnds of doIInrs. Soo
AIomnynhu & Wnrnor, Tho !IfofImo IsfrIbufIon of
HonIfh Cnro Cosfs, In 39 HonIfh SorvIco !osonrch 62?, 635
(Juno 2004). Whon n orson roquIros nonroufIno cnro, fho
cosf wIII gonornIIy oxcood whnf ho or sho cnn nfford fo ny.
A sIngIo hosIfnI sfny, for Insfnnco, fyIcnIIy cosfs u-
wnrds of $l0,000. Soo of. of HonIfh nnd Humnn Sor-
vIcos, OffIco of HonIfh IoIIcy, ASII !osonrch IrIof: Tho
VnIuo of HonIfh Insurnnco 5 (Mny 20ll). Tronfmonfs for
mnny sorIous, fhough nof uncommon, condIfIons sImIInrIy
cosf n subsfnnfInI sum. IrIof for IconomIc SchoInrs ns
Anici Curioe In o. ll398, . l0 (cIfIng n sfudy IndIcnf-
Ing fhnf, In l998, fho cosf of fronfIng n honrf nffnck for fho
fIrsf 90 dnys oxcoodod $20,000, whIIo fho nnnunI cosf of
fronfIng corfnIn cnncors wns moro fhnn $50,000).
AIfhough ovory !. S. domIcIIInry wIII Incur sIgnIfIcnnf
modIcnI oxonsos durIng hIs or hor IIfofImo, fho fImo whon
cnro wIII bo noodod Is offon unrodIcfnbIo. An nccIdonf, n
honrf nffnck, or n cnncor dIngnosIs commonIy occurs wIfh-
ouf wnrnIng. InoscnnbIy, wo nro nII nf orII of noodIng
modIcnI cnro wIfhouf n momonf`s nofIco. Soo, e.g., Cnm-
boII, own fho Insurnnco !nbbIf HoIo, . Y. TImos, Ar. 5,
20l2, . A23 (foIIIng of nn unInsurod 32-yonr-oId womnn
who, honIfhy ono dny, bocnmo n qundrIIogIc fho noxf duo
fo nn nufo nccIdonf).
To mnnngo fho rIsks nssocInfod wIfh modIcnI cnro
Ifs hIgh cosf, Ifs unrodIcfnbIIIfy, nnd Ifs InovIfnbIIIfy
mosf ooIo In fho !nIfod Sfnfos obfnIn honIfh Insurnnco.
Mnny (nroxImnfoIy l?0 mIIIIon In 2009) nro Insurod by
rIvnfo Insurnnco comnnIos. Ofhors, IncIudIng fhoso
ovor 65 nnd corfnIn oor nnd dIsnbIod orsons, roIy on
govornmonf-fundod Insurnnco rogrnms, nofnbIy ModIcnro
nnd ModIcnId. CombInod, rIvnfo honIfh Insurors nnd
Sfnfo nnd IodornI Covornmonfs fInnnco nImosf 85 of fho

5 CIfo ns: 56? !. S. ____ (20l2)
modIcnI cnro ndmInIsforod fo !. S. rosIdonfs. Soo Con-
grossIonnI Iudgof OffIco, CIO`s 20ll !ong-Torm Iudgof
OufIook 3? (Juno 20ll).
of nII !. S. rosIdonfs, howovor, hnvo honIfh Insurnnco.
In 2009, nroxImnfoIy 50 mIIIIon ooIo woro unInsurod,
oIfhor by choIco or, moro IIkoIy, bocnuso fhoy couId nof
nfford rIvnfo Insurnnco nnd dId nof qunIIfy for govorn-
monf nId. Soo of. of Commorco, Consus Iuronu, C.
onvns-WnIf, I. Irocfor, & J. SmIfh, Incomo, Iovorfy,
nnd HonIfh Insurnnco Covorngo In fho !nIfod Sfnfos: 2009,
. 23, TnbIo 8 (Sof. 20l0). As n grou, unInsurod IndIvId-
unIs nnnunIIy consumo moro fhnn $l00 bIIIIon In honIfh-
cnro sorvIcos, nonrIy 5 of fho nfIon`s fofnI. HIddon
HonIfh Tnx: AmorIcnns Iny n IromIum 2 (2009), nvnII-
nbIo nf hff://www.fnmIIIosusn.org (nII Infornof mnfo-
rInI ns vIsIfod Juno 25, 20l2, nnd IncIudod In CIork of
Courf`s cnso fIIo). Ovor 60 of fhoso wIfhouf Insurnnco
vIsIf n docfor`s offIco or omorgoncy room In n gIvon yonr.
Soo of. of HonIfh nnd Humnn SorvIcos, nfIonnI Con-
for for HonIfh SfnfIsfIcs, HonIfh!nIfod Sfnfos20l0,
. 282, TnbIo ?9 (Iob. 20ll).
I
Tho Inrgo numbor of IndIvIdunIs wIfhouf honIfh Insur-
nnco, Congross found, honvIIy burdons fho nnfIonnI
honIfh-cnro mnrkof. Soo 42 !. S. C. l809l(2). As jusf
nofod, fho cosf of omorgoncy cnro or fronfmonf for n sorI-
ous IIInoss gonornIIy oxcoods whnf nn IndIvIdunI cnn nfford
fo ny on hor own. !nIIko mnrkofs for mosf roducfs,
howovor, fho InnbIIIfy fo ny for cnro doos nof monn fhnf
nn unInsurod IndIvIdunI wIII rocoIvo no cnro. IodornI nnd
sfnfo Inw, ns woII ns rofossIonnI obIIgnfIons nnd ombod-
dod socInI norms, roquIro hosIfnIs nnd hysIcInns fo
rovIdo cnro whon If Is mosf noodod, rognrdIoss of fho
nfIonf`s nbIIIfy fo ny. Soo, e.g., 42 !. S. C. l395dd; IIn.
Sfnf. 395.l04l(3)(f) (20l0); Tox. HonIfh & Snfofy Codo

I!SIISS t. SIII!I!S
Ann. 3ll.022(n) nnd (b) (Wosf 20l0); AmorIcnn ModIcnI
AssocInfIon, CouncII on IfhIcnI nnd JudIcInI AffnIrs,
Codo of ModIcnI IfhIcs, Curronf OInIons: OInIon 8.ll
ogIocf of InfIonf, . ?0 (l998l999 od.).
As n consoquonco, modIcnI-cnro rovIdors doIIvor sIg-
nIfIcnnf nmounfs of cnro fo fho unInsurod for whIch fho
rovIdors rocoIvo no nymonf. In 2008, for oxnmIo, hosI-
fnIs, hysIcInns, nnd ofhor honIfh-cnro rofossIonnIs
rocoIvod no comonsnfIon for $43 bIIIIon worfh of fho $ll6
bIIIIon In cnro fhoy ndmInIsforod fo fhoso wIfhouf Insur-
nnco. 42 !. S. C. l809l(2)(I) (2006 od., Su. IV).
HonIfh-cnro rovIdors do nof nbsorb fhoso bnd dobfs.
Insfond, fhoy rnIso fhoIr rIcos, nssIng nIong fho cosf
of uncomonsnfod cnro fo fhoso who do ny roIInbIy: fho
govornmonf nnd rIvnfo Insurnnco comnnIos. In rosonso,
rIvnfo Insurors Incronso fhoIr romIums, shIffIng fho
cosf of fho oIovnfod bIIIs from rovIdors onfo fhoso who
cnrry Insurnnco. Tho nof rosuIf: Thoso wIfh honIfh Insur-
nnco subsIdIzo fho modIcnI cnro of fhoso wIfhouf If. As
oconomIsfs wouId doscrIbo whnf hnons, fho unInsurod
froo rIdo on fhoso who ny for honIfh Insurnnco.
Tho sIzo of fhIs subsIdy Is consIdornbIo. Congross found
fhnf fho cosf-shIffIng jusf doscrIbod Incronsos fnmIIy
|Insurnnco] romIums by on nvorngo ovor $l,000 n yonr.
1IiJ. HIghor romIums, In furn, rondor honIfh Insurnnco
Ioss nffordnbIo, forcIng moro ooIo fo go wIfhouf Insur-
nnco nnd IondIng fo furfhor cosf-shIffIng.
And If Is hnrdIy jusf fho curronfIy sIck or Injurod nmong
fho unInsurod who romf oIovnfIon of fho rIco of honIfh
cnro nnd honIfh Insurnnco. Insurnnco comnnIos nnd
honIfh-cnro rovIdors know fhnf somo orconfngo of
honIfhy, unInsurod ooIo wIII suffor sIcknoss or Injury
onch yonr nnd wIII rocoIvo modIcnI cnro dosIfo fhoIr Inn-
bIIIfy fo ny. In nnfIcInfIon of fhIs uncomonsnfod cnro,
honIfh-cnro comnnIos rnIso fhoIr rIcos, nnd Insurors
fhoIr romIums. In ofhor words, bocnuso nny unInsurod

? CIfo ns: 56? !. S. ____ (20l2)
orson mny nood modIcnI cnro nf nny momonf nnd bocnuso
honIfh-cnro comnnIos musf nccounf for fhnf rIsk, ovory
unInsurod orson Imncfs fho mnrkof rIco of modIcnI cnro
nnd modIcnI Insurnnco.
Tho fnIIuro of IndIvIdunIs fo ncquIro Insurnnco hns ofhor
doIoforIous offocfs on fho honIfh-cnro mnrkof. Iocnuso
fhoso wIfhouf Insurnnco gonornIIy Inck nccoss fo rovonfn-
fIvo cnro, fhoy do nof rocoIvo fronfmonf for condIfIons
IIko hyorfonsIon nnd dInbofosfhnf cnn bo succossfuIIy
nnd nffordnbIy fronfod If dIngnosod onrIy on. Soo InsfIfufo
of ModIcIno, nfIonnI AcndomIos, InsurIng AmorIcn`s
HonIfh: IrIncIIos nnd !ocommondnfIons 43 (2004). Whon
sIcknoss fInnIIy drIvos fho unInsurod fo sook cnro, onco
fronfnbIo condIfIons hnvo oscnInfod Info grnvo honIfh
robIoms, roquIrIng moro cosfIy nnd oxfonsIvo Inforvon-
fIon. 1J., nf 4344. Tho oxfrn fImo nnd rosourcos rovId-
ors sond sorvIng fho unInsurod Iossons fho rovIdors`
nbIIIfy fo cnro for fhoso who do hnvo Insurnnco. Soo KIIff,
HIgh !nInsurod !nfos Cnn KIII YouIvon If You Hnvo
Covorngo, WnshIngfon Iosf (Mny ?, 20l2) (doscrIbIng n
sfudy of CnIIfornIn`s honIfh-cnro mnrkof whIch found
fhnf, whon hosIfnIs dIvorf fImo nnd rosourcos fo rovIdo
uncomonsnfod cnro, fho qunIIfy of cnro fho hosIfnIs
doIIvor fo fhoso wIfh Insurnnco dros sIgnIfIcnnfIy), nvnIIn-
bIo nf hff://www.wnshIngfonosf.com/bIogs/ozrn-kIoIn/osf/
hIgh-unInsurod-rnfos-cnn-kIII-you-ovon-If-you-hnvo-covorngo/20l2/
05/0?/gIQA!H8T_rInf.hfmI.
C
Sfnfos cnnnof rosoIvo fho robIom of fho unInsurod on
fhoIr own. !Iko SocInI SocurIfy bonofIfs, n unIvorsnI
honIfh-cnro sysfom, If ndofod by nn IndIvIdunI Sfnfo,
wouId bo bnIf fo fho noody nnd doondonf oIsowhoro,
oncourngIng fhom fo mIgrnfo nnd sook n hnvon of rooso.
Heltering v. Dotie, 30l !. S. 6l9, 644 (l93?). Soo nIso
IrIof for CommonwonIfh of Mnssnchusoffs ns Anicue

I!SIISS t. SIII!I!S
Curioe In o. ll398, . l5 (nofIng fhnf, In 2009, Mnssn-
chusoffs` omorgoncy rooms sorvod fhousnnds of unInsurod,
ouf-of-sfnfo rosIdonfs). An InfIux of unhonIfhy IndIvIdunIs
Info n Sfnfo wIfh unIvorsnI honIfh cnro wouId rosuIf In
Incronsod sondIng on modIcnI sorvIcos. To covor fho
Incronsod cosfs, n Sfnfo wouId hnvo fo rnIso fnxos, nnd
rIvnfo honIfh-Insurnnco comnnIos wouId hnvo fo In-
cronso romIums. HIghor fnxos nnd Incronsod Insurnnco
cosfs wouId, In furn, oncourngo busInossos nnd honIfhy
IndIvIdunIs fo Ionvo fho Sfnfo.
Sfnfos fhnf undorfnko honIfh-cnro roforms on fhoIr own
fhus rIsk IncIng fhomsoIvos In n osIfIon of oconomIc
dIsndvnnfngo ns comnrod wIfh noIghbors or comofIfors.
Dotie, 30l !. S., nf 644. Soo nIso IrIof for HonIfh Cnro for
AII, Inc., of nI. ns Anici Curioe In o. ll398, . 4 (|O]uf-
of-sfnfo rosIdonfs confInuo fo sook nnd rocoIvo mIIIIons of
doIInrs In uncomonsnfod cnro In Mnssnchusoffs hosIfnIs,
IImIfIng fho Sfnfo`s offorfs fo Imrovo Ifs honIfh cnro
sysfom fhrough fho oIImInnfIon of uncomonsnfod cnro.).
IncIng fhnf rIsk, IndIvIdunI Sfnfos nro unIIkoIy fo fnko fho
InIfInfIvo In nddrossIng fho robIom of fho unInsurod, ovon
fhough soIvIng fhnf robIom Is In nII Sfnfos` bosf Inforosfs.
Congross` InforvonfIon wns noodod fo ovorcomo fhIs coIIocfIvo-
ncfIon Imnsso.

Awnro fhnf n nnfIonnI soIufIon wns roquIrod, Congross
couId hnvo fnkon ovor fho honIfh-Insurnnco mnrkof by
osfnbIIshIng n fnx-nnd-sond fodornI rogrnm IIko SocInI
SocurIfy. Such n rogrnm, commonIy roforrod fo ns n
sIngIo-nyor sysfom (whoro fho soIo nyor Is fho IodornI
Covornmonf), wouId hnvo Ioff IIffIo, If nny, room for rI-
vnfo onforrIso or fho Sfnfos. Insfond of goIng fhIs roufo,
Congross onncfod fho ACA, n soIufIon fhnf rofnIns n ro-
busf roIo for rIvnfo Insurors nnd sfnfo govornmonfs. To
mnko Ifs choson nronch work, howovor, Congross hnd fo

9 CIfo ns: 56? !. S. ____ (20l2)
uso somo now fooIs, IncIudIng n roquIromonf fhnf mosf
IndIvIdunIs obfnIn rIvnfo honIfh Insurnnco covorngo. Soo
26 !. S. C. 5000A (2006 od., Su. IV) (fho mInImum
covorngo rovIsIon). As oxInInod boIow, by omIoyIng
fhoso fooIs, Congross wns nbIo fo nchIovo n rncfIcnI, nIfo-
gofhor ronsonnbIo, soIufIon.
A confrnI nIm of fho ACA Is fo roduco fho numbor of
unInsurod !. S. rosIdonfs. Soo 42 !. S. C. l809l(2)(C)
nnd (I) (2006 od., Su. IV). Tho mInImum covorngo
rovIsIon ndvnncos fhIs objocfIvo by gIvIng ofonfInI rocI-
Ionfs of honIfh cnro n fInnncInI InconfIvo fo ncquIro Insur-
nnco. Ior fho mInImum covorngo rovIsIon, nn IndIvIdunI
musf oIfhor obfnIn Insurnnco or ny n foII consfrucfod ns n
fnx onnIfy. Soo 26 !. S. C. 5000A.
Tho mInImum covorngo rovIsIon sorvos n furfhor ur-
oso vIfnI fo Congross` Inn fo roduco fho numbor of unIn-
surod. Congross know fhnf oncourngIng IndIvIdunIs fo
urchnso Insurnnco wouId nof suffIco fo soIvo fho robIom,
bocnuso mosf of fho unInsurod nro nof unInsurod by
choIco.
l
Of nrfIcuInr concorn fo Congross woro ooIo
who, fhough dosornfoIy In nood of Insurnnco, offon cnnnof
ncquIro If: orsons who suffor from rooxIsfIng modIcnI
condIfIons.
Ioforo fho ACA`s onncfmonf, rIvnfo Insurnnco comn-
nIos fook nn nIIcnnf`s modIcnI hIsfory Info nccounf whon
soffIng Insurnnco rnfos or docIdIng whofhor fo Insuro nn
IndIvIdunI. Iocnuso IndIvIdunIs wIfh rooxIsfIng mod-

l
AccordIng fo ono sfudy conducfod by fho nfIonnI Confor for HonIfh
SfnfIsfIcs, fho hIgh cosf of Insurnnco Is fho mosf common ronson why
IndIvIdunIs Inck covorngo, foIIowod by Ioss of ono`s job, nn omIoyor`s
unwIIIIngnoss fo offor Insurnnco or nn Insurors` unwIIIIngnoss fo covor
fhoso wIfh rooxIsfIng modIcnI condIfIons, nnd Ioss of ModIcnId covor-
ngo. Soo of. of HonIfh nnd Humnn SorvIcos, nfIonnI Confor for
HonIfh SfnfIsfIcs, Summnry HonIfh SfnfIsfIcs for fho !. S. IouInfIon:
nfIonnI HonIfh InforvIow Survoy2009, Sor. l0, o. 248, . ?l, TnbIo
25 (oc. 20l0). |]Id nof wnnf or nood covorngo rocoIvod foo fow ro-
sonsos fo wnrrnnf Ifs own cnfogory. Soo iIiJ., n. 2.

I!SIISS t. SIII!I!S
IcnI condIfIons cosf Insurnnco comnnIos sIgnIfIcnnfIy moro
fhnn fhoso wIfhouf such condIfIons, Insurors roufInoIy ro-
fusod fo Insuro fhoso IndIvIdunIs, chnrgod fhom subsfnn-
fInIIy hIghor romIums, or offorod onIy IImIfod covorngo
fhnf dId nof IncIudo fho rooxIsfIng IIInoss. Soo of. of
HonIfh nnd Humnn SorvIcos, Covorngo onIod: How fho
Curronf HonIfh Insurnnco Sysfom !onvos MIIIIons IohInd
l (2009) (Ovor fho nsf fhroo yonrs, l2.6 mIIIIon non-
oIdorIy nduIfs woro donIod Insurnnco covorngo or chnrgod
hIghor romIums duo fo n rooxIsfIng condIfIon.).
To onsuro fhnf IndIvIdunIs wIfh modIcnI hIsforIos hnvo
nccoss fo nffordnbIo Insurnnco, Congross dovIsod n fhroo-
nrf soIufIon. IIrsf, Congross Imosod n gunrnnfood Is-
suo roquIromonf, whIch bnrs Insurors from donyIng
covorngo fo nny orson on nccounf of fhnf orson`s modIcnI
condIfIon or hIsfory. Soo 42 !. S. C. 300ggl, 300gg3,
300gg4(n) (2006 od., Su. IV). Socond, Congross roquIrod
Insurors fo uso communIfy rnfIng fo rIco fhoIr Insurnnco
oIIcIos. Soo 300gg. CommunIfy rnfIng, In offocf, bnrs
Insurnnco comnnIos from chnrgIng hIghor romIums
fo fhoso wIfh rooxIsfIng condIfIons.
Iuf fhoso fwo rovIsIons, Congross comrohondod, couId
nof work offocfIvoIy unIoss IndIvIdunIs woro gIvon n ow-
orfuI InconfIvo fo obfnIn Insurnnco. Soo HonrIngs boforo
fho Houso Wnys nnd Monns CommIffoo, lllfh Cong., lsf
Soss., l0, l3 (2009) (sfnfomonf of !wo !oInhnrdf) (|I]m-
osIfIon of connuni/,-ro/eJ preniune nnd guoron/eeJ
Issuo on n mnrkof of comofIng rIvnfo honIfh Insurors
wIII InoxornbIy drIvo fhnf mnrkof Info oxfIncfIon, unIoss
fhoso fwo fonfuros nro couIod wIfh . . . o nonJo/e on
inJitiJuol[e] /o Ie ineureJ. (omhnsIs In orIgInnI)).
In fho l990`s, sovornI SfnfosIncIudIng ow York, ow
Jorsoy, WnshIngfon, Konfucky, MnIno, ow HnmshIro,
nnd Vormonfonncfod gunrnnfood-Issuo nnd communIfy-
rnfIng Inws wIfhouf roquIrIng unIvorsnI ncquIsIfIon of
Insurnnco covorngo. Tho rosuIfs woro dIsnsfrous. AII

ll CIfo ns: 56? !. S. ____ (20l2)
sovon sfnfos sufforod from skyrockofIng Insurnnco ro-
mIum cosfs, roducfIons In IndIvIdunIs wIfh covorngo, nnd
roducfIons In Insurnnco roducfs nnd rovIdors. IrIof for
AmorIcnn AssocInfIon of IooIo wIfh IsnbIIIfIos of nI. ns
Anici Curioe In o. ll398, . 9 (horoInnffor AAI IrIof).
Soo nIso IrIof for Covornor of WnshIngfon ChrIsfIno
CrogoIro ns Anicue Curioe In o. ll398, . lll4 (do-
scrIbIng fho donfh sIrnI In fho Insurnnco mnrkof Wnsh-
Ingfon oxorIoncod whon fho Sfnfo nssod n Inw roquIrIng
covorngo for rooxIsfIng condIfIons).
Congross comrohondod fhnf gunrnnfood-Issuo nnd
communIfy-rnfIng Inws nIono wIII nof work. Whon Insur-
nnco comnnIos nro roquIrod fo Insuro fho sIck nf nffordn-
bIo rIcos, IndIvIdunIs cnn wnIf unfII fhoy bocomo III fo buy
Insurnnco. Iroffy soon, fhoso In nood of ImmodInfo modI-
cnI cnroi.e., fhoso who cosf Insurors fho mosfbocomo
fho Insurnnco comnnIos` mnIn cusfomors. ThIs ndvorso
soIocfIon robIom Ionvos Insurors wIfh fwo choIcos: Thoy
cnn oIfhor rnIso romIums drnmnfIcnIIy fo covor fhoIr
ovor-IncronsIng cosfs or fhoy cnn oxIf fho mnrkof. In fho
sovon Sfnfos fhnf frIod gunrnnfood-Issuo nnd communIfy-
rnfIng roquIromonfs wIfhouf n mInImum covorngo rovI-
sIon, fhnf Is rocIsoIy whnf Insurnnco comnnIos dId. Soo,
e.g., AAI IrIof l0 (|In MnIno,] |m]nny Insurnnco rovId-
ors doubIod fhoIr romIums In jusf fhroo yonrs or Ioss.);
iJ., nf l2 (!Iko ow York, Vormonf snw subsfnnfInI
Incronsos In romIums nffor Ifs . . . Insurnnco roform
monsuros fook offocf In l993.); HnII, An IvnIunfIon of
ow York`s !oform !nw, 25 J. HonIfh IoI. IoI`y & !. ?l,
9l92 (2000) (Cunrnnfood-Issuo nnd communIfy-rnfIng
Inws rosuIfod In n drnmnfIc oxodus of IndomnIfy Insurors
from ow York`s IndIvIdunI |Insurnnco] mnrkof.); IrIof
for Inrry IrIodmnn of nI. ns Anici Curioe In o. ll398,
. l? (In Konfucky, nII buf fwo Insurors (ono Sfnfo-run)
nbnndonod fho Sfnfo.).
Mnssnchusoffs, Congross wns foId, crnckod fho ndvorso

I!SIISS t. SIII!I!S
soIocfIon robIom. Iy roquIrIng mosf rosIdonfs fo obfnIn
Insurnnco, soo Mnss. Con. !nws, ch. lllM, 2 (Wosf 20ll),
fho CommonwonIfh onsurod fhnf Insurors wouId nof bo
Ioff wIfh onIy fho sIck ns cusfomors. As n rosuIf, fodornI
Inwmnkors obsorvod, Mnssnchusoffs succoodod whoro
ofhor Sfnfos hnd fnIIod. Soo IrIof for CommonwonIfh of
Mnssnchusoffs ns Anicue Curioe In o. ll398, . 3 (nof-
Ing fhnf fho CommonwonIfh`s roforms roducod fho numbor
of unInsurod rosIdonfs fo Ioss fhnn 2, fho Iowosf rnfo In
fho nfIon, nnd cuf fho nmounf of uncomonsnfod cnro
by n fhIrd); 42 !. S. C. l809l(2)() (2006 od., Su. IV)
(nofIng fho succoss of Mnssnchusoffs` roforms).
2
In cou-
IIng fho mInImum covorngo rovIsIon wIfh gunrnnfood-
Issuo nnd communIfy-rnfIng roscrIfIons, Congross
foIIowod Mnssnchusoffs` Iond.
* * *
In sum, Congross nssod fho mInImum covorngo rovI-
sIon ns n koy comononf of fho ACA fo nddross nn oconom-
Ic nnd socInI robIom fhnf hns Inguod fho nfIon for
docndos: fho Inrgo numbor of !. S. rosIdonfs who nro
unnbIo or unwIIIIng fo obfnIn honIfh Insurnnco. Whnfovor
ono fhInks of fho oIIcy docIsIon Congross mndo, If wns
Congross` rorognfIvo fo mnko If. !ovIowod wIfh nro-
rInfo doforonco, fho mInImum covorngo rovIsIon, nIIIod
fo fho gunrnnfood-Issuo nnd communIfy-rnfIng roscrI-
fIons, shouId survIvo monsuromonf undor fho Commorco
nnd ocossnry nnd Iroor CInusos.
II
A
Tho Commorco CInuso, If Is wIdoIy ncknowIodgod, wns
fho Irnmors` rosonso fo fho confrnI robIom fhnf gnvo

2
osIfo Ifs succoss, Mnssnchusoffs` modIcnI-cnro rovIdors sfIII nd-
mInIsfor subsfnnfInI nmounfs of uncomonsnfod cnro, much of fhnf fo
unInsurod nfIonfs from ouf-of-sfnfo. Soo eupro, nf ?8.

l3 CIfo ns: 56? !. S. ____ (20l2)
rIso fo fho ConsfIfufIon IfsoIf. 11OC v. W,oning, 460
!. S. 226, 244, 245, n. l (l983) (Sfovons, J., concurrIng)
(cIfIng sourcos). !ndor fho ArfIcIos of ConfodornfIon, fho
ConsfIfufIon`s rocursor, fho roguInfIon of commorco wns
Ioff fo fho Sfnfos. ThIs schomo rovod unworknbIo, bo-
cnuso fho IndIvIdunI Sfnfos, undorsfnndnbIy focusod on
fhoIr own oconomIc Inforosfs, offon fnIIod fo fnko ncfIons
crIfIcnI fo fho succoss of fho nfIon ns n whoIo. Soo VIcos
of fho IoIIfIcnI Sysfom of fho !nIfod Sfnfos, In Jnmos
MndIson: WrIfIngs 69, ?l, 5 (J. !nkovo od. l999) (As n
rosuIf of fho wnnf of concorf In mnffors whoro common
Inforosf roquIros If, fho nnfIonnI dIgnIfy, Inforosf, nnd rovo-
nuo |hnvo] sufforod.).
3
Whnf wns noodod wns n nnfIonnI Covornmonf . . .
nrmod wIfh n osIfIvo & comIonf nufhorIfy In nII cnsos
whoro unIform monsuros nro nocossnry. Soo !offor from
Jnmos MndIson fo Idmund !nndoIh (Ar. 8, l?8?), In 9
Inors of Jnmos MndIson 368, 3?0 (!. !ufInnd od. l9?5).
Soo nIso !offor from Coorgo WnshIngfon fo Jnmos MndI-
son (ov. 30, l?85), In 8 iJ., nf 428, 429 (Wo nro oIfhor n
!nIfod ooIo, or wo nro nof. If fho formor, Iof us, In nII
mnffors of gonornI concorn ncf ns n nnfIon, whIch hn|s]
nnfIonnI objocfs fo romofo, nnd n nnfIonnI chnrncfor
fo suorf.). Tho Irnmors` soIufIon wns fho Commorco
CInuso, whIch, ns fhoy orcoIvod If, grnnfod Congross fho
nufhorIfy fo onncf oconomIc IogIsInfIon In nII Cnsos for
fho gonornI Inforosfs of fho !nIon, nnd nIso In fhoso Cnsos
fo whIch fho Sfnfos nro sonrnfoIy Incomofonf. 2 !oc-
ords of fho IodornI ConvonfIon of l?8?, . l3ll32, 8

3
AIoxnndor HnmIIfon doscrIbod fho robIom fhIs wny: |Offon] If
wouId bo bonofIcInI fo nII fho sfnfos fo oncourngo, or suross|,] n
nrfIcuInr brnnch of frndo, whIIo If wouId bo dofrImonfnI . . . fo nffomf
If wIfhouf fho concurronco of fho rosf. Tho ConfInonfnIIsf o. V, In 3
Inors of AIoxnndor HnmIIfon ?5, ?8 (H. Syroff od. l962). Iocnuso fho
concurronco of nII Sfnfos wns oxcoodIngIy dIffIcuIf fo obfnIn, HnmIIfon
obsorvod, fho oxorImonf wouId robnbIy bo Ioff unfrIod. 1IiJ.

I!SIISS t. SIII!I!S
(M. Inrrnnd rov. l966). Soo nIso Aor/l Anericon Co. v.
S1C, 32? !. S. 686, ?05 (l946) (|Tho commorco owor]
Is nn nffIrmnfIvo owor commonsurnfo wIfh fho nnfIonnI
noods.).
Tho Irnmors undorsfood fhnf fho gonornI Inforosfs of
fho !nIon wouId chnngo ovor fImo, In wnys fhoy couId nof
nnfIcInfo. AccordIngIy, fhoy rocognIzod fhnf fho ConsfI-
fufIon wns of nocossIfy n gronf oufIIn|o], nof n dofnIIod
bIuorInf, soo McCullocl v. Mor,lonJ, 4 Whonf. 3l6, 40?
(l8l9), nnd fhnf Ifs rovIsIons IncIudod brond concofs, fo
bo oxInInod by fho confoxf or by fho fncfs of fho cnso,
!offor from Jnmos MndIson fo . I. TrIsf (oc. l83l), In 9
WrIfIngs of Jnmos MndIson 4?l, 4?5 (C. Hunf od. l9l0).
ofhIng . . . cnn bo moro fnIIncIous, AIoxnndor HnmIIfon
omhnsIzod, fhnn fo Infor fho oxfonf of nny owor, roor
fo bo Iodgod In fho nnfIonnI govornmonf, from . . . Ifs
ImmodInfo nocossIfIos. Thoro oughf fo bo n CAIACITY fo
rovIdo for fufuro confIngoncIos|,] ns fhoy mny hnon;
nnd ns fhoso nro IIIImIfnbIo In fhoIr nnfuro, If Is ImossIbIo
snfoIy fo IImIf fhnf cnncIfy. Tho IodornIIsf o. 34,
. 205, 206 (John Hnrvnrd !Ibrnry od. 2009). Soo nIso
McCullocl, 4 Whonf., nf 4l5 (Tho ocossnry nnd Iroor
CInuso Is Iodgod In n consfIfufIon|,] Infondod fo onduro
for ngos fo como, nnd consoquonfIy, fo bo ndnfod fo fho
vnrIous crieee of humnn nffnIrs.).
I
ConsIsfonf wIfh fho Irnmors` Infonf, wo hnvo roonfodIy
omhnsIzod fhnf Congross` nufhorIfy undor fho Commorco
CInuso Is doondonf uon rncfIcnI consIdornfIons,
IncIudIng ncfunI oxorIonco. Jonee & Lougllin S/eel
Corp., 30l !. S., nf 4l42; soo Wic/orJ v. IilIurn, 3l?
!. S. lll, l22 (l942); Ini/eJ S/o/ee v. Lopec, 5l4 !. S.
549, 5?3 (l995) (KIIY, J., concurrIng) (omhnsIzIng
fho Courf`s dofInIfIvo commIfmonf fo fho rncfIcnI con-
cofIon of fho commorco owor). Soo nIso Aor/l Anericon

l5 CIfo ns: 56? !. S. ____ (20l2)
Co., 32? !. S., nf ?05 (Commorco IfsoIf Is nn InfonsoIy
rncfIcnI mnffor. To donI wIfh If offocfIvoIy, Congross
musf bo nbIo fo ncf In forms of oconomIc nnd fInnncInI
ronIIfIos. (cIfnfIon omIffod)). Wo nfford Congross fho
Ioowny fo undorfnko fo soIvo nnfIonnI robIoms dIrocfIy
nnd ronIIsfIcnIIy. Anericon Pouer & Ligl/ Co. v. S1C,
329 !. S. 90, l03 (l946).
!nfII fodny, fhIs Courf`s rngmnfIc nronch fo judgIng
whofhor Congross vnIIdIy oxorcIsod Ifs commorco owor
wns guIdod by fwo fnmIIInr rIncIIos. IIrsf, Congross hns
fho owor fo roguInfo oconomIc ncfIvIfIos fhnf subsfnn-
fInIIy nffocf Inforsfnfo commorco. Goncolee v. Ioicl, 545
!. S. l, l? (2005). ThIs cnncIous owor oxfonds ovon fo
IocnI ncfIvIfIos fhnf, vIowod In fho nggrognfo, hnvo n sub-
sfnnfInI Imncf on Inforsfnfo commorco. Soo iIiJ. Soo
nIso Wic/orJ, 3l? !. S., nf l25 (|I]von If noIIoo`s ncfIv-
Ify bo IocnI nnd fhough If mny nof bo rognrdod ns com-
morco, If mny sfIII, ulo/eter i/e no/ure, bo ronchod by
Congross If If oxorfs n subsfnnfInI oconomIc offocf on
Inforsfnfo commorco. (omhnsIs nddod)); Jonee & Lougl-
lin S/eel Corp., 30l !. S., nf 3?.
Socond, wo owo n Inrgo monsuro of rosocf fo Congross
whon If frnmos nnd onncfs oconomIc nnd socInI IogIsInfIon.
Soo Ioicl, 545 !. S., nf l?. Soo nIso Peneion Benefi/
Guoron/, Corporo/ion v. I. A. Gro, & Co., 46? !. S. ?l?,
?29 (l984) (|S]frong doforonco |Is] nccordod IogIsInfIon In
fho fIoId of nnfIonnI oconomIc oIIcy.); HoJel v. 1nJiono,
452 !. S. 3l4, 326 (l98l) (ThIs |C]ourf wIII corfnInIy nof
subsfIfufo Ifs judgmonf for fhnf of Congross unIoss fho
roInfIon of fho subjocf fo Inforsfnfo commorco nnd Ifs of-
focf uon If nro cIonrIy non-oxIsfonf. (InfornnI quofnfIon
mnrks omIffod)). Whon nrnIsIng such IogIsInfIon, wo
nsk onIy (l) whofhor Congross hnd n rnfIonnI bnsIs for
concIudIng fhnf fho roguInfod ncfIvIfy subsfnnfInIIy nffocfs
Inforsfnfo commorco, nnd (2) whofhor fhoro Is n ronsonn-
bIo connocfIon bofwoon fho roguInfory monns soIocfod nnd

I!SIISS t. SIII!I!S
fho nssorfod onds. 1J., nf 323324. Soo nIso Ioicl, 545
!. S., nf 22; Lopec, 5l4 !. S., nf 55?; HoJel v. Virginio
Surfoce Mining & Ieclono/ion Aeen., 1nc., 452 !. S. 264,
2?? (l98l); Ko/cenIocl v. McClung, 3?9 !. S. 294, 303
(l964); Heor/ of A/lon/o Mo/el, 1nc. v. Ini/eJ S/o/ee, 3?9
!. S. 24l, 258 (l964); Ini/eJ S/o/ee v. Corolene ProJuc/e
Co., 304 !. S. l44, l52l53 (l938). In nnsworIng fhoso
quosfIons, wo rosumo fho sfnfufo undor rovIow Is consfI-
fufIonnI nnd mny sfrIko If down onIy on n InIn showIng
fhnf Congross ncfod IrrnfIonnIIy. Ini/eJ S/o/ee v. Morri-
eon, 529 !. S. 598, 60? (2000).
C
SfrnIghfforwnrd nIIcnfIon of fhoso rIncIIos wouId
roquIro fho Courf fo hoId fhnf fho mInImum covorngo
rovIsIon Is roor Commorco CInuso IogIsInfIon. Ioyond
dIsufo, Congross hnd n rnfIonnI bnsIs for concIudIng fhnf
fho unInsurod, ns n cInss, subsfnnfInIIy nffocf Inforsfnfo
commorco. Thoso wIfhouf Insurnnco consumo bIIIIons of
doIInrs of honIfh-cnro roducfs nnd sorvIcos onch yonr. Soo
eupro, nf 5. Thoso goods nro roducod, soId, nnd doIIvorod
InrgoIy by nnfIonnI nnd rogIonnI comnnIos who roufInoIy
frnnsncf busInoss ncross sfnfo IInos. Tho unInsurod nIso
cross sfnfo IInos fo rocoIvo cnro. Somo hnvo modIcnI omor-
goncIos whIIo nwny from homo. Ofhors, whon sIck, go fo n
noIghborIng Sfnfo fhnf rovIdos boffor cnro for fhoso who
hnvo nof ronId for cnro. Soo eupro, nf ?8.
of onIy do fhoso wIfhouf Insurnnco consumo n Inrgo
nmounf of honIfh cnro onch yonr; crIfIcnIIy, ns onrIIor
oxInInod, fhoIr InnbIIIfy fo ny for n sIgnIfIcnnf orfIon of
fhnf consumfIon drIvos u mnrkof rIcos, foIsfs cosfs on
ofhor consumors, nnd roducos mnrkof offIcIoncy nnd sfn-
bIIIfy. Soo eupro, nf 5?. CIvon fhoso fnr-ronchIng offocfs
on Inforsfnfo commorco, fho docIsIon fo forgo Insurnnco Is
hnrdIy InconsoquonfInI or oquIvnIonf fo doIng nofhIng,
on/e, nf 20; If Is, Insfond, nn oconomIc docIsIon Congross

l? CIfo ns: 56? !. S. ____ (20l2)
hns fho nufhorIfy fo nddross undor fho Commorco CInuso.
Soo eupro, nf l4l6. Soo nIso Wic/orJ, 3l? !. S., nf l28
(If Is woII osfnbIIshod by docIsIons of fhIs Courf fhnf
fho owor fo roguInfo commorco IncIudos fho owor fo rogu-
Info fho rIcos nf whIch commodIfIos In fhnf commorco nro
donIf In nnd proc/icee offec/ing eucl pricee. (omhnsIs
nddod)).
Tho mInImum covorngo rovIsIon, furfhormoro, bonrs n
ronsonnbIo connocfIon fo Congross` gonI of rofocfIng fho
honIfh-cnro mnrkof from fho dIsrufIon cnusod by IndIvId-
unIs who fnII fo obfnIn Insurnnco. Iy roquIrIng fhoso who
do nof cnrry Insurnnco fo ny n foII, fho mInImum covor-
ngo rovIsIon gIvos IndIvIdunIs n sfrong InconfIvo fo In-
suro. ThIs InconfIvo, Congross hnd good ronson fo boIIovo,
wouId roduco fho numbor of unInsurod nnd, corrosond-
IngIy, mIfIgnfo fho ndvorso Imncf fho unInsurod hnvo on
fho nnfIonnI honIfh-cnro mnrkof.
Congross nIso ncfod ronsonnbIy In roquIrIng unInsurod
IndIvIdunIs, whofhor sIck or honIfhy, oIfhor fo obfnIn
Insurnnco or fo ny fho socIfIod onnIfy. As onrIIor ob-
sorvod, bocnuso ovory orson Is nf rIsk of noodIng cnro nf
nny momonf, nII fhoso who Inck Insurnnco, rognrdIoss of
fhoIr curronf honIfh sfnfus, ndvorsoIy nffocf fho rIco of
honIfh cnro nnd honIfh Insurnnco. Soo eupro, nf 6?.
Moroovor, nn Insurnnco-urchnso roquIromonf IImIfod fo
fhoso In nood of ImmodInfo cnro sImIy couId nof work.
Insurnnco comnnIos wouId oIfhor chnrgo fhoso IndIvIdu-
nIs rohIbIfIvoIy oxonsIvo romIums, or, If communIfy-
rnfIng roguInfIons woro In Inco, cIoso u sho. Soo eupro,
nf 9ll. Soo nIso IrIof for Sfnfo of MnryInnd nnd l0
Ofhor Sfnfos of nI. ns Anici Curioe In o. ll398, . 28
(horoInnffor MnryInnd IrIof) (o Insurnnco rogImo cnn
survIvo If ooIo cnn of ouf whon fho rIsk Insurod ngnInsf
Is onIy n rIsk, buf of In whon fho rIsk mnforInIIzos.).
|W]horo wo fInd fhnf fho IogIsInfors . . . hnvo n rnfIonnI
bnsIs for fIndIng n choson roguInfory schomo nocossnry fo

I!SIISS t. SIII!I!S
fho rofocfIon of commorco, our InvosfIgnfIon Is nf nn ond.
Ko/cenIocl, 3?9 !. S., nf 303304. Congross` onncfmonf
of fho mInImum covorngo rovIsIon, whIch nddrossos n
socIfIc Inforsfnfo robIom In n rncfIcnI, oxorIonco-
Informod mnnnor, onsIIy moofs fhIs crIforIon.

!nfhor fhnn ovnIunfIng fho consfIfufIonnIIfy of fho
mInImum covorngo rovIsIon In fho mnnnor osfnbIIshod by
our rocodonfs, THI CHIII J!STICI roIIos on n nowIy
mInfod consfIfufIonnI docfrIno. Tho commorco owor doos
nof, THI CHIII J!STICI nnnouncos, ormIf Congross
fo como|I] IndIvIdunIs fo bocomo ncfIvo In commorco
by urchnsIng n roducf. An/e, nf 20 (omhnsIs doIofod).
l
n
THI CHIII J!STICI`s novoI consfrnInf on Congross`
commorco owor gnIns no forco from our rocodonf nnd for
fhnf ronson nIono wnrrnnfs dIsnrobnfIon. Soo infro, nf
232?. Iuf ovon nssumIng, for fho momonf, fhnf Congross
Incks nufhorIfy undor fho Commorco CInuso fo comoI
IndIvIdunIs nof ongngod In commorco fo urchnso nn
unwnnfod roducf, on/e, nf l8, such n IImIfnfIon wouId bo
InnIIcnbIo horo. Ivoryono wIII, nf somo oInf, consumo
honIfh-cnro roducfs nnd sorvIcos. Soo eupro, nf 3. Thus,
If THI CHIII J!STICI Is corrocf fhnf nn Insurnnco-
urchnso roquIromonf cnn bo nIIod onIy fo fhoso who
ncfIvoIy consumo honIfh cnro, fho mInImum covorngo
rovIsIon fIfs fho bIII.
THI CHIII J!STICI doos nof dIsufo fhnf nII !. S. rosI-
donfs nrfIcInfo In fho mnrkof for honIfh sorvIcos ovor
fho courso of fhoIr IIvos. Soo on/e, nf l6 (Ivoryono wIII
ovonfunIIy nood honIfh cnro nf n fImo nnd fo nn oxfonf
fhoy cnnnof rodIcf.). Iuf, THI CHIII J!STICI InsIsfs,
fho unInsurod cnnnof bo consIdorod ncfIvo In fho mnrkof

l9 CIfo ns: 56? !. S. ____ (20l2)
for honIfh cnro, bocnuso |f]ho roxImIfy nnd dogroo of
connocfIon bofwoon fho |unInsurod fodny] nnd |fhoIr]
subsoquonf commorcInI ncfIvIfy Is foo InckIng. An/e,
nf 2?.
ThIs nrgumonf hns muIfIIo fInws. IIrsf, moro fhnn
60 of fhoso wIfhouf Insurnnco vIsIf n hosIfnI or docfor`s
offIco onch yonr. Soo eupro, nf 5. onrIy 90 wIII wIfhIn
fIvo yonrs.
4
An unInsurod`s consumfIon of honIfh cnro Is
fhus quIfo roxImnfo: If Is vIrfunIIy corfnIn fo occur In fho
noxf fIvo yonrs nnd moro IIkoIy fhnn nof fo occur fhIs yonr.
IqunIIy ovIdonf, Congross hns no wny of sonrnfIng
fhoso unInsurod IndIvIdunIs who wIII nood omorgoncy modI-
cnI cnro fodny (suroIy fhoIr consumfIon of modIcnI cnro
Is suffIcIonfIy ImmInonf) from fhoso who wIII nof nood
modIcnI sorvIcos for yonrs fo como. o ono knows whon nn
omorgoncy wIII occur, yof omorgoncIos InvoIvIng fho unIn-
surod nrIso dnIIy. To cnfuro IndIvIdunIs who unoxocf-
odIy wIII obfnIn modIcnI cnro In fho vory nonr fufuro, fhon,
Congross noodod fo IncIudo IndIvIdunIs who wIII nof go fo
n docfor nnyfImo soon. Congross, our docIsIons Insfrucf,
hns nufhorIfy fo cnsf Ifs nof fhnf wIdo. Soo Perec v. Ini/eJ
S/o/ee, 402 !. S. l46, l54 (l9?l) (|W]hon If Is nocossnry
In ordor fo rovonf nn ovII fo mnko fho Inw ombrnco moro
fhnn fho rocIso fhIng fo bo rovonfod If mny do so. (In-
fornnI quofnfIon mnrks omIffod)).
5

4
Soo of. of HonIfh nnd Humnn SorvIcos, nfIonnI Confor for
HonIfh SfnfIsfIcs, Summnry HonIfh SfnfIsfIcs for !. S. AduIfs: nfIonnI
HonIfh InforvIow Survoy 2009, Sor. l0, o. 249, . l24, TnbIo 3?
(oc. 20l0).
5
IchoIng THI CHIII J!STICI, fho joInf dIssonfors urgo fhnf fho mIn-
Imum covorngo rovIsIon ImormIssIbIy roguInfos young ooIo who
hnvo no InfonfIon of urchnsIng |modIcnI cnro] nnd nro foo fnr ro-
movod from fho |honIfh-cnro] mnrkof. Soo poe/, nf 8, ll. ThIs crIfIcIsm
Ignoros fho ronIIfy fhnf n honIfhy young orson mny bo n dny nwny
from noodIng honIfh cnro. Soo eupro, nf 4. A vIcfIm of nn nccIdonf or
unforosoon IIInoss wIII consumo oxfonsIvo modIcnI cnro ImmodInfoIy,
fhough scnrcoIy oxocfIng fo do so.

I!SIISS t. SIII!I!S
Socond, If Is Congross` roIo, nof fho Courf`s, fo doIInonfo
fho boundnrIos of fho mnrkof fho !ogIsInfuro sooks fo
roguInfo. THI CHIII J!STICI dofInos fho honIfh-cnro mnr-
kof ns IncIudIng onIy fhoso frnnsncfIons fhnf wIII occur
oIfhor In fho noxf Insfnnf or wIfhIn somo (unsocIfIod)
roxImIfy fo fho noxf Insfnnf. Iuf Congross couId ronson-
nbIy hnvo vIowod fho mnrkof from n Iong-form orsocfIvo,
oncomnssIng nII frnnsncfIons vIrfunIIy corfnIn fo occur
ovor fho noxf docndo, soo eupro, nf l9, nof jusf fhoso oc-
currIng horo nnd now.
ThIrd, confrnry fo THI CHIII J!STICI`s confonfIon, our
rocodonf doos Indood suorf |f]ho roosIfIon fhnf
Congross mny dIcfnfo fho conducf of nn IndIvIdunI fodny
bocnuso of rohosIod fufuro ncfIvIfy. An/e, nf 26. In
Wic/orJ, fho Courf uhoId n onnIfy fho IodornI Covorn-
monf Imosod on n fnrmor who grow moro whonf fhnn ho
wns ormIffod fo grow undor fho AgrIcuIfurnI Adjusfmonf
Acf of l938 (AAA). 3l? !. S., nf ll4ll5. Ho couId nof
bo onnIIzod, fho fnrmor nrguod, ns ho wns growIng fho
whonf for homo consumfIon, nof for snIo on fho oon
mnrkof. 1J., nf ll9. Tho Courf rojocfod fhIs nrgumonf.
1J., nf l2?l29. Whonf Infondod for homo consumfIon,
fho Courf nofod, ovorhnngs fho mnrkof, nnd If Inducod by
rIsIng rIcos, fonds fo fIow Info fho mnrkof nnd chock rIco
Incronsos |Infondod by fho AAA]. 1J., nf l28.
SImIInr ronsonIng suorfod fho Courf`s judgmonf In
Ioicl, whIch uhoId Congross` nufhorIfy fo roguInfo mnrI-
junnn grown for orsonnI uso. 545 !. S., nf l9. Homo-
grown mnrIjunnn subsfnnfInIIy nffocfs fho Inforsfnfo mnr-
kof for mnrIjunnn, wo obsorvod, for fho hIgh domnnd In
fho Inforsfnfo mnrkof wIII |IIkoIy] drnw such mnrIjunnn
Info fhnf mnrkof. 1IiJ.
Our docIsIons fhus ncknowIodgo Congross` nufhorIfy,
undor fho Commorco CInuso, fo dIrocf fho conducf of nn
IndIvIdunI fodny (fho fnrmor In Wic/orJ, sfood from
growIng oxcoss whonf; fho InInfIff In Ioicl, ordorod fo

2l CIfo ns: 56? !. S. ____ (20l2)
conso cuIfIvnfIng mnrIjunnn) bocnuso of n rohosIod
fufuro frnnsncfIon (fho ovonfunI snIo of fhnf whonf or
mnrIjunnn In fho Inforsfnfo mnrkof). Congross` ncfIons
nro ovon moro rnfIonnI In fhIs cnso, whoro fho fufuro
ncfIvIfy (fho consumfIon of modIcnI cnro) Is corfnIn fo
occur, fho soIo uncorfnInfy boIng fho fImo fho ncfIvIfy wIII
fnko Inco.
MnInfnInIng fhnf fho unInsurod nro nof ncfIvo In fho
honIfh-cnro mnrkof, THI CHIII J!STICI drnws nn nnnIogy
fo fho cnr mnrkof. An IndIvIdunI Is nof 'ncfIvo In fho cnr
mnrkof,` THI CHIII J!STICI obsorvos, sImIy bocnuso ho
or sho mny somodny buy n cnr. An/e, nf 25. Tho nnnIogy
Is Innf. Tho InovIfnbIo yof unrodIcfnbIo nood for modI-
cnI cnro nnd fho gunrnnfoo fhnf omorgoncy cnro wIII bo
rovIdod whon roquIrod nro condIfIons nonoxIsfonf In
ofhor mnrkofs. Thnf Is so of fho mnrkof for cnrs, nnd of
fho mnrkof for broccoII ns woII. AIfhough nn IndIvIdunI
nigl/ buy n cnr or n crown of broccoII ono dny, fhoro Is no
corfnInfy sho wIII ovor do so. And If sho ovonfunIIy wnnfs
n cnr or hns n crnvIng for broccoII, sho wIII bo obIIgod fo
ny nf fho counfor boforo rocoIvIng fho vohIcIo or nour-
Ishmonf. Sho wIII gof no froo rIdo or food, nf fho oxonso
of nnofhor consumor forcod fo ny nn InfInfod rIco. Soo
Tlonoe More Lou Cen/er v. OIono, 65l I. 3d 529, 565
(CA6 20ll) (Suffon, J., concurrIng In nrf) (!oguInfIng
how cIfIzons ny for whnf fhoy nIrondy rocoIvo (honIfh
cnro), novor quIfo know whon fhoy wIII nood, nnd In fho
cnso of sovoro IIInossos or omorgoncIos gonornIIy wIII nof
bo nbIo fo nfford, hns fow (If nny) nrnIIoIs In modorn
IIfo.). !hoIdIng fho mInImum covorngo rovIsIon on fho
ground fhnf nII nro nrfIcInnfs or wIII bo nrfIcInnfs In
fho honIfh-cnro mnrkof wouId fhoroforo cnrry no ImIIcn-
fIon fhnf Congross mny jusfIfy undor fho Commorco
CInuso n mnndnfo fo buy ofhor roducfs nnd sorvIcos.
or Is If nccurnfo fo sny fhnf fho mInImum covorngo
rovIsIon comoI|s] IndIvIdunIs . . . fo urchnso nn un-

I!SIISS t. SIII!I!S
wnnfod roducf, on/e, nf l8, or suIfo of roducfs, poe/, nf
ll, n. 2 (joInf oInIon of SCA!IA, KIIY, THOMAS, nnd
A!ITO, JJ.). If unwnnfod fodny, modIcnI sorvIco socurod by
Insurnnco mny bo dosornfoIy noodod fomorrow. VIrfunIIy
ovoryono, I roIfornfo, consumos honIfh cnro nf somo oInf
In hIs or hor IIfo. Soo eupro, nf 3. HonIfh Insurnnco Is n
monns of nyIng for fhIs cnro, nofhIng moro. In roquIrIng
IndIvIdunIs fo obfnIn Insurnnco, Congross Is fhoroforo nof
mnndnfIng fho urchnso of n dIscrofo, unwnnfod roducf.
!nfhor, Congross Is moroIy dofInIng fho forms on whIch
IndIvIdunIs ny for nn Inforsfnfo good fhoy consumo:
Iorsons subjocf fo fho mnndnfo musf now ny for modIcnI
cnro In ndvnnco (Insfond of nf fho oInf of sorvIco) nnd
fhrough Insurnnco (Insfond of ouf of ockof). IsfnbIIshIng
nymonf forms for goods In or nffocfIng Inforsfnfo com-
morco Is quInfossonfInI oconomIc roguInfIon woII wIfhIn
Congross` domnIn. Soo, e.g., Ini/eJ S/o/ee v. Wrigl/uooJ
Doir, Co., 3l5 !. S. ll0, ll8 (l942). Cf. poe/, nf l3 (joInf
oInIon of SCA!IA, KIIY, THOMAS, nnd A!ITO, JJ.)
(rocognIzIng fhnf fho IodornI Covornmonf cnn roscrIbo
|n commodIfy`s] qunIIfy . . . nnd ovon |Ifs rIco]).
THI CHIII J!STICI nIso cnIIs fho mInImum covorngo
rovIsIon nn IIIogIfImnfo offorf fo mnko young, honIfhy
IndIvIdunIs subsIdIzo Insurnnco romIums nId by fho Ioss
hnIo nnd hnrdy. Soo on/e, nf l?, 2526. ThIs comInInf,
foo, Is surIous. !ndor fho curronf honIfh-cnro sysfom,
honIfhy orsons who Inck Insurnnco rocoIvo n bonofIf for
whIch fhoy do nof ny: Thoy nro nssurod fhnf, If fhoy nood
If, omorgoncy modIcnI cnro wIII bo nvnIInbIo, nIfhough fhoy
cnnnof nfford If. Soo eupro, nf 56. Thoso who hnvo In-
surnnco bonr fho cosf of fhIs gunrnnfoo. Soo iIiJ. Iy
roquIrIng fho honIfhy unInsurod fo obfnIn Insurnnco or
ny n onnIfy sfrucfurod ns n fnx, fho mInImum covorngo
rovIsIon onds fho froo rIdo fhoso IndIvIdunIs curronfIy
onjoy.
In fho fuIInoss of fImo, moroovor, fodny`s young nnd

23 CIfo ns: 56? !. S. ____ (20l2)
honIfhy wIII bocomo socIofy`s oId nnd InfIrm. VIowod ovor
n IIfosnn, fho cosfs nnd bonofIfs ovon ouf: Tho young who
ny moro fhnn fhoIr fnIr shnro curronfIy wIII ny Ioss fhnn
fhoIr fnIr shnro whon fhoy bocomo sonIor cIfIzons. And
ovon If, ns undoubfodIy wIII bo fho cnso, somo IndIvIdunIs,
ovor fhoIr IIfosnns, wIII ny moro for honIfh Insurnnco
fhnn fhoy rocoIvo In honIfh sorvIcos, fhoy hnvo IIffIo fo
comInIn nbouf, for fhnf Is how Insurnnco works. Ivory
Insurod orson rocoIvos rofocfIon ngnInsf n cnfnsfrohIc
Ioss, ovon fhough onIy n subsof of fho covorod cInss wIII
uIfImnfoIy nood fhnf rofocfIon.
b
In nny ovonf, THI CHIII J!STICI`s IImIfnfIon of fho
commorco owor fo fho roguInfIon of fhoso ncfIvoIy on-
gngod In commorco fInds no homo In fho foxf of fho ConsfI-
fufIon or our docIsIons. ArfIcIo I, 8, of fho ConsfIfufIon
grnnfs Congross fho owor |f]o roguInfo Commorco . . .
nmong fho sovornI Sfnfos. ofhIng In fhIs Inngungo Im-
IIos fhnf Congross` commorco owor Is IImIfod fo rogu-
InfIng fhoso ncfIvoIy ongngod In commorcInI frnnsncfIons.
Indood, ns fho . C. CIrcuIf obsorvod, |n]f fho fImo fho
ConsfIfufIon wns |frnmod], fo 'roguInfo` monnf, nmong
ofhor fhIngs, fo roquIro ncfIon. Soo Seten-S/, v. HolJer,
66l I. 3d l, l6 (20ll).
ArguIng fo fho confrnry, THI CHIII J!STICI nofos fhnf
fho ConsfIfufIon gIvos Congross fho owor fo 'coIn
Monoy,` In nddIfIon fo fho owor fo 'roguInfo fho VnIuo
fhoroof,` nnd sImIInrIy gIvos Congross fho owor fo 'rnIso
nnd suorf ArmIos` nnd fo 'rovIdo nnd mnInfnIn n nvy,` In
nddIfIon fo fho owor fo 'mnko !uIos for fho Covornmonf
nnd !oguInfIon of fho Innd nnd nnvnI Iorcos.` An/e, nf
l8l9 (cIfIng Arf. I, 8, cIs. 5, l2l4). In sonrnfIng fho
owor fo roguInfo from fho owor fo brIng fho subjocf of
fho roguInfIon Info oxIsfonco, THI CHIII J!STICI nssorfs,
|f]ho Inngungo of fho ConsfIfufIon rofIocfs fho nnfurnI

I!SIISS t. SIII!I!S
undorsfnndIng fhnf fho owor fo roguInfo nssumos fhoro Is
nIrondy somofhIng fo bo roguInfod. An/e, nf l9.
ThIs nrgumonf Is dIffIcuIf fo fnfhom. !oquIrIng IndIvId-
unIs fo obfnIn Insurnnco unquosfIonnbIy roguInfos fho Infor-
sfnfo honIfh-Insurnnco nnd honIfh-cnro mnrkofs, bofh of
fhom In oxIsfonco woII boforo fho onncfmonf of fho ACA.
Soo Wic/orJ, 3l? !. S., nf l28 (Tho sfImuInfIon of com-
morco Is n uso of fho roguInfory funcfIon quIfo ns dofInIfoIy
ns rohIbIfIons or rosfrIcfIons fhoroon.). Thus, fho somo-
fhIng fo bo roguInfod wns suroIy fhoro whon Congross
cronfod fho mInImum covorngo rovIsIon.
6
or doos our cnso Inw foo fho ncfIvIfy vorsus InncfIv-
Ify IIno. In Wic/orJ, for oxnmIo, wo uhoId fho onnIfy
Imosod on n fnrmor who grow foo much whonf, ovon
fhough fho roguInfIon hnd fho offocf of comoIIIng fnrmors
fo urchnso whonf In fho oon mnrkof. 1J., nf l2?l29.
|I]orcIng somo fnrmors Info fho mnrkof fo buy whnf fhoy
couId rovIdo for fhomsoIvos wns, fho Courf hoId, n vnIId
monns of roguInfIng commorco. 1J., nf l28l29. In nn-
ofhor confoxf, fhIs Courf sImIInrIy uhoId Congross` nufhor-
Ify undor fho commorco owor fo comoI nn InncfIvo Innd-
hoIdor fo submIf fo nn unwnnfod snIo. Soo Monongolelo
Aot. Co. v. Ini/eJ S/o/ee, l48 !. S. 3l2, 33533? (l893)
(|!]on /le [greo/] pouer /o regulo/e connerce|,] Con-
gross hns fho nufhorIfy fo mnndnfo fho snIo of ronI ro-
orfy fo fho Covornmonf, whoro fho snIo Is ossonfInI fo fho
Imrovomonf of n nnvIgnbIo wnforwny (omhnsIs nddod));
Clero/ee Ao/ion v. Sou/lern Koneoe I. Co., l35 !. S. 64l,

6
THI CHIII J!STICI`s roIInnco on fho quofod nssngos of fho ConsfI-
fufIon, soo on/e, nf l8l9, Is nIso dubIous on ofhor grounds. Tho owor
fo roguInfo fho VnIuo of fho nnfIonnI curroncy rosumnbIy IncIudos
fho owor fo Incronso fho curroncy`s worfhi.e., fo cronfo vnIuo whoro
nono rovIousIy oxIsfod. And If fho owor fo |r]oguInf|o] . . . fho Innd
nnd nnvnI Iorcos rosuosos fhoro Is nIrondy |In oxIsfonco] somo-
fhIng fo bo roguInfod, i.e., nn Army nnd n nvy, doos Congross Inck
nufhorIfy fo cronfo nn AIr Iorco

25 CIfo ns: 56? !. S. ____ (20l2)
65?659 (l890) (sImIInr roIInnco on fho commorco owor
rognrdIng mnndnfod snIo of rIvnfo roorfy for rnIIrond
consfrucfIon).
In concIudIng fhnf fho Commorco CInuso doos nof or-
mIf Congross fo roguInfo commorcInI InncfIvIfy, nnd fhoro-
foro doos nof nIIow Congross fo ndof fho rncfIcnI soIu-
fIon If dovIsod for fho honIfh-cnro robIom, THI CHIII
J!STICI vIows fho CInuso ns n fochnIcnI IognI concofIon,
rocIsoIy whnf our cnso Inw foIIs us nof fo do. Wic/orJ,
3l? !. S., nf l22 (InfornnI quofnfIon mnrks omIffod). Soo
nIso eupro, nf l4l6. ThIs Courf`s formor ondonvors fo
Imoso cnfogorIcnI IImIfs on fho commorco owor hnvo nof
fnrod woII. In sovornI ro-ow onI cnsos, fho Courf
nffomfod fo cnbIn Congross` Commorco CInuso nufhorIfy
by dIsfInguIshIng commorco from ncfIvIfy onco concoIvod
fo bo noncommorcInI, nofnbIy, roducfIon, mInIng, nnd
mnnufncfurIng. Soo, e.g., Ini/eJ S/o/ee v. 1. C. Knigl/
Co., l56 !. S. l, l2 (l895) (Commorco succoods fo mnnu-
fncfuro, nnd Is nof n nrf of If.); Cor/er v. Cor/er Cool Co.,
298 !. S. 238, 304 (l936) (MInIng brIngs fho subjocf
mnffor of commorco Info oxIsfonco. Commorco dIsosos of
If.). Tho Courf nIso soughf fo dIsfInguIsh ncfIvIfIos hnv-
Ing n dIrocf offocf on Inforsfnfo commorco, nnd for fhnf
ronson, subjocf fo fodornI roguInfIon, from fhoso hnvIng
onIy nn IndIrocf offocf, nnd fhoroforo nof nmonnbIo fo
fodornI confroI. Soo, e.g., A. L. A. Sclecl/er Poul/r, Corp.
v. Ini/eJ S/o/ee, 295 !. S. 495, 548 (l935) (|T]ho dIs-
fIncfIon bofwoon dIrocf nnd IndIrocf offocfs of Infrnsfnfo
frnnsncfIons uon Inforsfnfo commorco musf bo rocognIzod
ns n fundnmonfnI ono.).
Thoso IIno-drnwIng oxorcIsos woro unfonnbIo, nnd fho
Courf Iong ngo nbnndonod fhom. |Q]uosfIons of fho owor
of Congross |undor fho Commorco CInuso], wo hoId In
Wic/orJ, nro nof fo bo docIdod by roforonco fo nny for-
muIn whIch wouId gIvo confroIIIng forco fo nomoncInfuro such
ns 'roducfIon` nnd 'IndIrocf` nnd forocIoso consIdornfIon of

I!SIISS t. SIII!I!S
fho ncfunI offocfs of fho ncfIvIfy In quosfIon uon Infor-
sfnfo commorco. 3l? !. S., nf l20. Soo nIso Morrieon,
529 !. S., nf 64l644 (Soufor, J., dIssonfIng) (rocounfIng
fho Courf`s nonrIy dIsnsfrous oxorImonf wIfh formnIIs-
fIc IImIfs on Congross` commorco owor). InIIIng fo Ionrn
from fhIs hIsfory, THI CHIII J!STICI Iows nhond wIfh
hIs formnIIsfIc dIsfIncfIon bofwoon fhoso who nro ncfIvo
In commorco, on/e, nf 20, nnd fhoso who nro nof.
If Is nof hnrd fo show fho dIffIcuIfy courfs (nnd Con-
gross) wouId oncounfor In dIsfInguIshIng sfnfufos fhnf rog-
uInfo ncfIvIfy from fhoso fhnf roguInfo InncfIvIfy. As
Judgo Insforbrook nofod, If Is ossIbIo fo rosfnfo mosf
ncfIons ns corrosondIng InncfIons wIfh fho snmo offocf.
Arclie v. Iocine, 84? I. 2d l2ll, l2l3 (CA? l988) (on
bnnc). Tnko fhIs cnso ns nn oxnmIo. An IndIvIdunI who
ofs nof fo urchnso Insurnnco from n rIvnfo Insuror cnn
bo soon ns ncfIvoIy soIocfIng nnofhor form of Insurnnco:
soIf-Insurnnco. Soo Tlonoe More Lou Cen/er, 65l I. 3d,
nf 56l (Suffon, J., concurrIng In nrf) (o ono Is In-
ncfIvo whon docIdIng how fo ny for honIfh cnro, ns soIf-
Insurnnco nnd rIvnfo Insurnnco nro fwo forms of ncfIon
for nddrossIng fho snmo rIsk.). Tho mInImum covorngo
rovIsIon couId fhoroforo bo doscrIbod ns roguInfIng ncfIv-
Isfs In fho soIf-Insurnnco mnrkof.
?
Wic/orJ Is nnofhor
oxnmIo. Id fho sfnfufo fhoro nf Issuo fnrgof ncfIvIfy
(fho growIng of foo much whonf) or InncfIvIfy (fho fnrmor`s
fnIIuro fo urchnso whonf In fho mnrkofInco) If nny-
fhIng, fho Courf`s nnnIysIs suggosfod fho Inffor. Soo 3l?
!. S., nf l2?l29.
Af boffom, THI CHIII J!STICI`s nnd fho joInf dIssonf-

?
THI CHIII J!STICI`s chnrncforIznfIon of IndIvIdunIs who chooso nof
fo urchnso rIvnfo Insurnnco ns doIng nofhIng, on/e, nf 20, Is sImI-
InrIy quosfIonnbIo. A orson who soIf-Insuros ofs ngnInsf ronymonf for
n roducf fho orson wIII In fImo consumo. Whon nggrognfod, oxorcIso
of fhnf ofIon hns n subsfnnfInI Imncf on fho honIfh-cnro mnrkof. Soo
eupro, nf 5?, l6l?.

2? CIfo ns: 56? !. S. ____ (20l2)
ors` vIow fhnf nn IndIvIdunI cnnnof bo subjocf fo Com-
morco CInuso roguInfIon nbsonf voIunfnry, nffIrmnfIvo ncfs
fhnf onfor hIm or hor Info, or nffocf, fho Inforsfnfo mnr-
kof oxrossos n concorn for IndIvIdunI IIborfy fhnf |Is]
moro rodoIonf of uo Irocoss CInuso nrgumonfs. Seten-
S/,, 66l I. 3d, nf l9. Soo nIso Troxel v. Grontille, 530
!. S. 5?, 65 (2000) (IurnIIfy oInIon) (Tho |uo Irocoss]
CInuso nIso IncIudos n subsfnnfIvo comononf fhnf ro-
vIdos hoIghfonod rofocfIon ngnInsf govornmonf Inforfor-
onco wIfh corfnIn fundnmonfnI rIghfs nnd IIborfy Infor-
osfs. (InfornnI quofnfIon mnrks omIffod)). IInInfIffs hnvo
nbnndonod nny nrgumonf Innod fo subsfnnfIvo duo ro-
coss, howovor, soo 648 I. 3d l235, l29l, n. 93 (CAll
20ll), nnd now concodo fhnf fho rovIsIons horo nf Issuo
do nof offond fho uo Irocoss CInuso.
8
2
!ndorIyIng THI CHIII J!STICI`s vIow fhnf fho Com-
morco CInuso musf bo confInod fo fho roguInfIon of ncfIvo
nrfIcInnfs In n commorcInI mnrkof Is n fonr fhnf fho
commorco owor wouId ofhorwIso know no IImIfs. Soo,
e.g., on/e, nf 23 (AIIowIng Congross fo comoI nn IndIvId-
unI nof ongngod In commorco fo urchnso n roducf wouId
ormI|f] Congross fo ronch boyond fho nnfurnI oxfonf
of Ifs nufhorIfy, ovorywhoro oxfondIng fho shoro of Ifs
ncfIvIfy, nnd drnwIng nII owor Info Ifs Imofuous vorfox.
(InfornnI quofnfIon mnrks omIffod)). Tho joInf dIssonfors

8
Somo ndhoronfs fo fho joInf dIssonf hnvo quosfIonod fho oxIsfonco of
subsfnnfIvo duo rocoss rIghfs. Soo McDonolJ v. Clicogo, 56l !. S.
___, ___ (20l0) (THOMAS, J., concurrIng) (sII o., nf ?) (Tho nofIon fhnf
fho uo Irocoss CInuso couId dofIno fho subsfnnco of fh|o] rIgh|f fo
IIborfy] sfrnIns croduIIfy.); AlIrigl/ v. Oliter, 5l0 !. S. 266, 2?5 (l994)
(SCA!IA, J., concurrIng) (I rojocf fho roosIfIon fhnf fho uo Irocoss
CInuso gunrnnfoos corfnIn (unsocIfIod) IIborfIos|.]). CIvon fhoso
JusfIcos` roIucfnnco fo Inforrof fho uo Irocoss CInuso ns gunrnnfoo-
Ing IIborfy Inforosfs, fhoIr wIIIIngnoss fo Innf such rofocfIons In fho
Commorco CInuso Is sfrIkIng.

I!SIISS t. SIII!I!S
oxross n sImIInr nrohonsIon. Soo poe/, nf 8 (If fho
mInImum covorngo rovIsIon Is uhoId undor fho com-
morco owor fhon fho Commorco CInuso bocomos n fonf of
unIImIfod owor, . . . fho hIdoous monsfor whoso dovour-
Ing jnws . . . snro noIfhor sox nor ngo, nor hIgh nor Iow,
nor sncrod nor rofnno. (InfornnI quofnfIon mnrks omIf-
fod)). ThIs concorn Is unfoundod.
IIrsf, THI CHIII J!STICI couId corfnInIy uhoId fho
IndIvIdunI mnndnfo wIfhouf gIvIng Congross cor/e Iloncle
fo onncf nny nnd nII urchnso mnndnfos. As sovornI fImos
nofod, fho unIquo nffrIbufos of fho honIfh-cnro mnrkof
rondor ovoryono ncfIvo In fhnf mnrkof nnd gIvo rIso fo n
sIgnIfIcnnf froo-rIdIng robIom fhnf doos nof occur In ofhor
mnrkofs. Soo eupro, nf 3?, l6l8, 2l.
or wouId fho commorco owor bo unbrIdIod, nbsonf
THI CHIII J!STICI`s ncfIvIfy IImIfnfIon. Congross wouId
romnIn unnbIo fo roguInfo nonoconomIc conducf fhnf hns
onIy nn nffonunfod offocf on Inforsfnfo commorco nnd Is
frndIfIonnIIy Ioff fo sfnfo Inw. Soo Lopec, 5l4 !. S., nf
56?; Morrieon, 529 !. S., nf 6l?6l9. In Lopec, for
oxnmIo, fho Courf hoId fhnf fho IodornI Covornmonf
Inckod owor, undor fho Commorco CInuso, fo crImInnIIzo
fho ossossIon of n gun In n IocnI schooI zono. IossossIng
n gun nonr n schooI, fho Courf ronsonod, Is In no sonso
nn oconomIc ncfIvIfy fhnf mIghf, fhrough roofIfIon oIso-
whoro, subsfnnfInIIy nffocf nny sorf of Inforsfnfo com-
morco. 5l4 !. S., nf 56?; iIiJ. (nofIng fhnf fho Courf
wouId hnvo fo IIo Inforonco uon Inforonco fo concIudo
fhnf gun ossossIon hns n subsfnnfInI offocf on commorco).
!oIyIng on sImIInr IogIc, fho Courf concIudod In Morrieon
fhnf Congross couId nof roguInfo gondor-mofIvnfod vIo-
Ionco, whIch fho Courf doomod fo hnvo foo nffonunfod
|nn] offocf uon Inforsfnfo commorco. 529 !. S., nf 6l5.
An IndIvIdunI`s docIsIon fo soIf-Insuro, I hnvo oxInInod,
Is nn oconomIc ncf wIfh fho roquIsIfo connocfIon fo Infor-
sfnfo commorco. Soo eupro, nf l6l?. Ofhor choIcos

29 CIfo ns: 56? !. S. ____ (20l2)
IndIvIdunIs mnko nro unIIkoIy fo fIf fho snmo or sImIInr
doscrIfIon. As nn oxnmIo of fho fyo of roguInfIon ho
fonrs, THI CHIII J!STICI cIfos n Covornmonf mnndnfo fo
urchnso groon vogofnbIos. An/e, nf 2223. Ono couId cnII
fhIs concorn fho broccoII horrIbIo. Congross, THI CHIII
J!STICI osIfs, mIghf ndof such n mnndnfo, ronsonIng
fhnf nn IndIvIdunI`s fnIIuro fo onf n honIfhy dIof, IIko fho
fnIIuro fo urchnso honIfh Insurnnco, Imosos cosfs on
ofhors. Soo iIiJ.
ConsIdor fho chnIn of Inforoncos fho Courf wouId hnvo
fo nccof fo concIudo fhnf n vogofnbIo-urchnso mnndnfo
wns IIkoIy fo hnvo n subsfnnfInI offocf on fho honIfh-cnro
cosfs borno by IIfho AmorIcnns. Tho Courf wouId hnvo fo
boIIovo fhnf IndIvIdunIs forcod fo buy vogofnbIos wouId
fhon onf fhom (Insfond of fhrowIng or gIvIng fhom nwny),
wouId ronro fho vogofnbIos In n honIfhy wny (sfonmod
or rnw, nof doo-frIod), wouId cuf bnck on unhonIfhy foods,
nnd wouId nof nIIow ofhor fncfors (such ns Inck of oxorcIso
or IIffIo sIoo) fo frum fho Imrovod dIof.
9
Such II|Ing
of] Inforonco uon Inforonco Is jusf whnf fho Courf ro-
fusod fo do In Lopec nnd Morrieon.
Ofhor rovIsIons of fho ConsfIfufIon nIso chock congros-
sIonnI ovorronchIng. A mnndnfo fo urchnso n nrfIcu-
Inr roducf wouId bo unconsfIfufIonnI If, for oxnmIo, fho
odIcf ImormIssIbIy nbrIdgod fho froodom of sooch, Infor-
forod wIfh fho froo oxorcIso of roIIgIon, or InfrIngod on n
IIborfy Inforosf rofocfod by fho uo Irocoss CInuso.

9
Tho fnIIuro fo urchnso vogofnbIos In THI CHIII J!STICI`s hyofhof-
IcnI, fhon, Is no/ whnf Ionds fo hIghor honIfh-cnro cosfs for ofhors;
rnfhor, If Is fho fnIIuro of IndIvIdunIs fo mnInfnIn n honIfhy dIof, nnd
fho rosuIfIng obosIfy, fhnf cronfos fho cosf-shIffIng robIom. Soo on/e,
nf 2223. !oquIrIng IndIvIdunIs fo urchnso vogofnbIos Is fhus
sovornI sfos romovod from soIvIng fho robIom. Tho fnIIuro fo obfnIn
honIfh Insurnnco, by confrnsf, Is fho inneJio/e couee of fho cosf-shIffIng
Congross soughf fo nddross fhrough fho ACA. Soo eupro, nf 5?.
!oquIrIng IndIvIdunIs fo obfnIn Insurnnco nffncks fho sourco of fho
robIom dIrocfIy, In n sIngIo sfo.

I!SIISS t. SIII!I!S
SuIomonfIng fhoso IognI rosfrnInfs Is n formIdnbIo
chock on congrossIonnI owor: fho domocrnfIc rocoss. Soo
Ioicl, 545 !. S., nf 33; Wic/orJ, 3l? !. S., nf l20 (roonf-
Ing ChIof JusfIco MnrshnII`s wnrnIng fhnf offocfIvo ro-
sfrnInfs on |fho commorco owor`s] oxorcIso musf rocood
from oIIfIcnI rnfhor fhnn judIcInI rocossos (cIfIng GiI-
Ione v. OgJen, 9 Whonf. l, l9? (l824)). As fho confrovorsy
surroundIng fho nssngo of fho AffordnbIo Cnro Acf nf-
fosfs, urchnso mnndnfos nro IIkoIy fo ongondor oIIfIcnI
rosIsfnnco. ThIs rosocf Is borno ouf by fho bohnvIor of
sfnfo IogIsInfors. osIfo fhoIr ossossIon of unquosfIonod
nufhorIfy fo Imoso mnndnfos, sfnfo govornmonfs hnvo
rnroIy dono so. Soo HnII, Commorco CInuso ChnIIongos fo
HonIfh Cnro !oform, l59 !. In. !. !ov. l825, l838 (20ll).
Whon confomInfod In Ifs oxfromo, nImosf nny owor
Iooks dnngorous. Tho commorco owor, hyofhofIcnIIy,
wouId onnbIo Congross fo rohIbIf fho urchnso nnd homo
roducfIon of nII monf, fIsh, nnd dnIry goods, offocfIvoIy
comoIIIng AmorIcnns fo onf onIy vogofnbIos. Cf. Ioicl,
545 !. S., nf 9; Wic/orJ, 3l? !. S., nf l2?l29. Yof no ono
wouId offor fho hyofhofIcnI nnd unronI ossIbIIIf|y],
Pullnon Co. v. Kno//, 235 !. S. 23, 26 (l9l4), of n vogofnr-
Inn sfnfo ns n crodIbIo ronson fo dony Congross fho nufhor-
Ify ovor fo bnn fho ossossIon nnd snIo of goods. THI
CHIII J!STICI nccofs jusf such socIous IogIc whon ho
cIfos fho broccoII horrIbIo ns n ronson fo dony Congross
fho owor fo nss fho IndIvIdunI mnndnfo. Cf. !. Iork,
Tho TomfIng of AmorIcn l69 (l990) (Judgos nnd Inwyors
IIvo on fho sIIory sIoo of nnnIogIos; fhoy nro nof suosod
fo skI If fo fho boffom.). Iuf soo, e.g., poe/, nf 3 (joInf oIn-
Ion of SCA!IA, KIIY, THOMAS, nnd A!ITO, JJ.) (nssorf-
Ing, oufInndIshIy, fhnf If fho mInImum covorngo rovIsIon
Is susfnInod, fhon Congross couId mnko bronfhIng In nnd
ouf fho bnsIs for fodornI roscrIfIon).

3l CIfo ns: 56? !. S. ____ (20l2)
3
To boIsfor hIs nrgumonf fhnf fho mInImum covorngo
rovIsIon Is nof vnIId Commorco CInuso IogIsInfIon, THI
CHIII J!STICI omhnsIzos fho rovIsIon`s novoIfy. Soo
on/e, nf l8 (nssorfIng fhnf somofImos fho mosf foIIIng
IndIcnfIon of |n] sovoro consfIfufIonnI robIom . . . Is fho
Inck of hIsforIcnI rocodonf for Congross`s ncfIon (InfornnI
quofnfIon mnrks omIffod)). WhIIo nn Insurnnco-urchnso
mnndnfo mny bo novoI, THI CHIII J!STICI`s nrgumonf
corfnInIy Is nof. |I]n nImosf ovory Insfnnco of fho oxor-
cIso of fho |commorco] owor dIfforoncos nro nssorfod from
rovIous oxorcIsos of If nnd mndo n ground of nffnck.
Ho/e v. Ini/eJ S/o/ee, 22? !. S. 308, 320 (l9l3). Soo, e.g.,
IrIof for IofIfIonor In Perec v. Ini/eJ S/o/ee, O. T. l9?0,
o. 600, . 5 (unrocodonfod oxorcIso of owor); Su-
IomonfnI IrIof for AoIIoos In Ko/cenIocl v. McClung,
O. T. l964, o. 543, . 40 (novoI nssorfIon of fodornI
owor); IrIof for AoIIoo In Wic/orJ v. IilIurn, O. T.
l94l, o. 59, . 6 (comIofo donrfuro). Ior docndos,
fho Courf hns docIInod fo ovorrIdo IogIsInfIon bocnuso of
Ifs novoIfy, nnd for good ronson. As our nnfIonnI oconomy
grows nnd chnngos, wo hnvo rocognIzod, Congross musf
ndnf fo fho chnngIng oconomIc nnd fInnncInI ronIIfIos.
Soo eupro, nf l4l5. HIndorIng Congross` nbIIIfy fo do so
Is shorfsIghfod; If hIsfory Is nny guIdo, fodny`s consfrIcfIon
of fho Commorco CInuso wIII nof onduro. Soo eupro, nf
2526.
III
A
Ior fho ronsons oxInInod nbovo, fho mInImum covorngo
rovIsIon Is vnIId Commorco CInuso IogIsInfIon. Soo eu-
pro, Inrf II. Whon vIowod ns n comononf of fho onfIro
ACA, fho rovIsIon`s consfIfufIonnIIfy bocomos ovon InIn-
or.
Tho ocossnry nnd Iroor CInuso omowors Congross

I!SIISS t. SIII!I!S
fo onncf Inws In offocfunfIon of Ifs |commorco] owo|r]
fhnf nro nof wIfhIn Ifs nufhorIfy fo onncf In IsoInfIon.
Ioicl, 545 !. S., nf 39 (SCA!IA, J., concurrIng In judgmonf).
Honco, |n] comIox roguInfory rogrnm . . . cnn survIvo n
Commorco CInuso chnIIongo wIfhouf n showIng fhnf ovory
sIngIo fncof of fho rogrnm Is IndoondonfIy nnd dIrocfIy
roInfod fo n vnIId congrossIonnI gonI. 1nJiono, 452 !. S.,
nf 329, n. l?. If Is onough fhnf fho chnIIongod rovIsIons
nro nn InfogrnI nrf of fho roguInfory rogrnm nnd fhnf
fho roguInfory schomo whon consIdorod ns n whoIo snfIs-
fIos fhIs fosf. 1IiJ. (coIIocfIng cnsos). Soo nIso Ioicl,
545 !. S., nf 2425 (A chnIIongod sfnfufory rovIsIon
fIfs wIfhIn Congross` commorco nufhorIfy If If Is nn osson-
fInI nr|f] of n Inrgor roguInfIon of oconomIc ncfIvIfy,
such fhnf, In fho nbsonco of fho rovIsIon, fho roguInfory
schomo couId bo undorcuf. (quofIng Lopec, 5l4 !. S., nf
56l)); Ioicl, 545 !. S., nf 3? (SCA!IA, J., concurrIng In
judgmonf) (Congross mny roguInfo ovon nonoconomIc
IocnI ncfIvIfy If fhnf roguInfIon Is n nocossnry nrf of
n moro gonornI roguInfIon of Inforsfnfo commorco. Tho
roIovnnf quosfIon Is sImIy whofhor fho monns choson nro
'ronsonnbIy ndnfod` fo fho nffnInmonf of n IogIfImnfo ond
undor fho commorco owor. (cIfnfIon omIffod)).
!ocnII fhnf ono of Congross` gonIs In onncfIng fho Af-
fordnbIo Cnro Acf wns fo oIImInnfo fho Insurnnco Indus-
fry`s rncfIco of chnrgIng hIghor rIcos or donyIng covorngo
fo IndIvIdunIs wIfh rooxIsfIng modIcnI condIfIons. Soo
eupro, nf 9l0. Tho commorco owor nIIows Congross fo
bnn fhIs rncfIco, n oInf no ono dIsufos. Soo Ini/eJ
S/o/ee v. Sou/l-1oe/ern InJeruri/ere Aeen., 322 !. S. 533,
545, 552553 (l944) (Congross mny roguInfo fho mofhods
by whIch Inforsfnfo Insurnnco comnnIos do busInoss.).
Congross know, howovor, fhnf sImIy bnrrIng Insurnnco
comnnIos from roIyIng on nn nIIcnnf`s modIcnI hIsfory
wouId nof work In rncfIco. WIfhouf fho IndIvIdunI mnn-
dnfo, Congross Ionrnod, gunrnnfood-Issuo nnd communIfy-

33 CIfo ns: 56? !. S. ____ (20l2)
rnfIng roquIromonfs wouId frIggor nn ndvorso-soIocfIon
donfh-sIrnI In fho honIfh-Insurnnco mnrkof: Insurnnco
romIums wouId skyrockof, fho numbor of unInsurod
wouId Incronso, nnd Insurnnco comnnIos wouId oxIf fho
mnrkof. Soo eupro, nf l0ll. Whon comIomonfod by nn
Insurnnco mnndnfo, on fho ofhor hnnd, gunrnnfood Issuo
nnd communIfy rnfIng wouId work ns Infondod, IncronsIng
nccoss fo Insurnnco nnd roducIng uncomonsnfod cnro.
Soo eupro, nf lll2. Tho mInImum covorngo rovIsIon Is
fhus nn ossonfInI nr|f] of n Inrgor roguInfIon of oconomIc
ncfIvIfy; wIfhouf fho rovIsIon, fho roguInfory schomo
|w]ouId bo undorcuf. Ioicl, 545 !. S., nf 2425 (Infor-
nnI quofnfIon mnrks omIffod). Iuf dIfforonfIy, fho mInI-
mum covorngo rovIsIon, fogofhor wIfh fho gunrnnfood-
Issuo nnd communIfy-rnfIng roquIromonfs, Is 'ronsonnbIy
ndnfod` fo fho nffnInmonf of n IogIfImnfo ond undor
fho commorco owor: fho oIImInnfIon of rIcIng nnd
snIos rncfIcos fhnf fnko nn nIIcnnf`s modIcnI hIsfory
Info nccounf. Soo iJ., nf 3? (SCA!IA, J., concurrIng In
judgmonf).
I
AssorfIng fhnf fho ocossnry nnd Iroor CInuso doos
nof nufhorIzo fho mInImum covorngo rovIsIon, THI CHIII
J!STICI focusos on fho word roor. A mnndnfo fo
urchnso honIfh Insurnnco Is nof roor IogIsInfIon, THI
CHIII J!STICI urgos, bocnuso fho commnnd undor-
mIno|s] fho sfrucfuro of govornmonf osfnbIIshod by fho
ConsfIfufIon. An/e, nf 28. If Iong on rhoforIc, THI CHIII
J!STICI`s nrgumonf Is shorf on subsfnnco.
THI CHIII J!STICI cIfos onIy fwo cnsos In whIch fhIs
Courf concIudod fhnf n fodornI sfnfufo ImormIssIbIy
frnnsgrossod fho ConsfIfufIon`s boundnry bofwoon sfnfo
nnd fodornI nufhorIfy: Prin/c v. Ini/eJ S/o/ee, 52l !. S.
898 (l99?), nnd Aeu Yor/ v. Ini/eJ S/o/ee, 505 !. S.
l44 (l992). Soo on/e, nf 29. Tho sfnfufos nf Issuo In

I!SIISS t. SIII!I!S
bofh cnsos, howovor, comoIIod e/o/e officiole fo ncf on fho
IodornI Covornmonf`s bohnIf. 52l !. S., nf 925933 (hoId-
Ing unconsfIfufIonnI n sfnfufo obIIgnfIng sfnfo Inw on-
forcomonf offIcors fo ImIomonf n fodornI gun-confroI Inw);
Aeu Yor/, 505 !. S., nf l?6l?? (sfrIkIng down n sfnfufo
roquIrIng sfnfo IogIsInfors fo nss roguInfIons ursunnf fo
Congross` InsfrucfIons). |IodornI] Inws conscrIfIng sfnfo
offIcors, fho Courf ronsonod, vIoInfo sfnfo sovoroIgnfy
nnd nro fhus nof In nccord wIfh fho ConsfIfufIon. Prin/c,
52l !. S., nf 925, 935; Aeu Yor/, 505 !. S., nf l?6.
Tho mInImum covorngo rovIsIon, In confrnsf, ncfs
dIrocfIy uon IndIvIdunIs, wIfhouf omIoyIng fho Sfnfos
ns InformodInrIos. Aeu Yor/, 505 !. S., nf l64. Tho
rovIsIon Is fhus onfIroIy consIsfonf wIfh fho ConsfI-
fufIon`s dosIgn. Soo Prin/c, 52l !. S., nf 920 (|T]ho
Irnmors oxIIcIfIy choso n ConsfIfufIon fhnf confors uon
Congross fho owor fo roguInfo IndIvIdunIs, nof Sfnfos.
(InfornnI quofnfIon mnrks omIffod)).
!nckIng cnso Inw suorf for hIs hoIdIng, THI CHIII
J!STICI novorfhoIoss docInros fho mInImum covorngo
rovIsIon nof roor bocnuso If Is Ioss nnrrow In scoo
fhnn ofhor Inws fhIs Courf hns uhoId undor fho ocos-
snry nnd Iroor CInuso. An/e, nf 29 (cIfIng Ini/eJ S/o/ee
v. Cone/oc/, 560 !. S. ___ (20l0); SoIri v. Ini/eJ S/o/ee,
54l !. S. 600 (2004); Jin/e v. IicllonJ Coun/,, 538 !. S.
456 (2003)). THI CHIII J!STICI`s roIInnco on cnsos In
whIch fhIs Courf hns offirneJ Congross` brond nufhorIfy
fo onncf fodornI IogIsInfIon undor fho ocossnry nnd
Iroor CInuso, Cone/oc/, 560 !. S., nf ___ (sII o., nf 5),
Is undorwhoImIng.
or doos THI CHIII J!STICI nuso fo oxInIn ul, fho
owor fo dIrocf oIfhor fho urchnso of honIfh Insurnnco or,
nIfornnfIvoIy, fho nymonf of n onnIfy coIIocfIbIo ns n fnx
Is moro fnr-ronchIng fhnn ofhor ImIIod owors fhIs Courf
hns found moof undor fho ocossnry nnd Iroor CInuso.
Thoso owors IncIudo fho owor fo onncf crImInnI Inws,

35 CIfo ns: 56? !. S. ____ (20l2)
soo, e.g., Ini/eJ S/o/ee v. Iox, 95 !. S. 6?0, 6?2 (l8?8); fho
owor fo ImrIson, IncIudIng cIvII ImrIsonmonf, soo, e.g.,
Cone/oc/, 560 !. S., nf ___ (sII o., nf l); nnd fho owor
fo cronfo n nnfIonnI bnnk, soo McCullocl, 4 Whonf., nf 425.
Soo nIso Jin/e, 538 !. S., nf 463 (nffIrmIng Congross`
owor fo nIfor fho wny n sfnfo Inw Is nIIod In sfnfo courf,
whoro fho nIfornfIon romofos fnIr nnd offIcIonf oornfIon
of fho fodornI courfs).
l0
In fnIIIng fo oxInIn why fho IndIvIdunI mnndnfo fhronf-
ons our consfIfufIonnI ordor, THI CHIII J!STICI dIssorvos
fufuro courfs. How Is n judgo fo docIdo, whon ruIIng on
fho consfIfufIonnIIfy of n fodornI sfnfufo, whofhor Con-
gross omIoyod nn Indoondonf owor, on/e, nf 28, or
moroIy n dorIvnfIvo ono, on/e, nf 29. Whofhor fho owor
usod Is subsfnnfIvo, on/e, nf 30, or jusf IncIdonfnI, on/e,
nf 29 Tho InsfrucfIon THI CHIII J!STICI, In offocf,
rovIdos Iowor courfs: You wIII know If whon you soo If.
If Is moro fhnn oxnggornfIon fo suggosf fhnf fho mInI-
mum covorngo rovIsIon ImroorIy Infrudos on ossonfInI
nffrIbufos of sfnfo sovoroIgnfy. 1IiJ. (InfornnI quofnfIon
mnrks omIffod). IIrsf, fho AffordnbIo Cnro Acf doos nof
oornfo In |nn] nro|n] such ns crImInnI Inw onforcomonf or
oducnfIon whoro Sfnfos hIsforIcnIIy hnvo boon sovoroIgn.
Lopec, 5l4 !. S., nf 564. As ovIdoncod by ModIcnro, ModI-
cnId, fho ImIoyoo !ofIromonf Incomo SocurIfy Acf of
l9?4 (I!ISA), nnd fho HonIfh Insurnnco IorfnbIIIfy nnd
AccounfnbIIIfy Acf of l996 (HIIAA), fho IodornI Covorn-

l0
Indood, Congross roguInrIy nnd unconfrovorsInIIy roquIros IndIvId-
unIs who nro doIng nofhIng, soo on/e, nf 20, fo fnko ncfIon. Ixnm-
Ios IncIudo fodornI roquIromonfs fo roorf for jury dufy, 28 !. S. C.
l866(g) (2006 od., Su. IV); fo rogIsfor for soIocfIvo sorvIco, 50
!. S. C. A. 453; fo urchnso fIronrms nnd gonr In nnfIcInfIon of
sorvIco In fho MIIIfIn, l Sfnf. 2?l (!nIform MIIIfIn Acf of l?92); fo furn
goId curroncy ovor fo fho IodornI Covornmonf In oxchnngo for nor
curroncy, soo Aor/c v. Ini/eJ S/o/ee, 294 !. S. 3l?, 328 (l935); nnd fo
fIIo n fnx rofurn, 26 !. S. C. 60l2 (2006 od., Su. IV).

I!SIISS t. SIII!I!S
monf Inys n Iond roIo In fho honIfh-cnro socfor, bofh ns n
dIrocf nyor nnd ns n roguInfor.
Socond, nnd orhns mosf Imorfnnf, fho mInImum
covorngo rovIsIon, nIong wIfh ofhor rovIsIons of fho
ACA, nddrossos fho vory sorf of Inforsfnfo robIom fhnf
mndo fho commorco owor ossonfInI In our fodornI sysfom.
Soo eupro, nf l2l4. Tho crIsIs cronfod by fho Inrgo num-
bor of !. S. rosIdonfs who Inck honIfh Insurnnco Is ono of
nnfIonnI dImonsIon fhnf Sfnfos nro sonrnfoIy Incomo-
fonf fo hnndIo. Soo eupro, nf ?8, l3. Soo nIso MnryInnd
IrIof l526 (doscrIbIng fho ImodImonfs fo offocfIvo sfnfo
oIIcymnkIng fhnf fIow from fho Inforconnocfodnoss of
onch sfnfo`s honIfhcnro oconomy nnd omhnsIzIng fhnf
sfnfo-IovoI roforms cnnnof fuIIy nddross fho robIoms
nssocInfod wIfh uncomonsnfod cnro). Inr from frnm-
IIng on Sfnfos` sovoroIgnfy, fho ACA nffomfs n fodornI
soIufIon for fho vory ronson fhnf fho Sfnfos, ncfIng son-
rnfoIy, cnnnof moof fho nood. ofnbIy, fho ACA sorvos fho
gonornI woIfnro of fho ooIo of fho !nIfod Sfnfos whIIo
rofnInIng n romInonf roIo for fho Sfnfos. Soo iJ., nf 3l
36 (oxInInIng nnd IIIusfrnfIng how fho ACA nffords Sfnfos
wIdo InfIfudo In ImIomonfIng koy oIomonfs of fho Acf`s
roforms).
ll

ll
In n sonrnfo nrgumonf, fho joInf dIssonfors confond fhnf fho mIn-
Imum covorngo rovIsIon Is nof nocossnry nnd roor bocnuso If wns nof
fho onIy . . . wny Congross couId hnvo mndo fho gunrnnfood-Issuo nnd
communIfy-rnfIng roforms work. Poe/, nf 9l0. Congross couId nIso
hnvo nvoIdod nn Insurnnco-mnrkof donfh sIrnI, fho dIssonfors mnIn-
fnIn, by ImosIng n surchnrgo on fhoso who dId nof rovIousIy urchnso
Insurnnco whon fhoso IndIvIdunIs ovonfunIIy onfor fho honIfh-
Insurnnco sysfom. Poe/, nf l0. Or Congross couId don|y] n fuII Incomo
fnx crodIf fo fhoso who do nof urchnso Insurnnco. 1IiJ.
oIfhor n surchnrgo on fhoso who urchnso Insurnnco nor fho do-
nInI of n fnx crodIf fo fhoso who do nof wouId soIvo fho robIom cronfod
by gunrnnfood-Issuo nnd communIfy-rnfIng roquIromonfs. oIfhor
wouId romf fho urchnso of Insurnnco boforo sIcknoss or Injury
occurrod.

3? CIfo ns: 56? !. S. ____ (20l2)
IV
In fho onrIy 20fh confury, fhIs Courf roguInrIy sfruck
down oconomIc roguInfIon onncfod by fho ooIos` roro-
sonfnfIvos In bofh fho Sfnfos nnd fho IodornI Covornmonf.
Soo, e.g., Cor/er Cool Co., 298 !. S., nf 303304, 3093l0;
Dogenlor/, 24? !. S., nf 2?62??; Loclner v. Aeu Yor/,
l98 !. S. 45, 64 (l905). THI CHIII J!STICI`s Commorco
CInuso oInIon, nnd ovon moro so fho joInf dIssonfors`
ronsonIng, soo poe/, nf 4l6, bonr n dIsquIofIng rosom-
bInnco fo fhoso Iong-ovorruIod docIsIons.
!IfImnfoIy, fho Courf uhoIds fho IndIvIdunI mnndnfo
ns n roor oxorcIso of Congross` owor fo fnx nnd sond
for fho . . . gonornI WoIfnro of fho !nIfod Sfnfos. Arf. I,
8, cI. l; on/e, nf 4344. I concur In fhnf doformInnfIon,
whIch mnkos THI CHIII J!STICI`s Commorco CInuso
ossny nII fho moro uzzIIng. Why shouId THI CHIII
J!STICI sfrIvo so mIghfIIy fo hom In Congross` cnncIfy fo
moof fho now robIoms nrIsIng consfnnfIy In our ovor-
dovoIoIng modorn oconomy I fInd no snfIsfyIng rosonso
fo fhnf quosfIon In hIs oInIon.
l2

Iuf ovon nssumIng fhoro woro rncfIcnbIo nIfornnfIvos fo fho
mInImum covorngo rovIsIon, wo Iong ngo rojocfod fho vIow fhnf fho
ocossnry nnd Iroor CInuso domnnds fhnf nn Acf of Congross bo
'oIeolu/el, nocossnry` fo fho oxorcIso of nn onumornfod owor. Jin/e
v. IicllonJ Coun/,, 538 !. S. 456, 462 (2003) (quofIng McCullocl
v. Mor,lonJ, 4 Whonf. 3l6, 4l44l5 (l8l9)). !nfhor, fho sfnfufory
rovIsIon nf Issuo nood onIy bo conducIvo nnd |ronsonnbIy] ndnfod
fo fho gonI Congross sooks fo nchIovo. Jin/e, 538 !. S., nf 462 (InfornnI
quofnfIon mnrks omIffod). Tho mInImum covorngo rovIsIon moofs fhIs
roquIromonf. Soo eupro, nf 3l33.
l2
THI CHIII J!STICI sfnfos fhnf ho musf ovnIunfo fho consfIfufIon-
nIIfy of fho mInImum covorngo rovIsIon undor fho Commorco CInuso
bocnuso fho rovIsIon ronds moro nnfurnIIy ns n commnnd fo buy
Insurnnco fhnn ns n fnx. An/e, nf 44. THI CHIII J!STICI uIfImnfoIy
concIudos, howovor, fhnf InforrofIng fho rovIsIon ns n fnx Is n fnIrIy
ossIbIo consfrucfIon. An/e, nf 32 (InfornnI quofnfIon mnrks omIffod).
Thnf boIng so, I soo no ronson fo undorfnko n Commorco CInuso nnnIy-
sIs fhnf Is nof oufcomo doformInnfIvo.

I!SIISS t. SIII!I!S
V
Through ModIcnId, Congross hns offorod fho Sfnfos nn
oorfunIfy fo furnIsh honIfh cnro fo fho oor wIfh fho nId
of fodornI fInnncIng. To rocoIvo fodornI ModIcnId funds,
Sfnfos musf rovIdo honIfh bonofIfs fo socIfIod cnfogorIos
of noody orsons, IncIudIng rognnnf womon, chIIdron,
nronfs, nnd nduIfs wIfh dIsnbIIIfIos. Cunrnnfood oIIgIbII-
Ify vnrIos by cnfogory: for somo If Is fIod fo fho fodornI
ovorfy IovoI (Incomos u fo l00 or l33); for ofhors If
doonds on crIforIn such ns oIIgIbIIIfy for dosIgnnfod sfnfo
or fodornI nssIsfnnco rogrnms. Tho ACA onInrgos fho
ouInfIon of noody ooIo Sfnfos musf covor fo IncIudo
nduIfs undor ngo 65 wIfh Incomos u fo l33 of fho fod-
ornI ovorfy IovoI. Tho sondIng owor conforrod by fho
ConsfIfufIon, fho Courf hns novor doubfod, ormIfs Con-
gross fo dofIno fho confours of rogrnms fInnncod wIfh
fodornI funds. Soo, e.g., Pennlure/ S/o/e Sclool onJ Hoe-
pi/ol v. HolJernon, 45l !. S. l, l? (l98l). And fo oxnnd
covorngo, Congross couId hnvo rocnIIod fho oxIsfIng IogIs-
InfIon, nnd roIncod If wIfh n now Inw mnkIng ModIcnId ns
ombrncIvo of fho oor ns Congross choso.
Tho quosfIon osod by fho 20l0 ModIcnId oxnnsIon,
fhon, Is ossonfInIIy fhIs: To covor n nofnbIy Inrgor ouIn-
fIon, musf Congross fnko fho roonI/roonncf roufo, or mny
If nchIovo fho snmo rosuIf by nmondIng oxIsfIng Inw Tho
nnswor shouId bo fhnf Congross mny oxnnd by nmond-
monf fho cInssos of noody orsons onfIfIod fo ModIcnId
bonofIfs. A rIfunIIsfIc roquIromonf fhnf Congross roonI
nnd roonncf sondIng IogIsInfIon In ordor fo onInrgo fho
ouInfIon sorvod by n fodornIIy fundod rogrnm wouId
ndvnnco no consfIfufIonnI rIncIIo nnd wouId scnrcoIy
sorvo fho Inforosfs of fodornIIsm. To fho confrnry, such n
roquIromonf wouId rIgIdIfy Congross` offorfs fo omowor
Sfnfos by nrfnorIng wIfh fhom In fho ImIomonfnfIon of
fodornI rogrnms.
ModIcnId Is n rofofyIcnI oxnmIo of fodornI-sfnfo coo-

39 CIfo ns: 56? !. S. ____ (20l2)
ornfIon In sorvIng fho nfIon`s gonornI woIfnro. !nfhor
fhnn nufhorIzIng n fodornI ngoncy fo ndmInIsfor n unI-
form nnfIonnI honIfh-cnro sysfom for fho oor, Con-
gross offorod Sfnfos fho oorfunIfy fo fnIIor ModIcnId
grnnfs fo fhoIr nrfIcuInr noods, so Iong ns fhoy romnIn
wIfhIn bounds sof by fodornI Inw. In shnIng ModIcnId,
Congross dId nof ondonvor fo fIx ormnnonfIy fho forms
nrfIcInfIng sfnfos musf moof; Insfond, Congross ro-
sorvod fho rIghf fo nIfor, nmond, or roonI nny rovIsIon
of fho ModIcnId Acf. 42 !. S. C. l304. Sfnfos, for fhoIr
nrf, ngrood fo nmond fhoIr own ModIcnId Inns consIsfonf
wIfh chnngos from fImo fo fImo mndo In fho fodornI Inw.
Soo 42 CI! 430.l2(c)(I) (20ll). And from l965 fo fho
rosonf, Sfnfos hnvo roguInrIy conformod fo Congross`
nIfornfIons of fho ModIcnId Acf.
THI CHIII J!STICI ncknowIodgos fhnf Congross mny
condIfIon fho rocoIf of |fodornI] funds on fho Sfnfos`
comIyIng wIfh rosfrIcfIons on fho uso of fhoso funds,
on/e, nf 50, buf novorfhoIoss concIudos fhnf fho 20l0
oxnnsIon Is unduIy coorcIvo. HIs concIusIon rosfs on
fhroo romIsos, onch of fhom ossonfInI fo hIs fhoory. IIrsf,
fho ModIcnId oxnnsIon Is, In THI CHIII J!STICI`s vIow, n
now grnnf rogrnm, nof nn nddIfIon fo fho ModIcnId ro-
grnm oxIsfIng boforo fho ACA`s onncfmonf. Congross, THI
CHIII J!STICI mnInfnIns, hns fhronfonod Sfnfos wIfh fho
Ioss of funds from nn oId rogrnm In nn offorf fo gof fhom
fo ndof n now ono. Socond, fho oxnnsIon wns unforosoo-
nbIo by fho Sfnfos whon fhoy fIrsf sIgnod on fo ModIcnId.
ThIrd, fho fhronfonod Ioss of fundIng Is so Inrgo fhnf fho
Sfnfos hnvo no ronI choIco buf fo nrfIcInfo In fho ModI-
cnId oxnnsIon. THI CHIII J!STICI fhoroforofor /le
fire/ /ine eterfInds nn oxorcIso of Congross` sondIng
owor unconsfIfufIonnIIy coorcIvo.
ModIcnId, ns nmondod by fho ACA, howovor, Is nof fwo
sondIng rogrnms; If Is n sIngIo rogrnm wIfh n consfnnf
nImfo onnbIo oor orsons fo rocoIvo bnsIc honIfh cnro

I!SIISS t. SIII!I!S
whon fhoy nood If. CIvon nsf oxnnsIons, Ius oxross
sfnfufory wnrnIng fhnf Congross mny chnngo fho ro-
quIromonfs nrfIcInfIng Sfnfos musf moof, fhoro cnn bo
no fonnbIo cInIm fhnf fho ACA fnIIs for Inck of nofIco.
Moroovor, Sfnfos hnvo no onfIfIomonf fo rocoIvo nny ModI-
cnId funds; fhoy onjoy onIy fho oorfunIfy fo nccof funds
on Congross` forms. Iufuro Congrossos nro nof bound
by fhoIr rodocossors` dIsosIfIons; fhoy hnvo nufhorIfy fo
sond fodornI rovonuo ns fhoy soo fIf. Tho IodornI Cov-
ornmonf, fhoroforo, Is nof, ns THI CHIII J!STICI chnrgos,
fhronfonIng Sfnfos wIfh fho Ioss of oxIsfIng funds from
ono sondIng rogrnm In ordor fo Induco fhom fo of Info
nnofhor rogrnm. Congross Is sImIy roquIrIng Sfnfos fo
do whnf Sfnfos hnvo Iong boon roquIrod fo do fo rocoIvo
ModIcnId fundIng: comIy wIfh fho condIfIons Congross
roscrIbos for nrfIcInfIon.
A mnjorIfy of fho Courf, howovor, buys fho nrgumonf
fhnf rosocfIvo wIfhhoIdIng of funds formorIy nvnIInbIo
oxcoods Congross` sondIng owor. CIvon fhnf hoIdIng, I
onfIroIy ngroo wIfh THI CHIII J!STICI ns fo fho nrorI-
nfo romody. If Is fo bnr fho wIfhhoIdIng found ImormIs-
sIbIonof, ns fho joInf dIssonfors wouId hnvo If, fo scrn
fho oxnnsIon nIfogofhor, soo poe/, nf 4648. Tho dIssonf-
ors` vIow fhnf fho ACA musf fnII In Ifs onfIrofy Is n rndIcnI
donrfuro from fho Courf`s normnI courso. Whon n consfI-
fufIonnI InfIrmIfy mnrs n sfnfufo, fho Courf ordInnrIIy
romovos fho InfIrmIfy. If undorfnkos n snIvngo oornfIon;
If doos nof domoIIsh fho IogIsInfIon. Soo, e.g., Broc/e// v.
Spo/one ArcoJee, 1nc., 4?2 !. S. 49l, 504 (l985) (Courf`s
normnI courso Is fo docInro n sfnfufo InvnIId fo fho oxfonf
fhnf If ronchos foo fnr, buf ofhorwIso |fo Ionvo fho sfnfufo]
Infncf). Thnf courso Is InInIy In ordor whoro, ns In fhIs
cnso, Congross hns oxrossIy Insfrucfod courfs fo Ionvo
unfouchod ovory rovIsIon nof found InvnIId. Soo 42
!. S. C. l303. Iocnuso THI CHIII J!STICI fInds fho
wIfhhoIdIngnof fho grnnfIngof fodornI funds Incom-

4l CIfo ns: 56? !. S. ____ (20l2)
nfIbIo wIfh fho SondIng CInuso, Congross` oxfonsIon of
ModIcnId romnIns nvnIInbIo fo nny Sfnfo fhnf nffIrms Ifs
wIIIIngnoss fo nrfIcInfo.
A
IxnnsIon hns boon chnrncforIsfIc of fho ModIcnId ro-
grnm. AkIn fo fho ACA In 20l0, fho ModIcnId Acf ns
nssod In l965 nugmonfod oxIsfIng fodornI grnnf rogrnms
joInfIy ndmInIsforod wIfh fho Sfnfos.
l3
Sfnfos woro nof
roquIrod fo nrfIcInfo In ModIcnId. Iuf If fhoy dId, fho
IodornI Covornmonf nId nf Ionsf hnIf fho cosfs. To qunI-
Ify for fhoso grnnfs, Sfnfos hnd fo offor n mInImum IovoI of
honIfh covorngo fo bonofIcInrIos of four fodornIIy fundod,
sfnfo-ndmInIsforod woIfnro rogrnms: AId fo InmIIIos wIfh
oondonf ChIIdron; OId Ago AssIsfnnco; AId fo fho IIInd;
nnd AId fo fho IormnnonfIy nnd TofnIIy IsnbIod. Soo
SocInI SocurIfy Amondmonfs of l965, l2l(n), ?9 Sfnf.
343; Scluei/er v. Gro, Pon/lere, 453 !. S. 34, 3? (l98l).
Af fhoIr ofIon, Sfnfos couId onroII nddIfIonnI modIcnIIy
noody IndIvIdunIs; fhoso cosfs, foo, woro nrfInIIy borno by
fho IodornI Covornmonf nf fho snmo, nf Ionsf 50, rnfo.
1IiJ.
SInco l965, Congross hns nmondod fho ModIcnId ro-
grnm on moro fhnn 50 occnsIons, somofImos quIfo sIznbIy.
Mosf roIovnnf horo, bofwoon l988 nnd l990, Congross

l3
ModIcnId wns InInIy nn oxfonsIon of fho oxIsfIng Korr-MIIIs
grnnf rogrnm. HuborfoId, IodornIIzIng ModIcnId, l4 !. In. J. Consf.
!. 43l, 444445 (20ll). Indood, fho socfIon of fho Sonnfo roorf
donIIng wIfh TIfIo XIXfho fIfIo osfnbIIshIng ModIcnIdwns onfIfIod,
'Imrovomonf nnd IxfonsIon of Korr-MIIIs ModIcnI AssIsfnnco Iro-
grnm.` Sfovons & Sfovons, WoIfnro ModIcIno In AmorIcn 5l (l9?4)
(quofIng S. !o. o. 404, 89fh Cong., lsf Soss., f. l, . 9 (l965)).
SoffIng fho nfforn for ModIcnId, Korr-MIIIs roImbursod Sfnfos for n
orfIon of fho cosf of honIfh cnro rovIdod fo woIfnro rocIIonfs If
Sfnfos mof condIfIons socIfIod In fho fodornI Inw, e.g., nrfIcInfIng
Sfnfos woro obIIgod fo offor mInImum covorngo for hosIfnIIznfIon nnd
hysIcInn sorvIcos. Soo HuborfoId, eupro, nf 443444.

I!SIISS t. SIII!I!S
roquIrod nrfIcInfIng Sfnfos fo IncIudo nmong fhoIr bono-
fIcInrIos rognnnf womon wIfh fnmIIy Incomos u fo l33
of fho fodornI ovorfy IovoI, chIIdron u fo ngo 6 nf fho
snmo Incomo IovoIs, nnd chIIdron ngos 6 fo l8 wIfh fnmIIy
Incomos u fo l00 of fho ovorfy IovoI. Soo 42 !. S. C.
l396n(n)(l0)(A)(I), l396n(l); ModIcnro CnfnsfrohIc Cov-
orngo Acf of l988, 302, l02 Sfnf. ?50; OmnIbus Iudgof
!oconcIIInfIon Acf of l989, 640l, l03 Sfnf. 2258; Om-
nIbus Iudgof !oconcIIInfIon Acf of l990, 460l, l04 Sfnf.
l388l66. Thoso nmondmonfs nddod mIIIIons fo fho
ModIcnId-oIIgIbIo ouInfIon. ubny & Konnoy, !ossons
from fho ModIcnId IxnnsIons for ChIIdron nnd Irognnnf
Womon 5 (Ar. l99?).
Iofwoon l966 nnd l990, nnnunI fodornI ModIcnId sond-
Ing grow from $63l.6 mIIIIon fo $42.6 bIIIIon; sfnfo
sondIng roso fo $3l bIIIIon ovor fho snmo orIod. Soo of.
of HonIfh nnd Humnn SorvIcos, nfIonnI HonIfh IxondI-
furos by Tyo of SorvIco nnd Sourco of Iunds: CnIondnr
Yonrs l960 fo 20l0 (fnbIo).
l4
And bofwoon l990 nnd 20l0,
fodornI sondIng Incronsod fo $269.5 bIIIIon. 1IiJ. In-
Inrgomonf of fho ouInfIon nnd sorvIcos covorod by ModI-
cnId, In shorf, hns boon fho frond.
Comnrod fo nsf nIfornfIons, fho ACA Is nofnbIo for fho
oxfonf fo whIch fho IodornI Covornmonf wIII Ick u fho
fnb. ModIcnId`s 20l0 oxnnsIon Is fInnncod InrgoIy by
fodornI oufInys. In 20l4, fodornI funds wIII covor l00
of fho cosfs for nowIy oIIgIbIo bonofIcInrIos; fhnf rnfo wIII
grndunIIy docronso boforo soffIIng nf 90 In 2020. 42
!. S. C. l396d(y) (2006 od., Su. IV). Iy comnrIson,
fodornI confrIbufIons fownrd fho cnro of bonofIcInrIos
oIIgIbIo ro-ACA rnngo from 50 fo 83, nnd nvorngod
5? bofwoon 2005 nnd 2008. l396d(b) (2006 od., Su.

l4
AvnIInbIo onIIno nf hff://www.cms.gov/!osonrch-SfnfIsfIcs-nfn-
nnd-Sysfoms/SfnfIsfIcs-Tronds-nnd-!oorfs/nfIonnIHonIfhIxondnfn/
nfIonnIHonIfhAccounfsHIsforIcnI.hfmI.

43 CIfo ns: 56? !. S. ____ (20l2)
IV); of. of HonIfh nnd Humnn SorvIcos, Confors for
ModIcnro nnd ModIcnId SorvIcos, C. Truffor of nI., 20l0
AcfunrInI !oorf on fho IInnncInI OufIook for ModIcnId,
. 20.
or wIII fho oxnnsIon oxorbIfnnfIy Incronso sfnfo ModI-
cnId sondIng. Tho CongrossIonnI Iudgof OffIco (CIO)
rojocfs fhnf Sfnfos wIII sond 0.8 moro fhnn fhoy wouId
hnvo, nbsonf fho ACA. Soo CIO, SondIng & InroIImonf
ofnII for CIO`s Mnrch 2009 InsoIIno. Iuf soo on/e, nf
4445 (|T]ho Acf drnmnfIcnIIy Incronsos sfnfo obIIgnfIons
undor ModIcnId.); poe/, nf 45 (joInf oInIon of SCA!IA,
KIIY, THOMAS, nnd A!ITO, JJ.) (|A]ccofnnco of fho
|ACA oxnnsIon] wIII Imoso vory subsfnnfInI cosfs on
nrfIcInfIng Sfnfos.). Whnfovor fho Incronso In sfnfo
obIIgnfIons nffor fho ACA, If wIII nIo In comnrIson fo fho
Incronso In fodornI fundIng.
l5
IInnIIy, nny fnIr nrnIsnI of ModIcnId wouId roquIro
ncknowIodgmonf of fho consIdornbIo nufonomy Sfnfos
onjoy undor fho Acf. Inr from conscrIf|Ing] sfnfo ngon-
cIos Info fho nnfIonnI buronucrnfIc nrmy, on/e, nf 55
(cIfIng I1IC v. Mieeieeippi, 456 !. S. ?42, ??5 (l982)
(O`Connor, J., concurrIng In judgmonf In nrf nnd dIssonf-
Ing In nrf) (brnckofs In orIgInnI nnd InfornnI quofnfIon
mnrks omIffod)), ModIcnId Is dosIgnod fo ndvnnco cooor-
nfIvo fodornIIsm. Wieconein Dep/. of Heol/l onJ Ionil,
Serte. v. Bluner, 534 !. S. 4?3, 495 (2002) (cIfIng Horrie
v. McIoe, 448 !. S. 29?, 308 (l980)). Subjocf fo Ifs bnsIc

l5
Ivon fho sfudy on whIch fho InInfIffs roIy, soo IrIof for IofIfIonors
l0, concIudos fhnf |w]hIIo mosf sfnfos wIII oxorIonco somo Incronso In
sondIng, fhIs Is quIfo smnII roInfIvo fo fho fodornI mnfchIng nymonfs
nnd Iow roInfIvo fo fho cosfs of uncomonsnfod cnro fhnf |fho sfnfos]
wouId bonr If fho|ro] woro no honIfh roform. Soo KnIsor CommIssIon
on ModIcnId & fho !nInsurod, ModIcnId Covorngo & SondIng In
HonIfh !oform l6 (Mny 20l0). Thus fhoro cnn bo no objocfIon fo fho
ACA`s oxnnsIon of ModIcnId ns nn unfundod mnndnfo. QuIfo fho
confrnry, fho rogrnm Is ImrossIvoIy woII fundod.

I!SIISS t. SIII!I!S
roquIromonfs, fho ModIcnId Acf omowors Sfnfos fo soIocf
drnmnfIcnIIy dIfforonf IovoIs of fundIng nnd covorngo,
nIfor nnd oxorImonf wIfh dIfforonf fInnncIng nnd doIIvory
modos, nnd of fo covor (or nof fo covor) n rnngo of nrfI-
cuInr rocoduros nnd fhornIos. Sfnfos hnvo Iovorngod
fhIs oIIcy dIscrofIon fo gonornfo n myrInd of drnmnfIcnIIy
dIfforonf ModIcnId rogrnms ovor fho nsf sovornI doc-
ndos. !ugor, Of Icoborgs nnd CIncIors, ?5 !nw & Con-
fom. Irobs. 2l5, 233 (20l2) (foofnofo omIffod). Tho ACA
doos nof joffIson fhIs nronch. Sfnfos, ns fIrsf-IIno nd-
mInIsfrnfors, wIII confInuo fo guIdo fho dIsfrIbufIon of
subsfnnfInI rosourcos nmong fhoIr noody ouInfIons.
Tho nIfornnfIvo fo condIfIonnI fodornI sondIng, If bonrs
omhnsIs, Is nof sfnfo nufonomy buf sfnfo mnrgInnIIzn-
fIon.
l6
In l965, Congross oIocfod fo nnfIonnIIzo honIfh
covorngo for sonIors fhrough ModIcnro. If couId sImIInrIy
hnvo osfnbIIshod ModIcnId ns nn oxcIusIvoIy fodornI ro-
grnm. Insfond, Congross gnvo fho Sfnfos fho oorfunIfy
fo nrfnor In fho rogrnm`s ndmInIsfrnfIon nnd dovoIo-
monf. Absonf from fho nnfIonnIIzod modoI, of courso, Is
fho sfnfo-IovoI oIIcy dIscrofIon nnd oxorImonfnfIon fhnf
Is ModIcnId`s hnIImnrk; undoubfodIy fho Inforosfs of fod-
ornIIsm nro boffor sorvod whon Sfnfos rofnIn n monnIng-
fuI roIo In fho ImIomonfnfIon of n rogrnm of such
Imorfnnco. Soo CnmInkor, Sfnfo SovoroIgnfy nnd Sub-
ordInncy, 95 CoIum. !. !ov. l00l, l002l003 (l995) (cooorn-
fIvo fodornIIsm cnn rosorvo n sIgnIfIcnnf roIo for sfnfo
dIscrofIon In nchIovIng socIfIod fodornI gonIs, whoro fho
nIfornnfIvo Is comIofo fodornI roomfIon of nny sfnfo

l6
In l9?2, for oxnmIo, Congross ondod fho fodornI cnsh-nssIsfnnco
rogrnm for fho ngod, bIInd, nnd dIsnbIod. Thnf rogrnm rovIousIy
hnd boon oornfod joInfIy by fho IodornI nnd Sfnfo Covornmonfs, ns
Is fho cnso wIfh ModIcnId fodny. Congross roIncod fho cooornfIvo
fodornI rogrnm wIfh fho nnfIonnIIzod SuIomonfnI SocurIfy In-
como (SSI) rogrnm. Soo Scluei/er v. Gro, Pon/lere, 453 !. S. 34, 38
(l98l).

45 CIfo ns: 56? !. S. ____ (20l2)
roguInfory roIo); !oso-Ackormnn, CooornfIvo IodornIIsm
nnd Co-ofnfIon, 92 YnIo !. J. l344, l346 (l983) (If
fho fodornI govornmonf bogIns fo fnko fuII rosonsIbIIIfy
for socInI woIfnro sondIng nnd roomfs fho sfnfos, fho
rosuIf Is IIkoIy fo bo wonkor . . . sfnfo govornmonfs.).
l?
AIfhough Congross hns no obIIgnfIon fo uso Ifs Sond-
Ing CInuso owor fo dIsburso funds fo fho Sfnfos, College
Sotinge Bon/ v. IloriJo PrepoiJ Poe/eeconJor, 1J. 1x-
penee BJ., 52? !. S. 666, 686 (l999), If hns rovIdod ModI-
cnId grnnfs nofnbIo for fhoIr gonorosIfy nnd fIoxIbIIIfy.
|S]uch funds, wo onco obsorvod, nro gIffs, iJ., nf 686
68?, nnd so fhoy hnvo romnInod fhrough docndos of oxnn-
sIon In fhoIr sIzo nnd scoo.
I
Tho SondIng CInuso nufhorIzos Congross fo ny fho
obfs nnd rovIdo for fho . . . gonornI WoIfnro of fho
!nIfod Sfnfos. Arf. I, 8, cI. l. To onsuro fhnf fodornI funds
grnnfod fo fho Sfnfos nro sonf fo 'rovIdo for fho . . .
gonornI WoIfnro` In fho mnnnor Congross Infondod, on/e,
nf 46, Congross musf of courso hnvo nufhorIfy fo Imoso
IImIfnfIons on fho Sfnfos` uso of fho fodornI doIInrs. ThIs
Courf, fImo nnd ngnIn, hns rosocfod Congross` roscrI-
fIon of sondIng condIfIons, nnd hns roquIrod Sfnfos fo
nbIdo by fhom. Soo, e.g., Pennlure/, 45l !. S., nf l?
(|O]ur cnsos hnvo Iong rocognIzod fhnf Congross mny fIx
fho forms on whIch If shnII dIsburso fodornI monoy fo fho
Sfnfos.). In nrfIcuInr, wo hnvo rocognIzod Congross`
rorognfIvo fo condIfIon n Sfnfo`s rocoIf of ModIcnId

l?
THI CHIII J!STICI nnd fho joInf dIssonfors orcoIvo In cooornfIvo
fodornIIsm n fhron|f] fo oIIfIcnI nccounfnbIIIfy. An/e, nf 48; soo
poe/, nf 3435. Iy fhnf, fhoy monn vofor confusIon: CIfIzons usof by
unouInr govornmonf ncfIon, fhoy osIf, mny nscrIbo fo sfnfo offIcInIs
bInmo moro nrorInfoIy InId nf Congross` door. Iuf no such confu-
sIon Is nnronf In fhIs cnso: ModIcnId`s sfnfus ns n fodornIIy fundod,
sfnfo-ndmInIsforod rogrnm Is hnrdIy hIddon from vIow.

I!SIISS t. SIII!I!S
fundIng on comIInnco wIfh fho forms Congross sof for
nrfIcInfIon In fho rogrnm. Soo, e.g., Horrie, 448 !. S.,
nf 30l (|O]nco n Sfnfo oIocfs fo nrfIcInfo |In ModIcnId],
If musf comIy wIfh fho roquIromonfs of |fho ModIcnId
Acf].); Ar/oneoe Dep/. of Heol/l onJ Hunon Serte. v.
AllIorn, 54? !. S. 268, 2?5 (2006); Ireu v. Hou/ine, 540
!. S. 43l, 433 (2004); A//ine v. Iitero, 4?? !. S. l54, l56
l5? (l986).
Congross` nufhorIfy fo condIfIon fho uso of fodornI funds
Is nof confInod fo sondIng rogrnms ns fIrsf Inunchod.
Tho IogIsInfuro mny, nnd offon doos, nmond fho Inw, Im-
osIng now condIfIons grnnf rocIIonfs honcoforfh musf
moof In ordor fo confInuo rocoIvIng funds. Soo infro, nf 54
(doscrIbIng Benne// v. Ken/uc/, Dep/. of 1J., 4?0 !. S.
656, 659660 (l985) (onforcIng rosfrIcfIon nddod fIvo yonrs
nffor ndofIon of oducnfIonnI rogrnm)).
Yos, fhoro nro fodornIIsm-bnsod IImIfs on fho uso of
Congross` condIfIonnI sondIng owor. In fho IondIng
docIsIon In fhIs nron, Sou/l Do/o/o v. Dole, 483 !. S. 203
(l98?), fho Courf IdonfIfIod four crIforIn. Tho condIfIons
Incod on fodornI grnnfs fo Sfnfos musf (n) romofo fho
gonornI woIfnro, (b) unnmbIguousIy Inform Sfnfos whnf
Is domnndod of fhom, (c) bo gormnno fo fho fodornI Infor-
osf In nrfIcuInr nnfIonnI rojocfs or rogrnms, nnd (d)
nof Induco fho Sfnfos fo ongngo In ncfIvIfIos fhnf wouId
fhomsoIvos bo unconsfIfufIonnI. 1J., nf 20?208, 2l0
(InfornnI quofnfIon mnrks omIffod).
l8
Tho Courf In Dole monfIonod, buf dId nof ndof, n fur-
fhor IImIfnfIon, ono hyofhofIcnIIy rnIsod n hnIf-confury
onrIIor: In somo cIrcumsfnncos, Congross mIghf bo ro-
hIbIfod from offorIng n fInnncInI Inducomonf . . . so coor-

l8
AIfhough fho InInfIffs, In fho rocoodIngs boIow, dId nof confosf
fho ACA`s snfIsfncfIon of fhoso crIforIn, soo 648 I. 3d l235, l263 (CAll
20ll), THI CHIII J!STICI nonrs fo roIy honvIIy on fho socond crIfo-
rIon. Comnro on/e, nf 52, 54, wIfh infro, nf 5254.

4? CIfo ns: 56? !. S. ____ (20l2)
cIvo ns fo nss fho oInf nf whIch 'rossuro furns Info
comuIsIon.` 1J., nf 2ll (quofIng S/euorJ Mocline Co. v.
Dotie, 30l !. S. 548, 590 (l93?)). IrIor fo fodny`s docI-
sIon, howovor, fho Courf hns novor ruIod fhnf fho forms of
nny grnnf crossod fho IndIsfIncf IIno bofwoon fomfnfIon
nnd coorcIon.
Dole InvoIvod fho nfIonnI MInImum rInkIng Ago Acf,
23 !. S. C. l58, onncfod In l984. Thnf Acf dIrocfod fho
Socrofnry of TrnnsorfnfIon fo wIfhhoId 5 of fho fodornI
hIghwny funds ofhorwIso nynbIo fo n Sfnfo If fho Sfnfo
ormIffod urchnso of nIcohoIIc bovorngos by orsons
Ioss fhnn 2l yonrs oId. rInkIng ngo wns nof wIfhIn fho
nufhorIfy of Congross fo roguInfo, Soufh nkofn nrguod,
bocnuso fho Twonfy-IIrsf Amondmonf gnvo fho Sfnfos
oxcIusIvo owor fo confroI fho mnnufncfuro, frnnsorfn-
fIon, nnd consumfIon of nIcohoIIc bovorngos. Tho smnII
orconfngo of hIghwny-consfrucfIon funds Soufh nkofn
sfood fo Ioso by ndhorIng fo l9 ns fho ngo of oIIgIbIIIfy fo
urchnso 3.2 boor, howovor, wns nof onough fo qunIIfy ns
coorcIon, fho Courf concIudod.
ThIs cnso doos nof rosonf fho concorns fhnf Iod fho
Courf In Dole ovon fo consIdor fho rosocf of coorcIon. In
Dole, fho condIfIonsof 2l ns fho mInImum drInkIng ngo
dId nof foII fho Sfnfos how fo uso funds Congross ro-
vIdod for hIghwny consfrucfIon. Iurfhor, In vIow of fho
Twonfy-IIrsf Amondmonf, If wns nn oon quosfIon whofhor
Congross couId dIrocfIy Imoso n nnfIonnI mInImum
drInkIng ngo.
Tho ACA, In confrnsf, roInfos soIoIy fo fho fodornIIy
fundod ModIcnId rogrnm; If Sfnfos chooso nof fo comIy,
Congross hns nof fhronfonod fo wIfhhoId funds onrmnrkod
for nny ofhor rogrnm. or doos fho ACA uso ModIcnId
fundIng fo Induco Sfnfos fo fnko ncfIon Congross IfsoIf
couId nof undorfnko. Tho IodornI Covornmonf undoubf-
odIy couId oornfo Ifs own honIfh-cnro rogrnm for oor
orsons, jusf ns If oornfos ModIcnro for sonIors` honIfh

I!SIISS t. SIII!I!S
cnro. Soo eupro, nf 44.
Thnf Is whnf mnkos fhIs such n sImIo cnso, nnd fho
Courf`s docIsIon so unsoffIIng. Congross, nImIng fo nssIsf
fho noody, hns nrorInfod fodornI monoy fo subsIdIzo
sfnfo honIfh-Insurnnco rogrnms fhnf moof fodornI sfnnd-
nrds. Tho rIncInI sfnndnrd fho ACA sofs Is fhnf fho
sfnfo rogrnm covor nduIfs onrnIng no moro fhnn l33 of
fho fodornI ovorfy IIno. InforcIng fhnf roscrIfIon on-
suros fhnf fodornI funds wIII bo sonf on honIfh cnro for
fho oor In furfhornnco of Congross` rosonf orcofIon of
fho gonornI woIfnro.
C
THI CHIII J!STICI nssorfs fhnf fho ModIcnId oxnn-
sIon cronfos n now honIfh cnro rogrnm. An/e, nf 54.
Moroovor, Sfnfos couId hnrdIy nnfIcInfo fhnf Congross
wouId frnnsform |fho rogrnm] so drnmnfIcnIIy. An/e,
nf 55. Thoroforo, THI CHIII J!STICI mnInfnIns, Congross`
fhronf fo wIfhhoId oId ModIcnId funds bnsod on n Sfnfo`s
rofusnI fo nrfIcInfo In fho now rogrnm Is n fhron|f] fo
formInnfo |nn]ofhor . . . Indoondonf grnn|f]. An/e, nf 50,
5253. And bocnuso fho fhronf fo wIfhhoId n Inrgo nmounf
of funds from ono rogrnm Ionvos fho Sfnfos wIfh no ronI
ofIon buf fo ncquIosco |In n nowIy cronfod rogrnm], THI
CHIII J!STICI concIudos, fho ModIcnId oxnnsIon Is un-
consfIfufIonnIIy coorcIvo. An/e, nf 52.
l
Tho sfnrfIng romIso on whIch THI CHIII J!STICI`s
coorcIon nnnIysIs rosfs Is fhnf fho ACA dId nof ronIIy
oxfond ModIcnId; Insfond, Congross cronfod nn onfIroIy
now rogrnm fo co-oxIsf wIfh fho oId. THI CHIII J!STICI
cnIIs fho ACA now, buf In frufh, If sImIy ronchos moro of
AmorIcn`s oor fhnn Congross orIgInnIIy covorod.
ModIcnId wns cronfod fo onnbIo Sfnfos fo rovIdo modI-
cnI nssIsfnnco fo noody orsons. Soo S. !o. o. 404,

49 CIfo ns: 56? !. S. ____ (20l2)
89fh Cong., lsf Soss., f. l, . 9 (l965). Soo nIso l2l(n),
?9 Sfnf. 343 (Tho uroso of ModIcnId Is fo onnbIo Sfnfos
fo furnIsh . . . modIcnI nssIsfnnco on bohnIf of |corfnIn
orsons] whoso Incomo nnd rosourcos nro InsuffIcIonf fo
moof fho cosfs of nocossnry modIcnI sorvIcos.). Iy brIng-
Ing honIfh cnro wIfhIn fho ronch of n Inrgor ouInfIon of
AmorIcnns unnbIo fo nfford If, fho ModIcnId oxnnsIon Is
nn oxfonsIon of fhnf bnsIc nIm.
Tho ModIcnId Acf confnIns hundrods of rovIsIons gov-
ornIng oornfIon of fho rogrnm, soffIng condIfIons rnng-
Ing from !ImIfnfIon on nymonfs fo Sfnfos for oxond-
Ifuros nffrIbufnbIo fo fnxos, 42 !. S. C. l396n(f) (2006
od.), fo ModIcnI nssIsfnnco fo nIIons nof InwfuIIy ndmIffod
for ormnnonf rosIdonco, l396b(v) (2006 od. nnd Su.
IV). Tho ModIcnId oxnnsIon Ionvos unchnngod fho vnsf
mnjorIfy of fhoso rovIsIons; If ndds bonofIcInrIos fo fho
oxIsfIng rogrnm nnd socIfIos fho rnfo nf whIch Sfnfos
wIII bo roImbursod for sorvIcos rovIdod fo fho nddod bono-
fIcInrIos. Soo ACA 200l(n)(l), (3), l24 Sfnf. 2?l2?2.
Tho ACA doos nof doscrIbo oornfIonnI nsocfs of fho
rogrnm for fhoso nowIy oIIgIbIo orsons; for fhnf Infor-
mnfIon, ono musf rond fho oxIsfIng ModIcnId Acf. Soo 42
!. S. C. l396l396v(b) (2006 od. nnd Su. IV).
Congross sfyIod nnd cIonrIy vIowod fho ModIcnId oxnn-
sIon ns nn nmondmonf fo fho ModIcnId Acf, nof ns n now
honIfh-cnro rogrnm. To fho four cnfogorIos of bonofIcInr-
Ios for whom covorngo bocnmo mnndnfory In l965, nnd fho
fhroo mnndnfory cInssos nddod In fho Info l980`s, soo
eupro, nf 4l42, fho ACA ndds nn oIghfh: IndIvIdunIs
undor 65 wIfh Incomos nof oxcoodIng l33 of fho fodornI
ovorfy IovoI. Tho oxnnsIon Is offocfunfod by 200l of fho
ACA, nfIy fIfIod: ModIcnId Covorngo for fho !owosf
Incomo IouInfIons. l24 Sfnf. 2?l. Thnf socfIon nmonds
TIfIo 42, Chnfor ?, Subchnfor XIX: Crnnfs fo Sfnfos for
ModIcnI AssIsfnnco Irogrnms. CommonIy known ns fho
ModIcnId Acf, Subchnfor XIX fIIIod somo 2?8 ngos In

I!SIISS t. SIII!I!S
2006. SocfIon 200l of fho ACA wouId ndd nroxImnfoIy
fhroo ngos.
l9
Congross hns brond nufhorIfy fo consfrucf or ndjusf
sondIng rogrnms fo moof Ifs confomornry undorsfnnd-
Ing of fho gonornI WoIfnro. Heltering v. Dotie, 30l !. S.
6l9, 64064l (l93?). Courfs owo n Inrgo monsuro of ro-
socf fo Congross` chnrncforIznfIon of fho grnnf rogrnms
If osfnbIIshos. Soo S/euorJ Mocline, 30l !. S., nf 594.
Ivon If courfs woro IncIInod fo socond-guoss Congross`
concofIon of fho chnrncfor of Ifs IogIsInfIon, how wouId
rovIowIng judgos dIvIno whofhor nn Acf of Congross, ur-
orfIng fo nmond n Inw, Is In ronIIfy nof nn nmondmonf,
buf n now cronfIon Af whnf oInf doos nn oxfonsIon
bocomo so Inrgo fhnf If frnnsforms fho bnsIc Inw
IndonvorIng fo show fhnf Congross cronfod n now ro-
grnm, THI CHIII J!STICI cIfos fhroo nsocfs of fho ox-
nnsIon. IIrsf, ho nssorfs fhnf, In covorIng fhoso onrnIng
no moro fhnn l33 of fho fodornI ovorfy IIno, fho ModI-
cnId oxnnsIon, unIIko ro-ACA ModIcnId, doos nof cnro
for fho noodIosf nmong us. An/e, nf 53. Whnf mnkos
fhnf so SIngIo nduIfs onrnIng no moro fhnn $l4,856 or
yonrl33 of fho curronf fodornI ovorfy IovoIsuroIy
rnnk nmong fho nfIon`s oor.
Socond, nccordIng fo THI CHIII J!STICI, Congross
mnndnfod fhnf nowIy oIIgIbIo orsons rocoIvo n IovoI of
covorngo fhnf Is Ioss comrohonsIvo fhnn fho frndIfIonnI
ModIcnId bonofIf nckngo. 1IiJ. Thnf Ioss comrohonsIvo
bonofIf nckngo, howovor, Is nof nn InnovnfIon Infroducod
by fho ACA; sInco 2006, Sfnfos hnvo boon froo fo uso If for
mnny of fhoIr ModIcnId bonofIcInrIos.
20
Tho IovoI of bono-

l9
Comnro Subchnfor XIX, 42 !. S. C. l396l396v(b) (2006 od.
nnd Su. IV) wIfh l396n(n) (l0)(A)(I)(VIII) (2006 od. nnd Su.
IV); l396n(n) (l0)(A)(II)(XX), l396n(n)(?5), l396n(k), l396n(gg) fo (hh),
l396d(y), l396rl(o), l396u?(b)(5) fo (6).
20
Tho ofIcIf !oducfIon Acf of 2005 nufhorIzod Sfnfos fo rovIdo
bonchmnrk covorngo or bonchmnrk oquIvnIonf covorngo fo corfnIn

5l CIfo ns: 56? !. S. ____ (20l2)
fIfs offorod fhoroforo doos nof sof nnrf osf-ACA ModIcnId
rocIIonfs from nII fhoso onfIfIod fo bonofIfs ro-ACA.
ThIrd, THI CHIII J!STICI corrocfIy nofos fhnf fho
roImbursomonf rnfo for nrfIcInfIng Sfnfos Is dIffor-
onf rognrdIng IndIvIdunIs who bocnmo ModIcnId-oIIgIbIo
fhrough fho ACA. 1IiJ. Iuf fho rnfo dIffors onIy In Ifs
gonorosIfy fo nrfIcInfIng Sfnfos. !ndor ro-ACA ModI-
cnId, fho IodornI Covornmonf nys u fo 83 of fho cosfs
of covorngo for curronf onroIIoos, l396d(b) (2006 od. nnd
Su. IV); undor fho ACA, fho fodornI confrIbufIon sfnrfs
nf l00 nnd wIII ovonfunIIy soffIo nf 90, l396d(y).
Ivon If ono ngrood fhnf n chnngo of ns IIffIo ns ? orconf-
ngo oInfs cnrrIos consfIfufIonnI sIgnIfIcnnco, Is If nof
nssIng sfrnngo fo suggosf fhnf fho urorfod IncursIon on
sfnfo sovoroIgnfy mIghf hnvo boon nvorfod, or nf Ionsf
mIfIgnfod, hnd Congross offorod Sfnfos leee monoy fo cnrry
ouf fho snmo obIIgnfIons
ConsIdor nIso fhnf Congross couId hnvo roonIod ModI-
cnId. Soo eupro, nf 3839 (cIfIng 42 !. S. C. l304); IrIof
for IofIfIonors In o. ll400, . 4l. Thoronffor, Congross
couId hnvo onncfod ModIcnId II, n now rogrnm combIn-
Ing fho ro-20l0 covorngo wIfh fho oxnndod covorngo
roquIrod by fho ACA. Iy whnf rIghf doos n courf sfo
Congross from buIIdIng u wIfhouf fIrsf fonrIng down
2
THI CHIII J!STICI fInds fho ModIcnId oxnnsIon vuI-
nornbIo bocnuso If fook nrfIcInfIng Sfnfos by surrIso.
An/e, nf 54. A Sfnfo couId hnrdIy nnfIcInfo fhnf Con-
gros|s] wouId ondonvor fo frnnsform |fho ModIcnId ro-
grnm] so drnmnfIcnIIy, ho sfnfos. An/e, nf 5455. Ior fho
nofIon fhnf Sfnfos musf bo nbIo fo forosoo, whon fhoy sIgn
u, nIfornfIons Congross mIghf mnko Infor on, THI CHIII

ModIcnId ouInfIons. Soo 6044, l20 Sfnf. 88, 42 !. S. C. l396u?
(2006 od. nnd Su. IV). Sfnfos mny offor fho snmo IovoI of covorngo fo
orsons nowIy oIIgIbIo undor fho ACA. Soo l396n(k).

I!SIISS t. SIII!I!S
J!STICI cIfos onIy ono cnso: Pennlure/ S/o/e Sclool onJ
Hoepi/ol v. HolJernon, 45l !. S. l.
In Pennlure/, rosIdonfs of n sfnfo-run, fodornIIy fundod
InsfIfufIon for fho monfnIIy dIsnbIod comInInod of nbu-
sIvo fronfmonf nnd Inhumnno condIfIons In nIIogod vIoIn-
fIon of fho ovoIomonfnIIy IsnbIod AssIsfnnco nnd IIII
of !Ighfs Acf. 45l !. S., nf 56. Wo hoId fhnf fho Sfnfo
wns nof nnswornbIo In dnmngos for vIoInfIng condIfIons
If dId nof voIunfnrIIy nnd knowIngIy ncco|f]. 1J., nf l?,
2?. InsocfIng fho sfnfufory Inngungo nnd IogIsInfIvo hIs-
fory, wo found fhnf fho Acf dId nof unnmbIguousIy Im-
oso fho roquIromonf on whIch fho InInfIffs roIIod: fhnf
fhoy rocoIvo nrorInfo fronfmonf In fho Ionsf rosfrIcfIvo
onvIronmonf. 1J., nf l?l8. SnfIsfIod fhnf Congross hnd
nof cIonrIy condIfIonod fho Sfnfos` rocoIf of fodornI funds
on fho Sfnfos` rovIsIon of such fronfmonf, wo docIInod fo
rond such n roquIromonf Info fho Acf. Congross` sondIng
owor, wo concIudod, doos nof IncIudo surrIsIng nrfIcI-
nfIng Sfnfos wIfh osfnccofnnco or 'rofroncfIvo` condI-
fIons. 1J., nf 2425.
Pennlure/ fhus Insfrucfs fhnf If Congross Infonds fo
Imoso n condIfIon on fho grnnf of fodornI monoys, If musf
do so unnmbIguousIy. An/e, nf 53 (quofIng Pennlure/,
45l !. S., nf l?). Thnf roquIromonf Is mof In fhIs cnso.
SocfIon 200l doos nof fnko offocf unfII 20l4. Tho ACA
mnkos orfocfIy cIonr whnf wIII bo roquIrod of Sfnfos fhnf
nccof ModIcnId fundIng nffor fhnf dnfo: Thoy musf oxfond
oIIgIbIIIfy fo nduIfs wIfh Incomos no moro fhnn l33 of
fho fodornI ovorfy IIno. Soo 42 !. S. C. l396n(n)(l0)(A)
(I)(VIII) (2006 od. nnd Su. IV).
THI CHIII J!STICI nonrs fo fInd In Pennlure/ n
roquIromonf fhnf, whon sondIng IogIsInfIon Is fIrsf
nssod, or whon Sfnfos fIrsf onIIsf In fho fodornI rogrnm,
Congross musf rovIdo cIonr nofIco of condIfIons If mIghf
Infor Imoso. If I undorsfnnd hIs oInf corrocfIy, If wns
Incumbonf on Congross, In l965, fo wnrn fho Sfnfos cIonrIy

53 CIfo ns: 56? !. S. ____ (20l2)
of fho sIzo nnd shno ofonfInI chnngos fo ModIcnId mIghf
fnko. And nbsonf such nofIco, sIznbIo chnngos couId nof bo
mndo mnndnfory. Our docIsIons do nof suorf such n
roquIromonf.
2l
In Benne// v. Aeu Jeree,, 4?0 !. S. 632 (l985), fho
Socrofnry of IducnfIon soughf fo rocou TIfIo I funds
22
bnsod on fho Sfnfo`s noncomIInnco, from l9?0 fo l9?2,
wIfh n l9?8 nmondmonf fo TIfIo I. !oIyIng on Pennlure/,
wo rojocfod fho Socrofnry`s nffomf fo rocovor funds bnsod
on fho Sfnfos` nIIogod vIoInfIon of n ruIo fhnf dId nof oxIsf
whon fho Sfnfo nccofod nnd sonf fho funds. Soo 4?0
!. S., nf 640 (ow Jorsoy|,] whon If nIIod for nnd ro-
coIvod TIfIo I funds for fho yonrs l9?0l9?2|,] hnd no
bnsIs fo boIIovo fhnf fho rorIofy of fho oxondIfuros
wouId bo judgod by nny sfnndnrds ofhor fhnn fho onos In
offocf o/ /le /ine. (cIfIng Pennlure/, 45l !. S., nf l?, 24
25; omhnsIs nddod)).
Whon nmondmonf of nn oxIsfIng grnnf rogrnm hns no
such rofroncfIvo offocf, howovor, wo hnvo uhoId Congross`
InsfrucfIon. In Benne// v. Ken/uc/, Dep/. of 1J., 4?0 !. S.
656 (l985), fho Socrofnry suod fo rocnfuro TIfIo I funds
bnsod on fho CommonwonIfh`s l9?4 vIoInfIon of n sond-
Ing condIfIon Congross nddod fo TIfIo I In l9?0. !ojocfIng
Konfucky`s nrgumonf Innod fo Pennlure/, wo hoId fhnf

2l
THI CHIII J!STICI obsorvos fhnf SondIng CInuso IogIsInfIon
|I]s much In fho nnfuro of n con/roc/. An/e, nf 46 (InfornnI quofnfIon
mnrks omIffod). Soo nIso poe/, nf 33 (joInf oInIon of SCA!IA, KIIY,
THOMAS, nnd A!ITO, JJ.) (snmo). Iuf fho Courf rovIousIy hns roc-
ognIzod fhnf |u]nIIko normnI confrncfunI undorfnkIngs, fodornI grnnf
rogrnms orIgInnfo In nnd romnIn govornod by sfnfufory rovIsIons
oxrossIng fho judgmonf of Congross concornIng dosIrnbIo ubIIc
oIIcy. Benne// v. Ken/uc/, Dep/. of 1J., 4?0 !. S. 656, 669 (l985).
22
TIfIo I of fho IIomonfnry nnd Socondnry IducnfIon Acf of l965
rovIdod fodornI grnnfs fo fInnnco suIomonfnI oducnfIonnI rogrnms
In schooI dIsfrIcfs wIfh hIgh conconfrnfIons of chIIdron from Iow-Incomo
fnmIIIos. Soo Benne// v. Aeu Jeree,, 4?0 !. S. 632, 634635 (l985)
(cIfIng Iub. !. o. 89l0, ?9 Sfnf. 2?).

I!SIISS t. SIII!I!S
fho CommonwonIfh sufforod no surrIso nffor nccofIng
fho fodornI funds. Konfucky wns fhoroforo obIIgod fo ro-
furn fho monoy. 4?0 !. S., nf 665666, 6?36?4. Tho
condIfIons Imosod woro fo bo nssossod ns of l9?4, In IIghf
of fho IognI roquIromonfs In Inco whon fho grnnfs woro
mndo, iJ., nf 6?0, nof ns of l965, whon TIfIo I wns orIgI-
nnIIy onncfod.
As fhoso docIsIons show, Pennlure/`s ruIo domnnds fhnf
condIfIons on fodornI funds bo unnmbIguousIy cIonr nf fho
fImo n Sfnfo rocoIvos nnd usos fho monoynof nf fho fImo,
orhns yonrs onrIIor, whon Congross nssod fho Inw
osfnbIIshIng fho rogrnm. Soo nIso Dole, 483 !. S., nf 208
(fIndIng Pennlure/ snfIsfIod bnsod on fho cInrIfy of fho
IodornI AId HIghwny Acf ns nmondod In l984, wIfhouf
IookIng bnck fo l956, fho yonr of fho Acf`s ndofIon).
In nny ovonf, from fho sfnrf, fho ModIcnId Acf uf
Sfnfos on nofIco fhnf fho rogrnm couId bo chnngod: Tho
rIghf fo nIfor, nmond, or roonI nny rovIsIon of |ModI-
cnId], fho sfnfufo hns rond sInco l965, Is horoby rosorvod
fo fho Congross. 42 !. S. C. l304. Tho offocf of fhoso
fow sImIo words hns Iong boon soffIod. Soo Ao/ionol
IoilrooJ Poeeenger Corporo/ion v. A/clieon, T. & S. I. I.
Co., 4?0 !. S. 45l, 46?468, n. 22 (l985) (cIfIng Sin/ing
IunJ Coeee, 99 !. S. ?00, ?20 (l8?9)). Iy rosorvIng fho
rIghf fo nIfor, nmond, |or] roonI n sondIng rogrnm,
Congross hns gIvon socInI nofIco of Ifs InfonfIon fo rofnIn
. . . fuII nnd comIofo owor fo mnko such nIfornfIons nnd
nmondmonfs . . . ns como wIfhIn fho jusf scoo of IogIsIn-
fIvo owor. 1J., nf ?20.
Our docIsIon In Bouen v. PuIlic Agenciee OppoeeJ /o
Sociol Securi/, 1n/ropnen/, 4?? !. S. 4l, 5l52 (l986), Is
guIdIng horo. As onncfod In l935, fho SocInI SocurIfy Acf
dId nof covor sfnfo omIoyoos. 1J., nf 44. In rosonso fo
rossuro from Sfnfos fhnf wnnfod covorngo for fhoIr om-
Ioyoos, Congross, In l950, nmondod fho Acf fo nIIow
Sfnfos fo of Info fho rogrnm. 1J., nf 45. Tho sfnfufory

55 CIfo ns: 56? !. S. ____ (20l2)
rovIsIon gIvIng Sfnfos fhIs ofIon oxrossIy ormIffod
fhom fo wIfhdrnw from fho rogrnm. 1IiJ.
IogInnIng In fho Info l9?0`s, Sfnfos IncronsIngIy oxor-
cIsod fho ofIon fo wIfhdrnw. 1J., nf 46. Concornod fhnf
wIfhdrnwnIs woro fhronfonIng fho InfogrIfy of SocInI
SocurIfy, Congross roonIod fho formInnfIon rovIsIon.
Congross fhoroby chnngod SocInI SocurIfy from n rogrnm
voIunfnry for fho Sfnfos fo ono from whIch fhoy couId nof
oscno. 1J., nf 48. CnIIfornIn objocfod, nrguIng fhnf fho
chnngo ImormIssIbIy dorIvod If of n rIghf fo wIfhdrnw
from SocInI SocurIfy. 1J., nf 4950. Wo unnnImousIy
rojocfod CnIIfornIn`s nrgumonf. 1J., nf 5l53. Iy IncIud-
Ing In fho Acf n cInuso oxrossIy rosorvIng fo If '|f]ho
rIghf fo nIfor, nmond, or roonI nny rovIsIon` of fho Acf,
wo hoId, Congross uf Sfnfos on nofIco fhnf fho Acf
cronfod no confrncfunI rIghfs. 1J., nf 5l52. Tho Sfnfos
fhoroforo hnd no Inw-bnsod ground on whIch fo comInIn
nbouf fho nmondmonf, dosIfo fho sIgnIfIcnnf chnrncfor of
fho chnngo.
THI CHIII J!STICI novorfhoIoss wouId rowrIfo l304
fo counfonnnco onIy fho rIghf fo nIfor eoneulo/, or
nmond, Iu/ no/ /oo nucl. Congross, howovor, dId nof so
qunIIfy l304. Indood, Congross rofnInod dIscrofIon fo
roonI ModIcnId, wIIng If ouf onfIroIy. Cf. Del/o Air
Linee, 1nc. v. Augue/, 450 !. S. 346, 368 (l98l) (!ohnquIsf,
J., dIssonfIng) (InvokIng fho common-sonso mnxIm fhnf
fho gronfor IncIudos fho Iossor). As Bouen IndIcnfos, no
Sfnfo couId ronsonnbIy hnvo rond l304 ns rosorvIng fo
Congross nufhorIfy fo mnko ndjusfmonfs onIy If modosfIy
sIzod.
In fncf, no Sfnfo rocoodod on fhnf undorsfnndIng. In com-
IInnco wIfh ModIcnId roguInfIons, onch Sfnfo oxrossIy
undorfook fo nbIdo by fufuro ModIcnId chnngos. Soo 42
CI! 430.l2(c)(l) (20ll) (Tho |sfnfo ModIcnId] Inn musf
rovIdo fhnf If wIII bo nmondod whonovor nocossnry fo
rofIocf . . . |c]hnngos In IodornI Inw, roguInfIons, oIIcy

I!SIISS t. SIII!I!S
InforrofnfIons, or courf docIsIons.). Whonovor n Sfnfo
nofIfIos fho IodornI Covornmonf of n chnngo In Ifs own
ModIcnId rogrnm, fho Sfnfo corfIfIos bofh fhnf If knows
fho fodornIIy sof forms of nrfIcInfIon mny chnngo, nnd
fhnf If wIII nbIdo by fhoso chnngos ns n condIfIon of con-
fInuod nrfIcInfIon. Soo, e.g., IIorIdn Agoncy for HonIfh
Cnro AdmIn., Sfnfo IInn !ndor TIfIo XIX of fho SocInI
SocurIfy Acf ModIcnI AssIsfnnco Irogrnm ?.l, . 86 (Ocf.
6, l992).
THI CHIII J!STICI InsIsfs fhnf fho mosf roconf oxnn-
sIon, In confrnsf fo Ifs rodocossors, nccomIIshos n shIff
In kInd, nof moroIy dogroo. An/e, nf 53. Iuf why wns
ModIcnId nIforod onIy In dogroo, nof In kInd, whon Con-
gross roquIrod Sfnfos fo covor mIIIIons of chIIdron nnd
rognnnf womon Soo eupro, nf 4l42. Congross dId nof
moroIy nIfo|r] nnd oxnn|d] fho boundnrIos of fho AId fo
InmIIIos wIfh oondonf ChIIdron rogrnm. Iuf soo on/e,
nf 5355. !nfhor, Congross roquIrod nrfIcInfIng Sfnfos
fo rovIdo covorngo fIod fo fho fodornI ovorfy IovoI (ns If
Infor dId In fho ACA), rnfhor fhnn fo fho AIC rogrnm.
Soo IrIof for nfIonnI HonIfh !nw Irogrnm of nI. ns Anici
Curioe l6l8. In shorf, gIvon l304, fhIs Courf`s con-
sfrucfIon of l304`s Inngungo In Bouen, nnd fho onInrgo-
monf of ModIcnId In fho yonrs sInco l965,
23
n Sfnfo wouId
bo hnrd uf fo comInIn fhnf If Inckod fnIr nofIco whon,
In 20l0, Congross nIforod ModIcnId fo ombrnco n Inrgor
orfIon of fho nfIon`s oor.
3
THI CHIII J!STICI uIfImnfoIy nsks whofhor fho fInnn-

23
ofo, In fhIs rognrd, fho oxfonsIon of SocInI SocurIfy, whIch bognn
In l935 ns nn oId-ngo onsIon rogrnm, fhon oxnndod fo IncIudo sur-
vIvor bonofIfs In l939 nnd dIsnbIIIfy bonofIfs In l956. Soo SocInI
SocurIfy Acf, ch. 53l, 49 Sfnf. 622625; SocInI SocurIfy Acf Amond-
monfs of l939, 53 Sfnf. l364l365; SocInI SocurIfy Amondmonfs of
l956, ch. 836, l03, ?0 Sfnf. 8l58l6.

5? CIfo ns: 56? !. S. ____ (20l2)
cInI Inducomonf offorod by Congross . . . nss|od] fho oInf
nf whIch rossuro furns Info comuIsIon. An/e, nf 50
(InfornnI quofnfIon mnrks omIffod). Tho fInnncInI In-
ducomonf Congross omIoyod horo, ho concIudos, crossos
fhnf fhroshoId: Tho fhronfonod wIfhhoIdIng of oxIsfIng
ModIcnId funds Is n gun fo fho hond fhnf forcos Sfnfos fo
ncquIosco. An/e, nf 505l (cIfIng 42 !. S. C. l396c).
24
THI CHIII J!STICI soos no nood fo fIx fho ouformosf
IIno, S/euorJ Mocline, 30l !. S., nf 59l, whoro orsun-
sIon gIvos wny fo coorcIon, on/e, nf 55. oIfhor do fho
joInf dIssonfors. Soo poe/, nf 36, 38.
25
ofnbIy, fho docI-

24
Tho joInf dIssonfors, for fhoIr nrf, wouId mnko fhIs fho onfIro In-
quIry. |I]f Sfnfos ronIIy hnvo no choIco ofhor fhnn fo nccof fho nck-
ngo, fhoy nssorf, fho offor Is coorcIvo. Poe/, nf 35. THI CHIII J!STICI
rocognIzos Congross` nufhorIfy fo consfrucf n sIngIo fodornI rogrnm
nnd condIfIon fho rocoIf of funds on fho Sfnfos` comIyIng wIfh
rosfrIcfIons on fho uso of fhoso funds. An/e, nf 50. Ior fho joInf
dIssonfors, howovor, nII fhnf mnffors, If nonrs, Is whofhor Sfnfos cnn
rosIsf fho fomfnfIon of n gIvon fodornI grnnf. Poe/, nf 35. On fhIs
IogIc, nny fodornI sondIng rogrnm, suffIcIonfIy Inrgo nnd woII-fundod,
wouId bo unconsfIfufIonnI. Tho joInf dIssonfors oInf fo smnIIor ro-
grnms Sfnfos mIghf hnvo fho wIII fo rofuso. Soo poe/, nf 404l (oIomon-
fnry nnd socondnry oducnfIon). Iuf how Is n courf fo judgo whofhor
onIy 6.6 of nII sfnfo oxondIfuros, poe/, nf 4l, Is nn nmounf Sfnfos
couId or wouId do wIfhouf
SocuInfIons of fhIs gonro nro chnrncforIsfIc of fho joInf dIssonf. Soo,
e.g., poe/, nf 35 (If no, bo sfnfo offIcInIs who wIII bonr fho brunf of
ubIIc dIsnrovnI for joInf fodornI-sfnfo ondonvors); iIiJ., (fodornI
offIcInIs . . . no, romnIn InsuInfod from fho oIocfornI rnmIfIcnfIons of
fhoIr docIsIon); poe/, nf 3? (n honvy fodornI fnx . . . IovIod fo suorf n
fodornI rogrnm fhnf offors Inrgo grnnfs fo fho Sfnfos . . . no,, ns n
rncfIcnI mnffor, |Ionvo Sfnfos] unnbIo fo rofuso fo nrfIcInfo); iIiJ.
(wIfhdrnwnI from n fodornI rogrnm wouId li/el, forco fho Sfnfo fo
Imoso n hugo fnx Incronso); poe/, nf 46 (sfnfo shnro of ACA oxnnsIon
cosfs no, Incronso In fho fufuro) (nII omhnsIs nddod; somo InfornnI
quofnfIon mnrks omIffod). Tho joInf dIssonfors nro Iong on conjocfuro
nnd shorf on ronI-worId oxnmIos.
25
Tho joInf dIssonfors nIso roIy honvIIy on Congross` orcoIvod Infonf
fo coorco fho Sfnfos. Poe/, nf 4246; soo, e.g., poe/, nf 42 (In crnffIng fho
ACA, Congross cIonrIy oxrossod Ifs Informod vIow fhnf no Sfnfo couId

I!SIISS t. SIII!I!S
sIon on whIch fhoy roIy, S/euorJ Mocline, found fho
sfnfufo nf Issuo InsIdo fho IIno, whorovor fho IIno mny
bo. 30l !. S., nf 59l.
Whon fufuro SondIng CInuso chnIIongos nrrIvo, ns fhoy
IIkoIy wIII In fho wnko of fodny`s docIsIon, how wIII IIfI-
gnnfs nnd judgos nssoss whofhor n Sfnfo hns n IogIfImnfo
choIco whofhor fo nccof fho fodornI condIfIons In ox-
chnngo for fodornI funds An/e, nf 48. Aro courfs fo
monsuro fho numbor of doIInrs fho IodornI Covornmonf
mIghf wIfhhoId for noncomIInnco Tho orfIon of fho
Sfnfo`s budgof nf sfnko And whIch Sfnfo`sor Sfnfos`
budgof Is doformInnfIvo: fho Iond InInfIff, nII chnIIongIng
Sfnfos (26 In fhIs cnso, mnny wIfh quIfo dIfforonf fIscnI
sIfunfIons), or somo nnfIonnI modInn oos If mnffor fhnf
IIorIdn, unIIko mosf Sfnfos, Imosos no sfnfo Incomo fnx,
nnd fhoroforo mIghf bo nbIo fo roInco forogono fodornI
funds wIfh now sfnfo rovonuo
26
Or fhnf fho coorcIon sfnfo

ossIbIy rofuso fho offor fhnf fho ACA oxfonds.). Wo shouId nof IIghfIy
nscrIbo fo Congross nn Infonf fo vIoInfo fho ConsfIfufIon (nf Ionsf ns my
coIIonguos rond If). ThIs Is nrfIcuInrIy fruo whon fho ACA couId jusf
ns woII bo comrohondod ns domonsfrnfIng Congross` moro oxocfnfIon,
In IIghf of fho unIformIfy of nsf nrfIcInfIon nnd fho gonorosIfy of fho
fodornI confrIbufIon, fhnf Sfnfos wouId nof wIfhdrnw. Cf. Sou/l Do/o/o
v. Dole, 483 !. S. 203, 2ll (l98?) (Wo cnnnof concIudo . . . fhnf n con-
dIfIonnI grnnf of fodornI monoy . . . Is unconsfIfufIonnI sImIy by
ronson of Ifs succoss In nchIovIng fho congrossIonnI objocfIvo.).
26
IodornI fnxnfIon of n Sfnfo`s cIfIzons, nccordIng fo fho joInf dIssonf-
ors, mny dImInIsh n Sfnfo`s nbIIIfy fo rnIso now rovonuo. ThIs, In furn,
couId IImIf n Sfnfo`s cnncIfy fo roInco n fodornI rogrnm wIfh nn
oquIvnIonf sfnfo-fundod nnnIog. Poe/, nf 40. Iuf If cnnnof bo fruo
fhnf fho nmounf of fho fodornI fnxos oxfrncfod from fho fnxnyors of n
Sfnfo fo ny for fho rogrnm In quosfIon Is roIovnnf In doformInIng
whofhor fhoro Is ImormIssIbIo coorcIon. Poe/, nf 3?. Whon fho
!nIfod Sfnfos Covornmonf fnxos !nIfod Sfnfos cIfIzons, If fnxos fhom
In fhoIr IndIvIdunI cnncIfIos ns fho ooIo of AmorIcnnof ns
rosIdonfs of n nrfIcuInr Sfnfo. Soo I. S. Tern Lini/e, 1nc. v. Tlorn/on,
5l4 !. S. ??9, 839 (l995) (KIIY, J., concurrIng). Thnf Is bocnuso
fho Irnmors sIIf fho nfom of sovoroIgnfy|,] . . . osfnbIIshIng fwo ordors
of govornmonfono sfnfo nnd ono fodornIonch wIfh Ifs own dIrocf

59 CIfo ns: 56? !. S. ____ (20l2)
offIcInIs In fncf fonr Is unIshmonf nf fho bnIIof box for
furnIng down n oIIfIcnIIy ouInr fodornI grnnf
Tho coorcIon InquIry, fhoroforo, nonrs fo InvoIvo oIIf-
IcnI judgmonfs fhnf dofy judIcInI cnIcuInfIon. Soo Bo/er
v. Corr, 369 !. S. l86, 2l? (l962). Ivon commonfnfors
symnfhofIc fo robusf onforcomonf of Dole`s IImIfnfIons,
soo eupro, nf 46, hnvo concIudod fhnf concofIons of
ImormIssIbIo coorcIon romIsod on Sfnfos` orcoIvod
InnbIIIfy fo docIIno fodornI funds nro jusf foo nmorhous
fo bo judIcInIIy ndmInIsfrnbIo. Inkor & Iormnn, CoffIng
off fho Dole, ?8 Ind. !. J. 459, 52l, 522, n. 30? (2003)
(cIfIng, e.g., ScnIIn, Tho !uIo of !nw ns n !nw of !uIos, 56
!. ChI. !. !ov. ll?5 (l989)).
Af boffom, my coIIonguos` osIfIon Is fhnf fho Sfnfos`
roIInnco on fodornI funds IImIfs Congross` nufhorIfy fo
nIfor Ifs sondIng rogrnms. ThIs gofs fhIngs bnckwnrds:
Congross, nof fho Sfnfos, Is fnskod wIfh sondIng fodornI
monoy In sorvIco of fho gonornI woIfnro. And onch succos-
sIvo Congross Is omoworod fo nrorInfo funds ns If soos
fIf. Whon fho ll0fh Congross ronchod n concIusIon nbouf
ModIcnId funds fhnf dIfforod from Ifs rodocossors` vIow,
If nbrIdgod no Sfnfo`s rIghf fo oxIsfIng, or ro-oxIsfIng,
funds. Iuf soo on/e, nf 5l52; poe/, nf 4?48 (joInf oInIon
of SCA!IA, KIIY, THOMAS, nnd A!ITO, JJ.). Ior, In

roInfIonshI fo fho ooIo. 1J., nf 838.
A Sfnfo fhoroforo hns no cInIm on fho monoy Ifs rosIdonfs ny In
fodornI fnxos, nnd fodornI sondIng rogrnms nood nof hoI ooIo In
nII sfnfos In fho snmo monsuro. Soo IrIof for nvId Snfchor of nI. ns
Anici Curioe l9. In 2004, for oxnmIo, ow Jorsoy rocoIvod 55 confs
In fodornI sondIng for ovory doIInr Ifs rosIdonfs nId fo fho IodornI
Covornmonf In fnxos, whIIo MIssIssII rocoIvod $l.?? or fnx doIInr
nId. C. ubny, Tnx IoundnfIon, IodornI Tnx Iurdons nnd IxondI-
furos by Sfnfo: WhIch Sfnfos CnIn Mosf from IodornI IIscnI Oorn-
fIons 2 (Mnr. 2006). Thus no consfIfufIonnI robIom wns cronfod whon
ArIzonn docIInod for l6 yonrs fo nrfIcInfo In ModIcnId, ovon fhough
Ifs rosIdonfs` fnx doIInrs fInnncod ModIcnId rogrnms In ovory ofhor
Sfnfo.

I!SIISS t. SIII!I!S
fncf, fhoro nro no such funds. Thoro Is onIy monoy Sfnfos
on/icipo/e rocoIvIng from fufuro Congrossos.

Congross hns doIognfod fo fho Socrofnry of HonIfh nnd
Humnn SorvIcos fho nufhorIfy fo wIfhhoId, In whoIo or
In nrf, fodornI ModIcnId funds from Sfnfos fhnf fnII fo
comIy wIfh fho ModIcnId Acf ns orIgInnIIy comosod nnd ns
subsoquonfIy nmondod. 42 !. S. C. l396c.
2?
THI CHIII
J!STICI, howovor, hoIds fhnf fho ConsfIfufIon rocIudos
fho Socrofnry from wIfhhoIdIng oxIsfIng ModIcnId funds
bnsod on Sfnfos` rofusnI fo comIy wIfh fho oxnndod ModI-
cnId rogrnm. An/e, nf 55. Ior fho forogoIng ronsons, I
dIsngroo fhnf nny such wIfhhoIdIng wouId vIoInfo fho
SondIng CInuso. AccordIngIy, I wouId nffIrm fho docIsIon
of fho Courf of AonIs for fho IIovonfh CIrcuIf In fhIs
rognrd.
Iuf In vIow of THI CHIII J!STICI`s dIsosIfIon, I ngroo
wIfh hIm fhnf fho ModIcnId Acf`s sovornbIIIfy cInuso do-
formInos fho nrorInfo romody. Thnf cInuso rovIdos
fhnf |I]f nny rovIsIon of |fho ModIcnId Acf], or fho nII-
cnfIon fhoroof fo nny orson or cIrcumsfnnco, Is hoId In-
vnIId, fho romnIndor of fho chnfor, nnd fho nIIcnfIon of
such rovIsIon fo ofhor orsons or cIrcumsfnncos shnII nof
bo nffocfod fhoroby. 42 !. S. C. l303.
Tho Courf doos nof sfrIko down nny rovIsIon of fho

2?
As THI CHIII J!STICI obsorvos, fho Socrofnry Is nufhorIzod fo
wIfhhoId nII of n Sfnfo`s ModIcnId fundIng. Soo on/e, nf 5l. Iuf fofnI
wIfhdrnwnI Is whnf fho Socrofnry no,, nof musf, do. Sho hns dIscro-
fIon fo wIfhhoId onIy n orfIon of fho ModIcnId funds ofhorwIso duo n
noncomIInnf Sfnfo. Soo l396c; cf. 45 CI! 80.l0(f) (20ll) (Socrofnry
mny onforco TIfIo VI`s nondIscrImInnfIon roquIromonf fhrough rofusnI
fo grnnf or confInuo IodornI fInnncInI nssIsfnnco, in ulole or in por/.
(omhnsIs nddod)). Tho Socrofnry, If Is worfh nofIng, mny horsoIf
oxorIonco oIIfIcnI rossuros, whIch wouId mnko hor nII fho moro
roIucfnnf fo cuf off funds Congross hns nrorInfod for n Sfnfo`s noody
cIfIzons.

6l CIfo ns: 56? !. S. ____ (20l2)
ACA. If rohIbIfs onIy fho nIIcnfIon of fho Socrofnry`s
nufhorIfy fo wIfhhoId ModIcnId funds from Sfnfos fhnf
docIIno fo conform fhoIr ModIcnId Inns fo fho ACA`s
roquIromonfs. Thus fho ACA`s nufhorIznfIon of funds fo
fInnnco fho oxnnsIon romnIns Infncf, nnd fho Socrofnry`s
nufhorIfy fo wIfhhoId funds for ronsons ofhor fhnn non-
comIInnco wIfh fho oxnnsIon romnIns unnffocfod.
Ivon nbsonf l303`s commnnd, wo wouId hnvo no wnr-
rnnf fo InvnIIdnfo fho ModIcnId oxnnsIon, confrn poe/, nf
4648 (joInf oInIon of SCA!IA, KIIY, THOMAS, nnd
A!ITO, JJ.), nof fo monfIon fho onfIro ACA, poe/, nf 4964
(snmo). Ior whon n courf confronfs nn unconsfIfufIonnI
sfnfufo, Ifs ondonvor musf bo fo consorvo, nof dosfroy,
fho IogIsInfuro`s domInnnf objocfIvo. Soo, e.g., A,o//e v.
PlonneJ Poren/looJ of Aor/lern Aeu 1ng., 546 !. S. 320,
328330 (2006). In fhIs cnso, fhnf objocfIvo wns fo In-
cronso nccoss fo honIfh cnro for fho oor by IncronsIng fho
Sfnfos` nccoss fo fodornI funds. THI CHIII J!STICI Is
undoubfodIy rIghf fo concIudo fhnf Congross mny offor
Sfnfos funds fo oxnnd fho nvnIInbIIIfy of honIfh cnro, nnd
roquIr|o] fhnf Sfnfos nccofIng such funds comIy wIfh fho
condIfIons on fhoIr uso. An/e, nf 55. I fhoroforo concur
In fho judgmonf wIfh rosocf fo Inrf IVI of THI CHIII
J!STICI`s oInIon.
* * *
Ior fho ronsons sfnfod, I ngroo wIfh THI CHIII J!STICI
fhnf, ns fo fho vnIIdIfy of fho mInImum covorngo rovI-
sIon, fho judgmonf of fho Courf of AonIs for fho IIovonfh
CIrcuIf shouId bo rovorsod. In my vIow, fho rovIsIon on-
counfors no consfIfufIonnI obsfrucfIon. Iurfhor, I wouId
uhoId fho IIovonfh CIrcuIf`s docIsIon fhnf fho ModIcnId
oxnnsIon Is wIfhIn Congross` sondIng owor.

_________________

_________________

l CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIIY, THOMAS, nnd A!ITO, JJ., dIssonfIng
ll393 t.
ll398 t.
I!O!IA IT A!.
ll400
t.
|Juno 28, 20l2]
J!STICI SCA!IA, J!STICI KIIY, J!STICI THOMAS,
nnd J!STICI A!ITO, dIssonfIng.
Congross hns sof ouf fo romody fho robIom fhnf fho
bosf honIfh cnro Is boyond fho ronch of mnny AmorIcnns
who cnnnof nfford If. If cnn nssurodIy do fhnf, by oxorcIs-
Ing fho owors nccordod fo If undor fho ConsfIfufIon. Tho
quosfIon In fhIs cnso, howovor, Is whofhor fho comIox
sfrucfuros nnd rovIsIons of fho InfIonf IrofocfIon nnd
AffordnbIo Cnro Acf (AffordnbIo Cnro Acf or ACA) go bo-
yond fhoso owors. Wo concIudo fhnf fhoy do.
ThIs cnso Is In ono rosocf dIffIcuIf: If rosonfs fwo

I!SIISS t. SIII!I!S
quosfIons of fIrsf ImrossIon. Tho fIrsf of fhoso Is whofhor
fnIIuro fo ongngo In oconomIc ncfIvIfy (fho urchnso of
honIfh Insurnnco) Is subjocf fo roguInfIon undor fho Com-
morco CInuso. InIIuro fo ncf doos rosuIf In nn offocf
on commorco, nnd honco mIghf bo snId fo como undor
fhIs Courf`s nffocfIng commorco crIforIon of Commorco
CInuso jurIsrudonco. Iuf In nono of Ifs docIsIons hns fhIs
Courf oxfondod fho CInuso fhnf fnr. Tho socond quosfIon
Is whofhor fho congrossIonnI owor fo fnx nnd sond,
!. S. Consf., Arf. I, 8, cI. l, ormIfs fho condIfIonIng of
n Sfnfo`s confInuod rocoIf of nII funds undor n mnssIvo
sfnfo-ndmInIsforod fodornI woIfnro rogrnm uon Ifs nc-
cofnnco of nn oxnnsIon fo fhnf rogrnm. SovornI of our
oInIons hnvo suggosfod fhnf fho owor fo fnx nnd sond
cnnnof bo usod fo coorco sfnfo ndmInIsfrnfIon of n fodornI
rogrnm, buf wo hnvo novor found n Inw onncfod undor
fho sondIng owor fo bo coorcIvo. Thoso quosfIons nro
dIffIcuIf.
Tho cnso Is onsy nnd sfrnIghfforwnrd, howovor, In nn-
ofhor rosocf. Whnf Is nbsoIufoIy cIonr, nffIrmod by fho
foxf of fho l?89 ConsfIfufIon, by fho Tonfh Amondmonf
rnfIfIod In l?9l, nnd by InnumornbIo cnsos of ours In fho
220 yonrs sInco, Is fhnf fhoro nro sfrucfurnI IImIfs uon
fodornI oworuon whnf If cnn roscrIbo wIfh rosocf fo
rIvnfo conducf, nnd uon whnf If cnn Imoso uon fho
sovoroIgn Sfnfos. Whnfovor mny bo fho concofunI IImIfs
uon fho Commorco CInuso nnd uon fho owor fo fnx
nnd sond, fhoy cnnnof bo such ns wIII onnbIo fho IodornI
Covornmonf fo roguInfo nII rIvnfo conducf nnd fo com-
oI fho Sfnfos fo funcfIon ns ndmInIsfrnfors of fodornI
rogrnms.
Thnf cIonr rIncIIo cnrrIos fho dny horo. Tho sfrIkIng
cnso of Wic/orJ v. IilIurn, 3l? !. S. lll (l942), whIch
hoId fhnf fho oconomIc ncfIvIfy of growIng whonf, ovon
for ono`s own consumfIon, nffocfod commorco suffIcIonfIy
fhnf If couId bo roguInfod, nIwnys hns boon rognrdod ns

3 CIfo ns: 56? !. S. ____ (20l2)
fho ne plue ul/ro of oxnnsIvo Commorco CInuso jurIsru-
donco. To go boyond fhnf, nnd fo sny fho foilure fo grow
whonf (whIch Is no/ nn oconomIc ncfIvIfy, or nny ncfIvIfy
nf nII) nonofhoIoss nffocfs commorco nnd fhoroforo cnn bo
fodornIIy roguInfod, Is fo mnko moro bronfhIng In nnd ouf
fho bnsIs for fodornI roscrIfIon nnd fo oxfond fodornI
owor fo vIrfunIIy nII humnn ncfIvIfy.
As for fho consfIfufIonnI owor fo fnx nnd sond for
fho gonornI woIfnro: Tho Courf hns Iong sInco oxnndod
fhnf boyond (whnf MndIson fhoughf If monnf) fnxIng nnd
sondIng for fhoso nsocfs of fho gonornI woIfnro fhnf woro
wIfhIn fho IodornI Covornmonf`s onumornfod owors,
soo Ini/eJ S/o/ee v. Bu/ler, 29? !. S. l, 6566 (l936).
Thus, wo now hnvo sIznbIo fodornI onrfmonfs dovofod
fo subjocfs nof monfIonod nmong Congross` onumornfod
owors, nnd onIy mnrgInnIIy roInfod fo commorco: fho o-
nrfmonf of IducnfIon, fho onrfmonf of HonIfh nnd
Humnn SorvIcos, fho onrfmonf of HousIng nnd !rbnn
ovoIomonf. Tho rIncInI rncfIcnI obsfncIo fhnf ro-
vonfs Congross from usIng fho fnx-nnd-sond owor fo
nssumo nII fho gonornI-woIfnro rosonsIbIIIfIos frndIfIon-
nIIy oxorcIsod by fho Sfnfos Is fho shoor ImossIbIIIfy of
mnnngIng n IodornI Covornmonf Inrgo onough fo ndmInIs-
for such n sysfom. Thnf obsfncIo cnn bo ovorcomo by
grnnfIng funds fo fho Sfnfos, nIIowIng fhom fo ndmInIsfor
fho rogrnm. Thnf Is fnIr nnd consfIfufIonnI onough whon
fho Sfnfos frooIy ngroo fo hnvo fhoIr owors omIoyod nnd
fhoIr omIoyoos onIIsfod In fho fodornI schomo. Iuf If Is n
bInfnnf vIoInfIon of fho consfIfufIonnI sfrucfuro whon fho
Sfnfos hnvo no choIco.
Tho Acf boforo us horo oxcoods fodornI owor bofh In
mnndnfIng fho urchnso of honIfh Insurnnco nnd In dony-
Ing nonconsonfIng Sfnfos nII ModIcnId fundIng. Thoso
nrfs of fho Acf nro confrnI fo Ifs dosIgn nnd oornfIon,
nnd nII fho Acf`s ofhor rovIsIons wouId nof hnvo boon
onncfod wIfhouf fhom. In our vIow If musf foIIow fhnf fho

I!SIISS t. SIII!I!S
onfIro sfnfufo Is InoornfIvo.
I
!"# %&'()('*+, -+&'+.#
ArfIcIo I, 8, of fho ConsfIfufIon gIvos Congross fho
owor fo roguInfo Commorco . . . nmong fho sovornI
Sfnfos. Tho IndIvIdunI Mnndnfo In fho Acf commnnds
fhnf ovory nIIcnbIo IndIvIdunI shnII for onch monfh
bogInnIng nffor 20l3 onsuro fhnf fho IndIvIdunI, nnd nny
doondonf of fho IndIvIdunI who Is nn nIIcnbIo IndIvId-
unI, Is covorod undor mInImum ossonfInI covorngo. 26
!. S. C. 5000A(n) (2006 od., Su. IV). If fhIs rovIsIon
roguInfos nnyfhIng, If Is fho foilure fo mnInfnIn mInI-
mum ossonfInI covorngo. Ono mIghf nrguo fhnf If rogu-
Infos fhnf fnIIuro by roquIrIng If fo bo nccomnnIod by
nymonf of n onnIfy. Iuf fhnf fnIIurofhnf nbsfonfIon
from commorcoIs nof Commorco. To bo suro, purcloe-
ing Insurnnco ie Commorco; buf ono doos nof roguInfo
commorco fhnf doos nof oxIsf by comoIIIng Ifs oxIsfonco.
In GiIIone v. OgJen, 9 Whonf. l, l96 (l824), ChIof
JusfIco MnrshnII wrofo fhnf fho owor fo roguInfo com-
morco Is fho owor fo roscrIbo fho ruIo by whIch
commorco Is fo bo govornod. Thnf undorsfnndIng Is con-
sIsfonf wIfh fho orIgInnI monnIng of roguInfo nf fho fImo
of fho ConsfIfufIon`s rnfIfIcnfIon, whon fo roguInfo monnf
|f]o ndjusf by ruIo, mofhod or osfnbIIshod modo, 2 .
Wobsfor, An AmorIcnn IcfIonnry of fho IngIIsh !nn-
gungo (l828); |f]o ndjusf by ruIo or mofhod, 2 S. Johnson,
A IcfIonnry of fho IngIIsh !nngungo (?fh od. l?85); |f]o
ndjusf, fo dIrocf nccordIng fo ruIo, 2 J. Ash, ow nnd
ComIofo IcfIonnry of fho IngIIsh !nngungo (l??5); fo
uf In ordor, sof fo rIghfs, govorn or koo In ordor, T.
ycho & W. Inrdon, A ow ConornI IngIIsh IcfIonnry

5 CIfo ns: 56? !. S. ____ (20l2)
(l6fh od. l???).
l
If cnn monn fo dIrocf fho mnnnor of
somofhIng buf nof fo dIrocf fhnf somofhIng como Info
boIng. Thoro Is no Insfnnco In whIch fhIs Courf or Con-
gross (or nnyono oIso, fo our knowIodgo) hns usod roguInfo
In fhnf ocuIInr fnshIon. If fho word boro fhnf monnIng,
Congross` nufhorIfy |f]o mnko !uIos for fho Covorn-
monf nnd !oguInfIon of fho Innd nnd nnvnI Iorcos, !. S.
Consf., Arf. I, 8, cI. l4, wouId hnvo mndo suorfIuous
fho Infor rovIsIon for nufhorIfy |f]o rnIso nnd suorf
ArmIos, iJ., 8, cI. l2, nnd |f]o rovIdo nnd mnInfnIn n
nvy, iJ., 8, cI. l3.
Wo do nof doubf fhnf fho buyIng nnd soIIIng of honIfh
Insurnnco confrncfs Is commorco gonornIIy subjocf fo
fodornI roguInfIon. Iuf whon Congross rovIdos fhnf
(nonrIy) nII cIfIzons musf buy nn Insurnnco confrncf, If
goos boyond ndjusf|Ing] by ruIo or mofhod, Johnson,
eupro, or dIrocf|Ing] nccordIng fo ruIo, Ash, eupro, If
dIrocfs fho cronfIon of commorco.
In rosonso, fho Covornmonf offors fwo fhoorIos ns fo
why fho IndIvIdunI Mnndnfo Is novorfhoIoss consfIfu-
fIonnI. oIfhor fhoory suffIcos fo susfnIn Ifs vnIIdIfy.
A
IIrsf, fho Covornmonf submIfs fhnf 5000A Is InfogrnI
fo fho AffordnbIo Cnro Acf`s Insurnnco roforms nnd noc-
ossnry fo mnko offocfIvo fho Acf`s coro roforms. IrIof
for IofIfIonors In o. ll398 (MInImum Covorngo IrovI-
sIon) 24 (horoInnffor IofIfIonors` MInImum Covorngo IrIof).
Congross IncIudod n fIndIng fo sImIInr offocf In fho Acf

l
Tho mosf nufhorIfnfIvo IognI dIcfIonnrIos of fho foundIng orn Inck
nny dofInIfIon for roguInfo or roguInfIon, suggosfIng fhnf fho form
bonrs Ifs ordInnry monnIng (rnfhor fhnn somo socInIIzod IognI monn-
Ing) In fho consfIfufIonnI foxf. Soo !. Iurn, A ow !nw IcfIonnry 28l
(l?92); C. Jncob, A ow !nw IcfIonnry (l0fh od. l?82); 2 T. CunnIng-
hnm, A ow nnd ComIofo !nw IcfIonnry (2d od. l??l).

I!SIISS t. SIII!I!S
IfsoIf. Soo 42 !. S. C. l809l(2)(H).
As dIscussod In moro dofnII In Inrf V, infro, fho Acf
confnIns numorous honIfh Insurnnco roforms, buf mosf
nofnbIo for rosonf urosos nro fho gunrnnfood Issuo
nnd communIfy rnfIng rovIsIons, 300gg fo 300gg4.
Tho formor rovIdos fhnf, wIfh n fow oxcofIons, onch
honIfh Insurnnco Issuor fhnf offors honIfh Insurnnco cov-
orngo In fho IndIvIdunI or grou mnrkof In n Sfnfo musf
nccof ovory omIoyor nnd IndIvIdunI In fho Sfnfo fhnf
nIIos for such covorngo. 300ggl(n). Thnf Is, nn In-
suror mny nof dony covorngo on fho bnsIs of, nmong ofhor
fhIngs, nny ro-oxIsfIng modIcnI condIfIon fhnf fho nII-
cnnf mny hnvo, nnd fho rosuIfIng Insurnnco musf covor
fhnf condIfIon. Soo 300gg3.
!ndor ordInnry cIrcumsfnncos, of courso, Insurors wouId
rosond by chnrgIng hIgh romIums fo IndIvIdunIs wIfh
ro-oxIsfIng condIfIons. Tho Acf sooks fo rovonf fhIs
fhrough fho communIfy-rnfIng rovIsIon. SImIy uf, fho
communIfy-rnfIng rovIsIon roquIros Insurors fo cnIcuInfo
nn IndIvIdunI`s Insurnnco romIum bnsod on onIy four
fncfors: (I) whofhor fho IndIvIdunI`s Inn covors jusf
fho IndIvIdunI or hIs fnmIIy nIso, (II) fho rnfIng nron In
whIch fho IndIvIdunI IIvos, (III) fho IndIvIdunI`s ngo, nnd
(Iv) whofhor fho IndIvIdunI usos fobncco. 300gg(n)(l)(A).
AsIdo from fho rough roxIos of ngo nnd fobncco uso (nnd
ossIbIy rnfIng nron), fho Acf doos nof nIIow nn Insuror fo
fncfor fho IndIvIdunI`s honIfh chnrncforIsfIcs Info fho rIco
of hIs Insurnnco romIum. ThIs cronfos n now InconfIvo
for young nnd honIfhy IndIvIdunIs wIfhouf ro-oxIsfIng
condIfIons. Tho Insurnnco romIums for fhoso In fhIs
grou wIII nof rofIocf fhoIr own Iow ncfunrInI rIsks buf wIII
subsIdIzo Insurnnco for ofhors In fho ooI. Mnny of fhom
mny docIdo fhnf urchnsIng honIfh Insurnnco Is nof nn oco-
nomIcnIIy sound docIsIonosocInIIy sInco fho gunrnnfood-
Issuo rovIsIon wIII onnbIo fhom fo urchnso If nf fho
snmo cosf In Infor yonrs nnd ovon If fhoy hnvo dovoIood n

? CIfo ns: 56? !. S. ____ (20l2)
ro-oxIsfIng condIfIon. Iuf wIfhouf fho confrIbufIon of
nbovo-rIsk romIums from fho young nnd honIfhy, fho
communIfy-rnfIng rovIsIon wIII nof onnbIo Insurors fo
fnko on hIgh-rIsk IndIvIdunIs wIfhouf n mnssIvo Incronso
In romIums.
Tho Covornmonf rosonfs fho IndIvIdunI Mnndnfo ns n
unIquo fonfuro of n comIIcnfod roguInfory schomo govorn-
Ing mnny nrfIos wIfh counforvnIIIng InconfIvos fhnf musf
bo cnrofuIIy bnInncod. Congross hns Imosod nn oxfonsIvo
sof of roguInfIons on fho honIfh Insurnnco Indusfry, nnd
comIInnco wIfh fhoso roguInfIons wIII IIkoIy cosf fho In-
dusfry n gronf donI. If fho Indusfry doos nof rosond by
IncronsIng romIums, If Is nof IIkoIy fo survIvo. And If
fho Indusfry doos Incronso romIums, fhon fhoro Is n sorI-
ous rIsk fhnf Ifs roducfsInsurnnco InnswIII bocomo
oconomIcnIIy undosIrnbIo for mnny nnd rohIbIfIvoIy ox-
onsIvo for fho rosf.
ThIs Is nof n dIIommn unIquo fo roguInfIon of fho honIfh-
Insurnnco Indusfry. Covornmonf roguInfIon fyIcnIIy
Imosos cosfs on fho roguInfod IndusfryosocInIIy rogu-
InfIon fhnf rohIbIfs oconomIc bohnvIor In whIch mosf
mnrkof nrfIcInnfs nro nIrondy ongngIng, such ns Ioc-
Ing ouf fho mnrkof by soIIIng fho roducf fo dIfforonf
cInssos of ooIo nf dIfforonf rIcos (In fho rosonf confoxf,
rovIdIng much Iowor Insurnnco rnfos fo young nnd
honIfhy buyors). And mnny IndusfrIos so roguInfod fnco
fho ronIIfy fhnf, wIfhouf nn nrfIfIcInI Incronso In domnnd,
fhoy cnnnof confInuo on. Whon Congross Is roguInfIng
fhoso IndusfrIos dIrocfIy, If onjoys fho brond owor fo
onncf 'nII nrorInfo IogIsInfIon` fo 'rofoc|f]` nnd
'ndvnnc|o]` commorco, ALIB v. Jonee & Lougllin S/eel
Corp., 30l !. S. l, 363? (l93?) (quofIng Tle Doniel Boll,
l0 WnII. 55?, 564 (l8?l)). Thus, Congross mIghf rofocf
fho ImorIIod Indusfry by rohIbIfIng Iow-cosf comofIfIon,
or by nccordIng If roforonfInI fnx fronfmonf, or ovon by
grnnfIng If n dIrocf subsIdy.

I!SIISS t. SIII!I!S
Horo, howovor, Congross hns Imrossod Info sorvIco
fhIrd nrfIos, honIfhy IndIvIdunIs who couId bo buf nro nof
cusfomors of fho roIovnnf Indusfry, fo offsof fho undosIr-
nbIo consoquoncos of fho roguInfIon. Congross` dosIro fo
forco fhoso IndIvIdunIs fo urchnso Insurnnco Is mofIvnfod
by fho fncf fhnf fhoy nro furfhor romovod from fho mnrkof
fhnn unhonIfhy IndIvIdunIs wIfh ro-oxIsfIng condIfIons,
bocnuso fhoy nro Ioss IIkoIy fo nood oxfonsIvo cnro In
fho nonr fufuro. If Congross cnn ronch ouf nnd commnnd
ovon fhoso furfhosf romovod from nn Inforsfnfo mnrkof fo
nrfIcInfo In fho mnrkof, fhon fho Commorco CInuso
bocomos n fonf of unIImIfod owor, or In HnmIIfon`s words,
fho hIdoous monsfor whoso dovourIng jnws . . . snro
noIfhor sox nor ngo, nor hIgh nor Iow, nor sncrod nor ro-
fnno. Tho IodornIIsf o. 33, . 202 (C. !ossIfor od. l96l).
Af fho oufor odgo of fho commorco owor, fhIs Courf hns
InsIsfod on cnrofuI scrufIny of roguInfIons fhnf do nof
ncf dIrocfIy on nn Inforsfnfo mnrkof or Ifs nrfIcInnfs. In
Aeu Yor/ v. Ini/eJ S/o/ee, 505 !. S. l44 (l992), wo hoId
fhnf Congross couId nof, In nn offorf fo roguInfo fho dIs-
osnI of rndIoncfIvo wnsfo roducod In sovornI dIfforonf
IndusfrIos, ordor fho Sfnfos fo fnko fIfIo fo fhnf wnsfo.
1J., nf l?4l??. In Prin/c v. Ini/eJ S/o/ee, 52l !. S.
898 (l99?), wo hoId fhnf Congross couId nof, In nn offorf fo
roguInfo fho dIsfrIbufIon of fIronrms In fho Inforsfnfo mnr-
kof, comoI sfnfo Inw-onforcomonf offIcInIs fo orform
bnckground chocks. 1J., nf 933935. In Ini/eJ S/o/ee v.
Lopec, 5l4 !. S. 549 (l995), wo hoId fhnf Congross couId
nof, ns n monns of fosforIng nn oducnfod Inforsfnfo Inbor
mnrkof fhrough fho rofocfIon of schooIs, bnn fho ossos-
sIon of n fIronrm wIfhIn n schooI zono. 1J., nf 559563.
And In Ini/eJ S/o/ee v. Morrieon, 529 !. S. 598 (2000), wo
hoId fhnf Congross couId nof, In nn offorf fo onsuro fho fuII
nrfIcInfIon of womon In fho Inforsfnfo oconomy, subjocf
rIvnfo IndIvIdunIs nnd comnnIos fo suIf for gondor-
mofIvnfod vIoIonf forfs. 1J., nf 6096l9. Tho Iosson of

9 CIfo ns: 56? !. S. ____ (20l2)
fhoso cnsos Is fhnf fho Commorco CInuso, ovon whon su-
Iomonfod by fho ocossnry nnd Iroor CInuso, Is nof
cor/e Iloncle for doIng whnfovor wIII hoI nchIovo fho
onds Congross sooks by fho roguInfIon of commorco. And
fho Insf fwo of fhoso cnsos show fhnf fho scoo of fho
ocossnry nnd Iroor CInuso Is oxcoodod nof onIy whon
fho congrossIonnI ncfIon dIrocfIy vIoInfos fho sovoroIgnfy
of fho Sfnfos buf nIso whon If vIoInfos fho bnckground
rIncIIo of onumornfod (nnd honco IImIfod) fodornI owor.
Tho cnso uon whIch fho Covornmonf rIncInIIy roIIos
fo susfnIn fho IndIvIdunI Mnndnfo undor fho ocossnry
nnd Iroor CInuso Is Goncolee v. Ioicl, 545 !. S. l (2005).
Thnf cnso hoId fhnf Congross couId, In nn offorf fo rosfrnIn
fho Inforsfnfo mnrkof In mnrIjunnn, bnn fho IocnI cuIfIvn-
fIon nnd ossossIon of fhnf drug. 1J., nf l522. Ioicl
Is no rocodonf for whnf Congross hns dono horo. Thnf
cnso`s rohIbIfIon of growIng (cf. Wic/orJ, 3l? !. S. lll),
nnd of ossossIon (cf. InnumornbIo fodornI sfnfufos) dId nof
rorosonf fho oxnnsIon of fho fodornI owor fo dIrocf Info
n brond now fIoId. Tho mnndnfIng of oconomIc ncfIvIfy
doos, nnd sInco If Is n fIoId so IImIfIoss fhnf If convorfs fho
Commorco CInuso Info n gonornI nufhorIfy fo dIrocf fho
oconomy, fhnf mnndnfIng Is nof consIsf|onf] wIfh fho
Ioffor nnd sIrIf of fho consfIfufIon. McCullocl v. Mor,-
lonJ, 4 Whonf. 3l6, 42l (l8l9).
Moroovor, Ioicl Is fnr dIfforonf from fho IndIvIdunI
Mnndnfo In nnofhor rosocf. Tho Courf`s oInIon In Ioicl
oInfod ouf fhnf fho growIng nnd ossossIon rohIbIfIons
woro fho onIy rncfIcnbIo wny of onnbIIng fho rohIbIfIon
of Inforsfnfo frnffIc In mnrIjunnn fo bo offocfIvoIy onforcod.
545 !. S., nf 22. Soo nIso Slretepor/ Io/e Coeee, 234 !. S.
342 (l9l4) (ocossnry nnd Iroor CInuso nIIows roguIn-
fIons of Infrnsfnfo frnnsncfIons If nocossnry fo fho roguIn-
fIon of nn Inforsfnfo mnrkof). Infrnsfnfo mnrIjunnn couId
no moro bo dIsfInguIshod from Inforsfnfo mnrIjunnn fhnn,
for oxnmIo, ondnngorod-socIos frohIos obfnInod boforo

I!SIISS t. SIII!I!S
fho socIos wns fodornIIy rofocfod cnn bo dIsfInguIshod
from frohIos obfnInod nfforwnrdswhIch mndo If nocos-
snry nnd roor fo rohIbIf fho snIo of nII such frohIos,
soo AnJrue v. AllorJ, 444 !. S. 5l (l9?9).
WIfh fho rosonf sfnfufo, by confrnsf, fhoro nro mnny
wnys ofhor fhnn fhIs unrocodonfod IndIvIdunI Mnndnfo
by whIch fho roguInfory schomo`s gonIs of roducIng Insur-
nnco romIums nnd onsurIng fho rofIfnbIIIfy of Insurors
couId bo nchIovod. Ior Insfnnco, fhoso who dId nof ur-
chnso Insurnnco couId bo subjocfod fo n surchnrgo whon
fhoy do onfor fho honIfh Insurnnco sysfom. Or fhoy couId
bo donIod n fuII Incomo fnx crodIf gIvon fo fhoso who do
urchnso fho Insurnnco.
Tho Covornmonf wns InvIfod, nf ornI nrgumonf, fo
suggosf whnf fodornI confroIs ovor rIvnfo conducf (ofhor
fhnn fhoso oxIIcIfIy rohIbIfod by fho IIII of !Ighfs or
ofhor consfIfufIonnI confroIs) couId no/ bo jusfIfIod ns
nocossnry nnd roor for fho cnrryIng ouf of n gonornI
roguInfory schomo. Soo Tr. of OrnI Arg. 2?30, 4345
(Mnr. 2?, 20l2). If wns unnbIo fo nnmo nny. As wo snId nf
fho oufsof, whorons fho rocIso scoo of fho Commorco
CInuso nnd fho ocossnry nnd Iroor CInuso Is uncorfnIn,
fho roosIfIon fhnf fho IodornI Covornmonf cnnnof do
ovoryfhIng Is n fundnmonfnI rocof. Soo Lopec, 5l4 !. S.,
nf 564 (|I]f wo woro fo nccof fho Covornmonf`s nrgu-
monfs, wo nro hnrd rossod fo osIf nny ncfIvIfy by nn In-
dIvIdunI fhnf Congross Is wIfhouf owor fo roguInfo).
SocfIon 5000A Is dofonfod by fhnf roosIfIon.
I
Tho Covornmonf`s socond fhoory In suorf of fho In-
dIvIdunI Mnndnfo Is fhnf 5000A Is vnIId bocnuso If Is
ncfunIIy n roguInf|Ion of] ncfIvIfIos hnvIng n subsfnnfInI
roInfIon fo Inforsfnfo commorco, . . . i.e., . . . ncfIvIfIos fhnf
subsfnnfInIIy nffocf Inforsfnfo commorco. 1J., nf 558559.
Soo nIso Slretepor/ Io/e Coeee, eupro. ThIs nrgumonf

ll CIfo ns: 56? !. S. ____ (20l2)
fnkos n fow dIfforonf forms, buf fho bnsIc Idon Is fhnf
5000A roguInfos fho wny In whIch IndIvIdunIs fInnnco
fhoIr nrfIcInfIon In fho honIfh-core mnrkof. IofIfIonors`
MInImum Covorngo IrIof 33 (omhnsIs nddod). Thnf Is,
fho rovIsIon dIrocfs fho mnnnor In whIch IndIvIdunIs
urchnso honIfh cnro sorvIcos nnd roInfod goods (dIrocfIng
fhnf fhoy bo urchnsod fhrough Insurnnco) nnd Is fhoro-
foro n sfrnIghfforwnrd oxorcIso of fho commorco owor.
Tho rImnry robIom wIfh fhIs nrgumonf Is fhnf 5000A
doos nof nIy onIy fo orsons who urchnso nII, or mosf,
or ovon nny, of fho honIfh cnro sorvIcos or goods fhnf fho
mnndnfod Insurnnco covors. Indood, fho mnIn objocfIon
mnny hnvo fo fho Mnndnfo Is fhnf fhoy hnvo no InfonfIon
of urchnsIng mosf or ovon nny of such goods or sorvIcos
nnd fhus no nood fo buy Insurnnco for fhoso urchnsos.
Tho Covornmonf rosonds fhnf fho honIfh-cnro mnrkof
InvoIvos ossonfInIIy unIvorsnI nrfIcInfIon, iJ., nf 35.
Tho rIncInI dIffIcuIfy wIfh fhIs rosonso Is fhnf If Is, In
fho onIy roIovnnf sonso, nof fruo. If Is fruo onough fhnf
ovoryono consumos honIfh cnro, If fho form Is fnkon fo
IncIudo fho urchnso of n boffIo of nsIrIn. Iuf fho honIfh
cnro mnrkof fhnf Is fho objocf of fho IndIvIdunI Mnndnfo
nof onIy IncIudos buf rIncInIIy consIsfs of goods nnd
sorvIcos fhnf fho young ooIo rImnrIIy nffocfod by fho
Mnndnfo Jo no/ purcloee. Thoy nro quIfo sImIy nof
nrfIcInnfs In fhnf mnrkof, nnd cnnnof bo mndo so (nnd
fhoroby subjocfod fo roguInfIon) by fho sImIo dovIco of
dofInIng nrfIcInnfs fo IncIudo nII fhoso who wIII, Infor In
fhoIr IIfofImo, robnbIy urchnso fho goods or sorvIcos
covorod by fho mnndnfod Insurnnco.
2
Such n dofInIfIon of

2
J!STICI CISI!!C Is fhoroforo rIghf fo nofo fhnf Congross Is nof
mnndnfIng fho urchnso of n dIscrofo, unwnnfod roducf. An/e, nf 22
(oInIon concurrIng In nrf, concurrIng In judgmonf In nrf, nnd dIs-

I!SIISS t. SIII!I!S
mnrkof nrfIcInnfs Is unrocodonfod, nnd woro If fo bo n
romIso for fho oxorcIso of nnfIonnI owor, If wouId hnvo
no rIncIIod IImIfs.
In n vnrInfIon on fhIs nffomfod oxorcIso of fodornI
owor, fho Covornmonf oInfs ouf fhnf Congross In fhIs
Acf hns urorfod fo roguInfo oconomIc nnd fInnncInI
docIsIon|s] fo forogo [eic] honIfh Insurnnco covorngo nnd
|fo] nffomf fo soIf-Insuro, 42 !. S. C. l809l(2)(A), sInco
fhoso docIsIons hnvo n subsfnnfInI nnd doIoforIous offocf
on Inforsfnfo commorco, IofIfIonors` MInImum Covorngo
IrIof 34. Iuf ns fho dIscussIon nbovo mnkos cIonr, fho
docIsIon fo forgo nrfIcInfIon In nn Inforsfnfo mnrkof Is
nof IfsoIf commorcInI ncfIvIfy (or Indood nny ncfIvIfy nf nII)
wIfhIn Congross` owor fo roguInfo. If Is fruo fhnf, nf fho
ond of fho dny, If Is InovIfnbIo fhnf onch AmorIcnn wIII
nffocf commorco nnd bocomo n nrf of If, ovon If nof by
choIco. Iuf If ovory orson comos wIfhIn fho Commorco
CInuso owor of Congross fo roguInfo by fho sImIo ronson
fhnf ho wIII ono dny ongngo In commorco, fho Idon of n
IImIfod Covornmonf owor Is nf nn ond.
Wic/orJ v. IilIurn hns boon rognrdod ns fho mosf ox-
nnsIvo nssorfIon of fho commorco owor In our hIsfory. A
cIoso socond Is Perec v. Ini/eJ S/o/ee, 402 !. S. l46 (l9?l),
whIch uhoId n sfnfufo crImInnIIzIng fho omInonfIy IocnI
ncfIvIfy of Ionn-shnrkIng. Iofh of fhoso cnsos, howovor,

sonfIng In nrf). Insfond, If Is mnndnfIng fho urchnso of nn unwnnfod
suIfo of roducfse.g., hysIcInn offIco vIsIfs, omorgoncy room vIsIfs,
hosIfnI room nnd bonrd, hysIcnI fhorny, durnbIo modIcnI oquImonf,
monfnI honIfh cnro, nnd subsfnnco nbuso dofoxIfIcnfIon. Soo SoIocfod
ModIcnI IonofIfs: A !oorf from fho of. of !nbor fo fho of. of
HonIfh & Humnn SorvIcos (ArII l5, 20ll) (roorfIng fhnf ovor fwo-
fhIrds of rIvnfo Indusfry honIfh Inns covor fhoso goods nnd sorvIcos),
onIIno nf hff://www.bIs.gov/ncs/obs/s/soImodbonsroorf.df (nII Infor-
nof mnforInIs ns vIsIfod Juno 26, 20l2, nnd nvnIInbIo In CIork of Courf`s
cnso fIIo).

l3 CIfo ns: 56? !. S. ____ (20l2)
InvoIvod commorcInI oc/iti/,. To go boyond fhnf, nnd fo
sny fhnf fho fnIIuro fo grow whonf or fho rofusnI fo mnko
Ionns nffocfs commorco, so fhnf growIng nnd IondIng cnn
bo fodornIIy comoIIod, Is fo oxfond fodornI owor fo vIrfu-
nIIy ovoryfhIng. AII of us consumo food, nnd whon wo do
so fho IodornI Covornmonf cnn roscrIbo whnf Ifs qunIIfy
musf bo nnd ovon how much wo musf ny. Iuf fho moro
fncf fhnf wo nII consumo food nnd nro fhus, soonor or Infor,
nrfIcInnfs In fho mnrkof for food, doos nof omowor
fho Covornmonf fo sny whon nnd whnf wo wIII buy. Thnf
Is ossonfInIIy whnf fhIs Acf sooks fo do wIfh rosocf fo fho
urchnso of honIfh cnro. If oxcoods fodornI owor.
C
A fow rosocffuI rosonsos fo J!STICI CISI!!C`s dIs-
sonf on fho Issuo of fho Mnndnfo nro In ordor. Thnf dIs-
sonf duIy rocIfos fho fosf of Commorco CInuso owor fhnf
our oInIons hnvo nIIod, buf dIsrognrds fho romIso fho
fosf confnIns. If Is fruo onough fhnf Congross noods onIy n
'rnfIonnI bnsIs` for concIudIng fhnf fho regulo/eJ oc/iti/,
subsfnnfInIIy nffocfs Inforsfnfo commorco, on/e, nf l5 (om-
hnsIs nddod). Iuf If musf bo oc/iti/, nffocfIng com-
morco fhnf Is roguInfod, nnd nof moroIy fho fnIIuro fo
ongngo In commorco. And ono Is nof now urchnsIng
fho honIfh cnro covorod by fho Insurnnco mnndnfo sImIy
bocnuso ono Is IIkoIy fo bo urchnsIng If In fho fufuro. Our
fosf`s romIso of roguInfod ncfIvIfy Is nof Invonfod ouf of
whoIo cIofh, buf rosfs uon fho ConsfIfufIon`s roquIromonf
fhnf If bo commorco whIch Is roguInfod. If nII InncfIvIfy
nffocfIng commorco Is commorco, commorco Is ovoryfhIng.
!IfImnfoIy fho dIssonf Is drIvon fo snyIng fhnf fhoro Is
ronIIy no dIfforonco bofwoon ncfIon nnd InncfIon, on/e, nf
26, n roosIfIon fhnf hns novor rocommondod IfsoIf,
noIfhor fo fho Inw nor fo common sonso. To sny, for oxnm-
Io, fhnf fho InncfIon horo consIsfs of ncfIvIfy In fho soIf-
Insurnnco mnrkof, iIiJ., sooms fo us wordIny. Iy nrIfy

I!SIISS t. SIII!I!S
of ronsonIng fho fnIIuro fo buy n cnr cnn bo cnIIod nrfIcI-
nfIon In fho non-rIvnfo-cnr-frnnsorfnfIon mnrkof. Com-
morco bocomos ovoryfhIng.
Tho dIssonf cInIms fhnf wo fnI|I] fo oxInIn why fho
IndIvIdunI mnndnfo fhronfons our consfIfufIonnI ordor.
An/e, nf 35. Iuf wo hnvo dono so. If fhronfons fhnf ordor
bocnuso If gIvos such nn oxnnsIvo monnIng fo fho Com-
morco CInuso fhnf oll rIvnfo conducf (IncIudIng fnIIuro fo
ncf) bocomos subjocf fo fodornI confroI, offocfIvoIy dosfroy-
Ing fho ConsfIfufIon`s dIvIsIon of govornmonfnI owors.
Thus fho dIssonf, on fho fhoorIos roosod for fho vnIIdIfy
of fho Mnndnfo, wouId nIfor fho nccofod consfIfufIonnI
roInfIon bofwoon fho IndIvIdunI nnd fho nfIonnI Covorn-
monf. Tho dIssonf rofosfs fhnf fho ocossnry nnd Iroor
CInuso hns boon hoId fo IncIudo fho owor fo onncf crImI-
nnI Inws, . . . fho owor fo ImrIson, . . . nnd fho owor fo
cronfo n nnfIonnI bnnk, on/e, nf 3435. Is nof fho owor
fo comoI urchnso of honIfh Insurnnco much Iossor o,
nof If (unIIko fhoso ofhor dIsosIfIons) Ifs nIIcnfIon rosfs
uon n fhoory fhnf ovoryfhIng Is wIfhIn fodornI confroI
sImIy bocnuso If oxIsfs.
Tho dIssonf`s oxosIfIon of fho wondorfuI fhIngs fho Iod-
ornI Covornmonf hns nchIovod fhrough oxorcIso of Ifs
nssIgnod owors, such ns fho rovIsIon of oId-ngo nnd
survIvors` bonofIfs In fho SocInI SocurIfy Acf, on/e, nf 2,
Is quIfo bosIdo fho oInf. Tho Issuo horo Is whofhor fho
fodornI govornmonf cnn Imoso fho IndIvIdunI Mnndnfo
fhrough fho Commorco CInuso. And fho roIovnnf hIsfory
Is nof fhnf Congross hns nchIovod wIdo nnd wondorfuI
rosuIfs fhrough fho roor oxorcIso of Ifs nssIgnod owors
In fho nsf, buf fhnf If hns novor boforo usod fho Com-
morco CInuso fo comoI onfry Info commorco.
3
Tho dIssonf

3
In Ifs offorf fo show fho confrnry, J!STICI CISI!!C`S dIssonf comos

l5 CIfo ns: 56? !. S. ____ (20l2)
fronfs fho ConsfIfufIon ns fhough If Is nn onumornfIon of
fhoso robIoms fhnf fho IodornI Covornmonf cnn nd-
drossnmong whIch, If fInds, Is fho nfIon`s courso In
fho oconomIc nnd socInI woIfnro ronIm, iIiJ., nnd moro
socIfIcnIIy fho robIom of fho unInsurod, on/e, nf ?.
Tho ConsfIfufIon Is nof fhnf. If onumornfos nof fodornIIy
soIubIo proIlene, buf fodornIIy nvnIInbIo pouere. Tho
IodornI Covornmonf cnn nddross whnfovor robIoms If
wnnfs buf cnn brIng fo fhoIr soIufIon onIy fhoso owors
fhnf fho ConsfIfufIon confors, nmong whIch Is fho owor fo
roguInfo commorco. ono of our cnsos sny nnyfhIng oIso.
ArfIcIo I confnIns no whnfovor-If-fnkos-fo-soIvo-n-nnfIonnI-
robIom owor.
Tho dIssonf dIsmIssos fho concIusIon fhnf fho owor fo
comoI onfry Info fho honIfh-Insurnnco mnrkof wouId
IncIudo fho owor fo comoI onfry Info fho now-cnr or
broccoII mnrkofs. Tho Inffor urchnsors, If snys, wIII bo
obIIgod fo ny nf fho counfor boforo rocoIvIng fho vohIcIo

u wIfh nofhIng moro fhnn fwo condomnnfIon cnsos, whIch If snys
domonsfrnfo Congross` nufhorIfy undor fho commorco owor fo comoI
nn 'InncfIvo` InndhoIdor fo submIf fo nn unwnnfod snIo. An/e, nf 24.
Wrong on bofh scoros. As Ifs nnmo suggosfs, fho condomnnfIon owor
doos nof comoI nnyono fo do nnyfhIng. If ncfs in ren, ngnInsf fho
roorfy fhnf Is condomnod, nnd Is offocfIvo wIfh or wIfhouf n frnnsfor
of fIfIo from fho formor ownor. Moro Imorfnnf, fho owor fo condomn
for ubIIc uso Is n sonrnfo sovoroIgn owor, oxIIcIfIy ncknowIodgod In
fho IIffh Amondmonf, whIch rovIdos fhnf rIvnfo roorfy |shnII nof]
bo fnkon for ubIIc uso, wIfhouf jusf comonsnfIon.
Thus, fho owor fo condomn fonds fo rofufo rnfhor fhnn suorf
fho owor fo comoI urchnso of unwnnfod goods nf n roscrIbod rIco:
Tho Inffor Is rnfhor IIko fho owor fo condomn cnsh for ubIIc uso. If If
oxIsfod, why wouId If nof (IIko fho condomnnfIon owor) bo nccomn-
nIod by n roquIromonf of fnIr comonsnfIon for fho orfIon of fho
oxncfod rIco fhnf oxcoods fho goods` fnIr mnrkof vnIuo (horo, fho
dIfforonco bofwoon whnf fho froo mnrkof wouId chnrgo for n honIfh-
Insurnnco oIIcy on n young, honIfhy orson wIfh no ro-oxIsfIng
condIfIons, nnd fho govornmonf-oxncfod communIfy-rnfod romIum)

I!SIISS t. SIII!I!S
or nourIshmonf, whorons fhoso rofusIng fo urchnso
honIfh-Insurnnco wIII uIfImnfoIy gof fronfod nnywny, nf
ofhors` oxonso. An/e, nf 2l. |T]ho unIquo nffrIbufos of
fho honIfh-cnro mnrkof . . . gIvo rIso fo n sIgnIfIcnnf froo-
rIdIng robIom fhnf doos nof occur In ofhor mnrkofs.
An/e, nf 28. And n vogofnbIo-urchnso mnndnfo (or n
cnr-urchnso mnndnfo) Is nof IIkoIy fo hnvo n subsfnnfInI
offocf on fho honIfh-cnro cosfs borno by ofhor AmorIcnns.
An/e, nf 29. Thoso dIfforoncos mnko n vory good nrgumonf
by fho dIssonf`s own IIghfs, sInco fhoy show fhnf fho fnII-
uro fo urchnso honIfh Insurnnco, unIIko fho fnIIuro fo
urchnso cnrs or broccoII, cronfos n nnfIonnI, socInI-woIfnro
robIom fhnf Is (In fho dIssonf`s vIow) IncIudod nmong fho
unonumornfod robIoms fhnf fho ConsfIfufIon nufhor-
Izos fho IodornI Covornmonf fo soIvo. Iuf fhoso dIfforoncos
do nof show fhnf fho fnIIuro fo onfor fho honIfh-Insurnnco
mnrkof, unIIko fho fnIIuro fo buy cnrs nnd broccoII, Is
nn oc/iti/, fhnf Congross cnn roguInfo. (Of courso ono
dny fho fnIIuro of somo of fho ubIIc fo urchnso Amor-
Icnn cnrs mny ondnngor fho oxIsfonco of domosfIc nufomo-
bIIo mnnufncfurors; or fho fnIIuro of somo fo onf broccoII
mny bo found fo dorIvo fhom of n nowIy dIscovorod cnncor-
fIghfIng chomIcnI whIch onIy fhnf food confnIns, roducIng
honIfh-cnro cosfs fhnf nro n burdon on fho rosf of usIn
whIch cnso, undor fho fhoory of J!STICI CISI!!C`s dIs-
sonf, movIng ngnInsf fhoso InncfIvIfIos wIII nIso como
wIfhIn fho IodornI Covornmonf`s unonumornfod robIom-
soIvIng owors.)
II
!"# !+/(&0 123#4
As fnr ns 5000A Is concornod, wo wouId sfo fhoro.
Congross hns nffomfod fo roguInfo boyond fho scoo of Ifs

l? CIfo ns: 56? !. S. ____ (20l2)
Commorco CInuso nufhorIfy,
4
nnd 5000A Is fhoroforo
InvnIId. Tho Covornmonf confonds, howovor, ns oxrossod
In fho cnfIon fo Inrf II of Ifs brIof, fhnf THI MIIM!M
COVI!ACI I!OVISIO IS IIIIIT!Y A!THO!IZI IY
COC!ISS`S TAXIC IOWI!. IofIfIonors` MInImum Cov-
orngo IrIof 52. Tho hrnso IndoondonfIy nufhorIzod
suggosfs fho oxIsfonco of n cronfuro novor hIfhorfo soon
In fho !nIfod Sfnfos !oorfs: A onnIfy for consfIfufIonnI
urosos fhnf Is oleo n fnx for consfIfufIonnI urosos. In
nII our cnsos fho fwo nro mufunIIy oxcIusIvo. Tho rovI-
sIon chnIIongod undor fho ConsfIfufIon Is oIfhor n onnIfy
or oIso n fnx. Of courso In mnny cnsos whnf wns n rogu-
Infory mnndnfo onforcod by n onnIfy coulJ lote Ieen
Imosod ns n fnx uon ormIssIbIo ncfIon; or whnf wns Im-
osod ns n fnx uon ormIssIbIo ncfIon coulJ lote Ieen n
roguInfory mnndnfo onforcod by n onnIfy. Iuf wo know
of no cnso, nnd fho Covornmonf cIfos nono, In whIch fho
ImosIfIon wns, for consfIfufIonnI urosos, bofh.
5
Tho
fwo nro mufunIIy oxcIusIvo. Thus, whnf fho Covornmonf`s
cnfIon shouId hnvo rond wns A!TI!ATIVI!Y, THI
MIIM!M COVI!ACI I!OVISIO IS OT A MAATI-WITH-
IIA!TY I!T A TAX. If Is Imorfnnf fo bonr fhIs In mInd
In ovnIunfIng fho fnx nrgumonf of fho Covornmonf nnd of
fhoso who suorf If: Tho Issuo Is nof whofhor Congross

4
o ono sorIousIy confonds fhnf nny of Congross` ofhor onumornfod
owors gIvos If fho nufhorIfy fo onncf 5000A oe o regulo/ion.
5
Of courso If cnn bo bofh for sfnfufory urosos, sInco Congross cnn
dofIno fnx nnd onnIfy In Ifs onncfmonfs nny wny If wIshos. Thnf Is
why Ini/eJ S/o/ee v. So/elo, 436 !. S. 268 (l9?8), doos nof dIsrovo our
sfnfomonf. Thnf cnso hoId fhnf n onnIfy for wIIIfuI fnIIuro fo ny
ono`s fnxos wns IncIudod nmong fho fnxos mndo non-dIschnrgonbIo
undor fho Innkrufcy Codo. 436 !. S., nf 2?32?5. Whofhor fho
onnIfy wns n fnx wIfhIn fho monnIng of fho Innkrufcy Codo hnd
nbsoIufoIy no bonrIng on whofhor If oscnod fho consfIfufIonnI IImIfn-
fIons on onnIfIos.

I!SIISS t. SIII!I!S
hnd fho pouer fo frnmo fho mInImum-covorngo rovIsIon
ns n fnx, buf whofhor If JiJ so.
In nnsworIng fhnf quosfIon wo musf, If fnIrIy ossIbIo,
Crouell v. Beneon, 285 !. S. 22, 62 (l932), consfruo fho
rovIsIon fo bo n fnx rnfhor fhnn n mnndnfo-wIfh-onnIfy,
sInco fhnf wouId rondor If consfIfufIonnI rnfhor fhnn un-
consfIfufIonnI (u/ ree nogie toleo/ quon pereo/). Iuf wo
cnnnof rowrIfo fho sfnfufo fo bo whnf If Is nof. ' |A]I-
fhough fhIs Courf wIII offon sfrnIn fo consfruo IogIs-
InfIon so ns fo snvo If ngnInsf consfIfufIonnI nffnck, If
musf nof nnd wIII nof cnrry fhIs fo fho oInf of orvorfIng
fho uroso of n sfnfufo . . . or judIcInIIy rowrIfIng If.`
ConnoJi/, Iu/uree TroJing Conn`n v. Sclor, 4?8 !. S.
833, 84l (l986) (quofIng Ap/le/er v. Secre/or, of S/o/e,
3?8 !. S. 500, 5l5 (l964), In furn quofIng Scolee v. Ini/eJ
S/o/ee, 36? !. S. 203, 2ll (l96l)). In fhIs cnso, fhoro Is
sImIy no wny, wIfhouf doIng vIoIonco fo fho fnIr monnIng
of fho words usod, GrenoJo Coun/, Supertieore v. Brog-
Jen, ll2 !. S. 26l, 269 (l884), fo oscno whnf Congross
onncfod: n mnndnfo fhnf IndIvIdunIs mnInfnIn mInImum
ossonfInI covorngo, onforcod by n onnIfy.
Our cnsos osfnbIIsh n cIonr IIno bofwoon n fnx nnd n
onnIfy: '|A] fnx Is nn onforcod confrIbufIon fo rovIdo for
fho suorf of govornmonf; n onnIfy . . . Is nn oxncfIon
Imosod by sfnfufo ns unIshmonf for nn unInwfuI ncf.`
Ini/eJ S/o/ee v. IeorgoniceJ CI&1 IoIrico/ore of I/ol,
1nc., 5l8 !. S. 2l3, 224 (l996) (quofIng Ini/eJ S/o/ee v. Lo
Ironco, 282 !. S. 568, 5?2 (l93l)). In n fow cnsos, fhIs
Courf hns hoId fhnf n fnx Imosod uon rIvnfo conducf
wns so onorous ns fo bo In offocf n onnIfy. Iuf wo hnvo
novor hoIdneterfhnf n onnIfy Imosod for vIoInfIon of
fho Inw wns so frIvInI ns fo bo In offocf n fnx. Wo hnvo
novor hoId fhnf on, oxncfIon Imosod for vIoInfIon of
fho Inw Is nn oxorcIso of Congross` fnxIng oworovon
whon fho sfnfufo colle If n fnx, much Ioss whon (ns horo)
fho sfnfufo roonfodIy cnIIs If n onnIfy. Whon nn ncf

l9 CIfo ns: 56? !. S. ____ (20l2)
ndof|s] fho crIforIn of wrongdoIng nnd fhon Imosos n
monofnry onnIfy ns fho rIncInI consoquonco on fhoso
who frnnsgross Ifs sfnndnrd, If cronfos n roguInfory on-
nIfy, nof n fnx. ClilJ LoIor Tox Coee, 259 !. S. 20, 38
(l922).
So fho quosfIon Is, quIfo sImIy, whofhor fho oxncfIon
horo Is Imosod for vIoInfIon of fho Inw. If unquosfIon-
nbIy Is. Tho mInImum-covorngo rovIsIon Is found In 26
!. S. C. 5000A, onfIfIod Iequirenen/ fo mnInfnIn mInI-
mum ossonfInI covorngo. (ImhnsIs nddod.) If commnnds
fhnf ovory nIIcnbIo IndIvIdunI eloll . . . onsuro fhnf fho
IndIvIdunI . . . Is covorod undor mInImum ossonfInI covor-
ngo. 1IiJ. (omhnsIs nddod). And fho ImmodInfoIy foI-
IowIng rovIsIon sfnfos fhnf, |I]f . . . nn nIIcnbIo
IndIvIdunI . . . fnIIs fo moof fho requirenen/ of subsocfIon
(n) . . . fhoro Is horoby Imosod . . . n penol/,. 5000A(b)
(omhnsIs nddod). And sovornI of Congross` IogIsInfIvo
fIndIngs wIfh rognrd fo 5000A confIrm fhnf If sofs forfh
n IognI roquIromonf nnd consfIfufos fho nssorfIon of rogu-
Infory owor, nof moro fnxIng owor. Soo 42 !. S. C.
l809l(2)(A) (Tho roquIromonf roguInfos ncfIvIfy . . .);
l809l(2)(C) (Tho roquIromonf . . . wIII ndd mIIIIons of
now consumors fo fho honIfh Insurnnco mnrkof . . .);
l809l(2)() (Tho roquIromonf nchIovos nonr-unIvorsnI
covorngo); l809l(2)(H) (Tho roquIromonf Is nn ossonfInI
nrf of fhIs Inrgor roguInfIon of oconomIc ncfIvIfy, nnd fho
nbsonco of fho roquIromonf wouId undorcuf IodornI rogu-
InfIon of fho honIfh Insurnnco mnrkof); l809l(3) (|T]ho
Suromo Courf of fho !nIfod Sfnfos ruIod fhnf Insurnnco
Is Inforsfnfo commorco subjocf fo IodornI roguInfIon).
Tho Covornmonf nnd fhoso who suorf Ifs vIow on fho
fnx oInf roIy on Aeu Yor/ v. Ini/eJ S/o/ee, 505 !. S. l44,
fo jusfIfy rondIng shnII fo monn mny. Tho shnII In
fhnf cnso wns confnInod In nn Infroducfory rovIsIonn
rocIfnI fhnf rovIdod for no IognI consoquoncoswhIch
snId fhnf |o]nch Sfnfo shnII bo rosonsIbIo for rovIdIng

I!SIISS t. SIII!I!S
. . . for fho dIsosnI of . . . Iow-IovoI rndIoncfIvo wnsfo. 42
!. S. C. 202lc(n)(l)(A). Tho Courf dId nof hoId fhnf
shnII couId bo consfruod fo monn mny, buf rnfhor fhnf
fhIs roIImInnry rovIsIon couId nof Imoso uon fho oor-
nfIvo rovIsIons of fho Acf n mnndnfo fhnf fhoy dId nof
confnIn: Wo . . . docIIno ofIfIonors` InvIfnfIon fo con-
sfruo 202lc(n)(l)(A), nIono nnd In IsoInfIon, ns n com-
mnnd fo fho Sfnfos Indoondonf of fho romnIndor of fho
Acf. Aeu Yor/, 505 !. S., nf l?0. Our oInIon fhon
rocoodod fo consIdor onch |of fho fhroo oornfIvo rovI-
sIons] In furn. 1IiJ. Horo fho mnndnfofho shnIIIs
confnInod nof In nn InoornfIvo roIImInnry rocIfnI, buf In
fho dIsosIfIvo oornfIvo rovIsIon IfsoIf. Aeu Yor/ ro-
vIdos no suorf for rondIng If fo bo ormIssIvo.
QuIfo sonrnfoIy, fho fncf fhnf Congross (In Ifs own
words) Imosod . . . n onnIfy, 26 !. S. C. 5000A(b)(l),
for fnIIuro fo buy Insurnnco Is nIono suffIcIonf fo rondor
fhnf fnIIuro unInwfuI. If Is ono of fho cnnons of Inforrofn-
fIon fhnf n sfnfufo fhnf onnIIzos nn ncf mnkos If unInw-
fuI: |W]horo fho sfnfufo InfIIcfs n onnIfy for doIng nn ncf,
nIfhough fho ncf IfsoIf Is nof oxrossIy rohIbIfod, yof fo do
fho ncf Is unInwfuI, bocnuso If cnnnof bo suosod fhnf fho
!ogIsInfuro Infondod fhnf n onnIfy shouId bo InfIIcfod for
n InwfuI ncf. Poulo/on S/eonIoo/ Co. v. Appono//ox I.
Co., 24 How. 24?, 252 (l86l). Or In fho words of ChnncoI-
Ior Konf: If n sfnfufo InfIIcfs n onnIfy for doIng nn ncf,
fho onnIfy ImIIos n rohIbIfIon, nnd fho fhIng Is unInw-
fuI, fhough fhoro bo no rohIbIfory words In fho sfnfufo.
l J. Konf, CommonfnrIos on AmorIcnn !nw 436 (l826).
Wo novor hnvo cInssIfIod ns n fnx nn oxncfIon Imosod
for vIoInfIon of fho Inw, nnd so foo, wo novor hnvo cInssI-
fIod ns n fnx nn oxncfIon doscrIbod In fho IogIsInfIon IfsoIf
ns n onnIfy. To bo suro, wo hnvo somofImos fronfod ns n
fnx n sfnfufory oxncfIon (Imosod for somofhIng ofhor
fhnn n vIoInfIon of Inw) whIch boro nn ngnosfIc InboI fhnf
doos nof onfnII fho sIgnIfIcnnf consfIfufIonnI consoquoncos

2l CIfo ns: 56? !. S. ____ (20l2)
of n onnIfysuch ns IIconso (Licenee Tox Coeee, 5 WnII.
462 (l86?)) or surchnrgo (Aeu Yor/ v. Ini/eJ S/o/ee,
eupro.). Iuf wo hnvo novorneterfronfod ns n fnx nn
oxncfIon whIch fncos u fo fho crIfIcnI dIfforonco bofwoon
n fnx nnd n onnIfy, nnd oxIIcIfIy donomInnfos fho oxnc-
fIon n onnIfy. IIghfoon fImos In 5000A IfsoIf nnd oIso-
whoro fhroughouf fho Acf, Congross cnIIod fho oxncfIon In
5000A(b) n onnIfy.
Thnf 5000A Imosos nof n sImIo fnx buf n mnndnfo fo
whIch n onnIfy Is nffnchod Is domonsfrnfod by fho fncf
fhnf somo nro oxomf from fho fnx who nro nof ox-
omf from fho mnndnfon dIsfIncfIon fhnf wouId mnko
no sonso If fho mnndnfo woro nof n mnndnfo. SocfIon
5000A(d) oxomfs fhroo cInssos of ooIo from fho dofInI-
fIon of nIIcnbIo IndIvIdunI subjocf fo fho mInImum
covorngo roquIromonf: Thoso wIfh roIIgIous objocfIons or
who nrfIcInfo In n honIfh cnro shnrIng mInIsfry,
5000A(d)(2); fhoso who nro nof InwfuIIy rosonf In fho
!nIfod Sfnfos, 5000A(d)(3); nnd fhoso who nro Incnrcor-
nfod, 5000A(d)(4). SocfIon 5000A(o) fhon cronfos n son-
rnfo sof of oxomfIons, oxcusIng from IInbIIIfy for fho
onnIfy corfnIn IndIvIdunIs who nro subjocf fo fho mInI-
mum covorngo roquIromonf: Thoso who cnnnof nfford
covorngo, 5000A(o)(l); who onrn foo IIffIo Incomo fo ro-
quIro fIIIng n fnx rofurn, 5000A(o)(2); who nro mombors
of nn IndInn frIbo, 5000A(o)(3); who oxorIonco onIy shorf
gns In covorngo, 5000A(o)(4); nnd who, In fho judgmonf
of fho Socrofnry of HonIfh nnd Humnn SorvIcos, hnvo
sufforod n hnrdshI wIfh rosocf fo fho cnnbIIIfy fo obfnIn
covorngo, 5000A(o)(5). If 5000A woro n fnx, fhoso fwo
cInssos of oxomfIon wouId mnko no sonso; fhoro boIng no
roquIromonf, oll fho oxomfIons wouId nffnch fo fho on-
nIfy (ronnmod fnx) nIono.
In fho fnco of nII fhoso IndIcnfIons of n roguInfory ro-
quIromonf nccomnnIod by n onnIfy, fho SoIIcIfor ConornI
nssuros us fhnf noIfhor fho Tronsury onrfmonf nor fho

I!SIISS t. SIII!I!S
onrfmonf of HonIfh nnd Humnn SorvIcos Inforrofs
SocfIon 5000A ns ImosIng n IognI obIIgnfIon, IofIfIonors`
MInImum Covorngo IrIof 6l, nnd fhnf |I]f |fhoso subjocf
fo fho Acf] ny fho fnx onnIfy, fhoy`ro In comIInnco wIfh
fho Inw, Tr. of OrnI Arg. 50 (Mnr. 26, 20l2). Thoso soIf-
sorvIng IIfIgnfIng osIfIons nro onfIfIod fo no woIghf.
Whnf counfs Is whnf fho sfnfufo snys, nnd fhnf Is onfIroIy
cIonr. If Is worfh nofIng, moroovor, fhnf fhoso nssurnncos
confrndIcf fho Covornmonf`s osIfIon In roInfod IIfIgnfIon.
ShorfIy boforo fho AffordnbIo Cnro Acf wns nssod, fho
CommonwonIfh of VIrgInIn onncfod Vn. Codo Ann. 38.2
3430.l:l (!oxIs Su. 20ll), whIch sfnfos, o rosIdonf of
|fho] CommonwonIfh . . . shnII bo roquIrod fo obfnIn or
mnInfnIn n oIIcy of IndIvIdunI Insurnnco covorngo oxcof
ns roquIrod by n courf or fho onrfmonf of SocInI Sor-
vIcos . . . . In oosIng VIrgInIn`s nssorfIon of sfnndIng fo
chnIIongo 5000A bnsod on fhIs sfnfufo, fho Covornmonf
snId fhnf If fho mInImum covorngo rovIsIon Is unconsfI-
fufIonnI, fho |VIrgInIn] sfnfufo Is unnocossnry, nnd If fho
mInImum covorngo rovIsIon Is uhoId, fho sfnfo sfnfufo Is
voId undor fho Suromncy CInuso. IrIof for AoIInnf
In o. lll05? ofc. (CA4), . 29. Iuf If wouId bo voId
undor fho Suromncy CInuso onIy If If wns confrndIcfod by
n fodornI roquIro|monf] fo obfnIn or mnInfnIn n oIIcy of
IndIvIdunI Insurnnco covorngo.
AgnInsf fho mounfnIn of ovIdonco fhnf fho mInImum
covorngo roquIromonf Is whnf fho sfnfufo cnIIs Ifn ro-
quIromonfnnd fhnf fho onnIfy for Ifs vIoInfIon Is whnf
fho sfnfufo cnIIs Ifn onnIfyfho Covornmonf brIngs
forwnrd fho fIImsIosf of IndIcnfIons fo fho confrnry. If
nofos fhnf |f]ho mInImum covorngo rovIsIon nmonds fho
InfornnI !ovonuo Codo fo rovIdo fhnf n non-oxomfod
IndIvIdunI . . . wIII owo n monofnry onnIfy, In nddIfIon fo
fho Incomo fnx IfsoIf, nnd fhnf |f]ho |InfornnI !ovonuo
SorvIco (I!S)] wIII nssoss nnd coIIocf fho onnIfy In fho
snmo mnnnor ns nssossnbIo onnIfIos undor fho InfornnI

23 CIfo ns: 56? !. S. ____ (20l2)
!ovonuo Codo. IofIfIonors` MInImum Covorngo IrIof 53.
Tho mnnnor of coIIocfIon couId orhns suggosf n fnx If
I!S onnIfy-coIIocfIon woro unhonrd-of or rnro. If Is nof.
Soo, e.g., 26 !. S. C. 52?(j) (2006 od.) (I!S-coIIocfIbIo on-
nIfy for fnIIuro fo mnko cnmnIgn-fInnnco dIscIosuros);
5?6l(c) (I!S-coIIocfIbIo onnIfy for domosfIc snIos of fo-
bncco roducfs InboIod for oxorf); 9?0? (I!S-coIIocfIbIo
onnIfy for fnIIuro fo mnko roquIrod honIfh-Insurnnco
romIum nymonfs on bohnIf of mInIng omIoyoos). In
IeorgoniceJ CI&1 IoIrico/ore of I/ol, 1nc., 5l8 !. S.
2l3, wo hoId fhnf nn oxncfIon nof onIy enforceJ by fho
CommIssIonor of InfornnI !ovonuo buf ovon colleJ n fnx
wns In fncf n onnIfy. |I]f fho concof of onnIfy monns
nnyfhIng, wo snId, If monns unIshmonf for nn unInwfuI
ncf or omIssIon. 1J., nf 224. Soo nIso Lip/e v. LeJerer,
259 !. S. 55? (l922) (snmo). Moroovor, whIIo fho onnIfy
Is nssossod nnd coIIocfod by fho I!S, 5000A Is ndmInIs-
forod bofh by fhnf ngoncy nnd by fho onrfmonf of
HonIfh nnd Humnn SorvIcos (nnd nIso fho Socrofnry of
Vofornn AffnIrs), soo 5000A(o)(l)(), (o)(5), (f)(l)(A)(v),
(f)(l)(I) (2006 od., Su. IV), whIch Is rosonsIbIo for
dofInIng Ifs subsfnnfIvo scoon fonfuro fhnf wouId bo
quIfo oxfrnordInnry for fnxos.
Tho Covornmonf oInfs ouf fhnf |f]ho nmounf of fho
onnIfy wIII bo cnIcuInfod ns n orconfngo of housohoId
Incomo for fodornI Incomo fnx urosos, subjocf fo n fIoor
nnd |n] cn|], nnd fhnf IndIvIdunIs who onrn so IIffIo
monoy fhnf fhoy nro nof roquIrod fo fIIo Incomo fnx ro-
furns for fho fnxnbIo yonr nro nof subjocf fo fho onnIfy
(fhough fhoy nro, ns wo dIscussod onrIIor, subjocf fo fho
mnndnfo). IofIfIonors` MInImum Covorngo IrIof l2, 53.
Iuf vnryIng n onnIfy nccordIng fo nbIIIfy fo ny Is nn
ufforIy fnmIIInr rncfIco. Soo, e.g., 33 !. S. C. l3l9(d)
(2006 od., Su. IV) (In doformInIng fho nmounf of n cIvII
onnIfy fho courf shnII consIdor . . . fho oconomIc Imncf of
fho onnIfy on fho vIoInfor); soo nIso 6 !. S. C. 488o(c); ?

I!SIISS t. SIII!I!S
!. S. C. ??34(b)(2), 83l3(b)(2); l2 !. S. C. l?0lql(d)(3),
l?23I(c)(3), l?35fl4(c)(3), l?35fl5(d)(3), 4585(c)(2); l5
!. S. C. 45(m)(l)(C), ??hl(g)(3), ?8u2(d), 80n9(d)(4),
80b3(I)(4), l68ls(n)(2)(I), l?l?n(b)(3), l825(b)(l), 26l5(n)
(2)(I), 5408(b)(2); 33 !. S. C. 2?l6n(n).
Tho Insf of fho foobIo nrgumonfs In fnvor of ofIfIon-
ors fhnf wo wIII nddross Is fho confonfIon fhnf whnf fhIs
sfnfufo roonfodIy cnIIs n onnIfy Is In fncf n fnx bocnuso If
confnIns no scIonfor roquIromonf. Tho preeence of such n
roquIromonf suggosfs n onnIfyfhough ono cnn ImngIno
n fnx Imosod onIy on wIIIfuI ncfIon; buf fho oIeence of
such n roquIromonf doos nof suggosf n fnx. IonnIfIos for
nbsoIufo-IInbIIIfy offonsos nro commonInco. And whoro n
sfnfufo Is sIIonf ns fo scIonfor, wo frndIfIonnIIy rosumo
n nene reo roquIromonf If fho sfnfufo Imosos n sovoro
onnIfy. S/oplee v. Ini/eJ S/o/ee, 5ll !. S. 600, 6l8
(l994). SInco wo hnvo nn onfIro jurIsrudonco nddrossIng
whon If Is fhnf n scIonfor roquIromonf shouId bo Inforrod
from n onnIfy, If Is quIfo IIIogIcnI fo suggosf fhnf n
onnIfy Is nof n onnIfy for wnnf of nn oxross scIonfor
roquIromonf.
And fho nnII In fho coffIn Is fhnf fho mnndnfo nnd on-
nIfy nro Iocnfod In TIfIo I of fho Acf, Ifs oornfIvo coro,
rnfhor fhnn whoro n fnx wouId bo foundIn TIfIo IX,
confnInIng fho Acf`s !ovonuo IrovIsIons. In sum, fho
forms of |fho] ncf rondo|r] If unnvoIdnbIo, Poreone v.
BeJforJ, 3 Iof. 433, 448 (l830), fhnf Congross Imosod n
roguInfory onnIfy, nof n fnx.
Ior nII fhoso ronsons, fo sny fhnf fho IndIvIdunI Mnn-
dnfo moroIy Imosos n fnx Is nof fo Inforrof fho sfnfufo
buf fo rowrIfo If. JudIcInI fnx-wrIfIng Is nrfIcuInrIy froubI-
Ing. Tnxos hnvo novor boon ouInr, soo, e.g., Sfnm Acf
of l?65, nnd In nrf for fhnf ronson, fho ConsfIfufIon
roquIros fnx Incronsos fo orIgInnfo In fho Houso of !oro-
sonfnfIvos. Soo Arf. I, ?, cI. l. Thnf Is fo sny, fhoy musf
orIgInnfo In fho IogIsInfIvo body mosf nccounfnbIo fo fho

25 CIfo ns: 56? !. S. ____ (20l2)
ooIo, whoro IogIsInfors musf woIgh fho nood for fho fnx
ngnInsf fho forrIbIo rIco fhoy mIghf ny nf fhoIr noxf
oIocfIon, whIch Is novor moro fhnn fwo yonrs off. Tho
IodornIIsf o. 58 dofond|od] fho docIsIon fo gIvo fho
orIgInnfIon owor fo fho Houso on fho ground fhnf fho
Chnmbor fhnf Is moro nccounfnbIo fo fho ooIo shouId
hnvo fho rImnry roIo In rnIsIng rovonuo. Ini/eJ S/o/ee
v. Munoc-Iloree, 495 !. S. 385, 395 (l990). Wo hnvo no
doubf fhnf Congross know rocIsoIy whnf If wns doIng
whon If rojocfod nn onrIIor vorsIon of fhIs IogIsInfIon fhnf
Imosod n fnx Insfond of n roquIromonf-wIfh-onnIfy. Soo
AffordnbIo HonIfh Cnro for AmorIcn Acf, H. !. 3962, lllfh
Cong., lsf Soss., 50l (2009); AmorIcn`s HonIfhy Iufuro
Acf of 2009, S. l?96, lllfh Cong., lsf Soss., l30l. Imos-
Ing n fnx fhrough judIcInI IogIsInfIon Invorfs fho consfIfu-
fIonnI schomo, nnd Incos fho owor fo fnx In fho brnnch of
govornmonf Ionsf nccounfnbIo fo fho cIfIzonry.
IInnIIy, wo musf obsorvo fhnf rowrIfIng 5000A ns n fnx
In ordor fo susfnIn Ifs consfIfufIonnIIfy wouId forco us fo
confronf n dIffIcuIf consfIfufIonnI quosfIon: whofhor fhIs Is
n dIrocf fnx fhnf musf bo norfIonod nmong fho Sfnfos
nccordIng fo fhoIr ouInfIon. Arf. I, 9, cI. 4. Iorhns If
Is nof (wo hnvo no nood fo nddross fho oInf); buf fho
monnIng of fho Irocf Tnx CInuso Is fnmousIy uncIonr, nnd
Ifs nIIcnfIon horo Is n quosfIon of fIrsf ImrossIon fhnf
dosorvos moro fhoughffuI consIdornfIon fhnn fho IIck-nnd-
n-romIso nccordod by fho Covornmonf nnd Ifs suorfors.
Tho Covornmonf`s oonIng brIof dId nof ovon nddross fho
quosfIonorhns bocnuso, unfII fodny, no fodornI courf
hns nccofod fho ImInusIbIo nrgumonf fhnf 5000A Is
nn oxorcIso of fho fnx owor. And onco rosondonfs rnIsod
fho Issuo, fho Covornmonf dovofod n moro 2l IInos of Ifs
roIy brIof fo fho Issuo. IofIfIonors` MInImum Covorngo
!oIy IrIof 25. Af ornI nrgumonf, fho mosf roIongod
sfnfomonf nbouf fho Issuo wns jusf ovor 50 words. Tr. of
OrnI Arg. ?9 (Mnr. 2?, 20l2). Ono wouId oxocf fhIs Courf

I!SIISS t. SIII!I!S
fo domnnd moro fhnn fIy-by-nIghf brIofIng nnd nrgumonf
boforo docIdIng n dIffIcuIf consfIfufIonnI quosfIon of fIrsf
ImrossIon.
III
!"# 5&.(6%&7*&8.(2& 58.
Thoro Is nnofhor oInf roInfod fo fho IndIvIdunI Mnn-
dnfo fhnf wo musf dIscussn oInf fhnf IogIcnIIy shouId
hnvo boon dIscussod fIrsf: Whofhor jurIsdIcfIon ovor fho
chnIIongos fo fho mInImum-covorngo rovIsIon Is rocIudod
by fho AnfI-InjuncfIon Acf, whIch rovIdos fhnf no suIf
for fho uroso of rosfrnInIng fho nssossmonf or coIIocfIon
of nny fnx shnII bo mnInfnInod In nny courf by nny or-
son, 26 !. S. C. ?42l(n) (2006 od.).
Wo hnvo Ioff fho quosfIon fo fhIs oInf bocnuso If
soomod fo us fhnf fho dIsosIfIvo quosfIon whofhor fho
mInImum-covorngo rovIsIon Is n fnx Is moro nrorInfoIy
nddrossod In fho sIgnIfIcnnf consfIfufIonnI confoxf of
whofhor If Is nn oxorcIso of Congross` fnxIng owor. Hnv-
Ing found fhnf If Is nof, wo hnvo no dIffIcuIfy In docIdIng
fhnf fhoso suIfs do nof hnvo fho uroso of rosfrnInIng
fho nssossmonf or coIIocfIon of nny fnx.
6

6
Tho onicue noInfod fo dofond fho roosIfIon fhnf fho AnfI-
InjuncfIon Acf dorIvos us of jurIsdIcfIon sfrossos fhnf fho onnIfy for
fnIIIng fo comIy wIfh fho mnndnfo shnII bo nssossod nnd coIIocfod
In fho snmo mnnnor ns nn nssossnbIo onnIfy undor subchnfor I of
chnfor 68, 26 !. S. C. 5000A(g)(l) (2006 od., Su. IV), nnd fhnf
such onnIfIos shnII bo nssossod nnd coIIocfod In fho snmo mnnnor
ns fnxos, 66?l(n) (2006 od.). Iuf fhnf oInf sooms fo us fo confIrm
fho inopplicoIili/, of fho AnfI-InjuncfIon Acf. Thnf fho onnIfy Is fo
bo nssossod nnd coIIocfod in /le eone nonner oe fnxos rofufos fho
roosIfIon fhnf If ie n fnx for nII sfnfufory urosos, IncIudIng wIfh
rosocf fo fho AnfI-InjuncfIon Acf. Moroovor, oIsowhoro In fho InfornnI
!ovonuo Codo, Congross hns rovIdod Io/l fhnf n nrfIcuInr nymonf
shnII bo nssossod nnd coIIocfod In fho snmo mnnnor ns n fnx onJ fhnf
no suIf shnII bo mnInfnInod fo rosfrnIn fho nssossmonf or coIIocfIon of
fho nymonf. Soo, e.g., ?42l(b)(l), 690l(n); 6305(n), (b). Tho

2? CIfo ns: 56? !. S. ____ (20l2)
Tho Covornmonf nnd fhoso who suorf Ifs osIfIon on
fhIs oInf mnko fho romnrknbIo nrgumonf fhnf 5000A Is
nof n fnx for urosos of fho AnfI-InjuncfIon Acf, soo IrIof
for IofIfIonors In o. ll398 (AnfI-InjuncfIon Acf), buf
Is n fnx for consfIfufIonnI urosos, soo IofIfIonors` MInI-
mum Covorngo IrIof 5262. Tho rhoforIcnI dovIco fhnf
frIos fo cIonk fhIs nrgumonf In suorfIcInI InusIbIIIfy Is
fho snmo dovIco omIoyod In nrguIng fhnf for consfIfu-
fIonnI urosos fho mInImum-covorngo rovIsIon Is n fnx:
confusIng fho quosfIon of whnf Congross JiJ wIfh fho
quosfIon of whnf Congross coulJ lote Jone. Whnf qunII-
fIos ns n fnx for urosos of fho AnfI-InjuncfIon Acf, unIIko
whnf qunIIfIos ns n fnx for urosos of fho ConsfIfufIon, Is
onfIroIy wIfhIn fho confroI of Congross. Comnro Boile, v.
George, 259 !. S. l6, 20 (l922) (AnfI-InjuncfIon Acf bnrrod
suIf fo rosfrnIn coIIocfIons undor fho ChIId !nbor Tnx
!nw), wIfh ClilJ LoIor Tox Coee, 259 !. S., nf 364l
(hoIdIng fho snmo Inw unconsfIfufIonnI ns oxcoodIng Con-
gross` fnxIng owor). Congross couId hnvo dofInod fnx
for urosos of fhnf sfnfufo In such fnshIon ns fo oxcIudo
somo oxncfIons fhnf In fncf nro fnxos. If mIghf hnvo
roscrIbod, for oxnmIo, fhnf n nrfIcuInr oxorcIso of fho
fnxIng owor shnII nof bo rognrdod ns n fnx for urosos
of fho AnfI-InjuncfIon Acf. Iuf fhoro Is no such roscrI-
fIon horo. Whnf fho Covornmonf wouId hnvo us boIIovo In

Inffor dIrocfIvo wouId bo suorfIuous If fho formor Invokod fho AnfI-
InjuncfIon Acf.
Anicue nIso suggosfs fhnf fho onnIfy shouId bo fronfod ns n fnx
bocnuso If Is nn nssossnbIo onnIfy, nnd fho Codo`s nssossmonf rovI-
sIon nufhorIzos fho Socrofnry of fho Tronsury fo nssoss nII fnxos (In-
cIudIng Inforosf, nddIfIonnI nmounfs, nddIfIons fo fho fnx, nnd ns-
sossnbIo onnIfIos) Imosod by fhIs fIfIo. 620l(n) (2006 od., Su.
IV). Iuf fho fncf fhnf such Ifoms nro IncIudod ns fnxos for urosos of
nssossmonf doos nof osfnbIIsh fhnf fhoy nro IncIudod ns fnxos for
urosos of ofhor socfIons of fho Codo, such ns fho AnfI-InjuncfIon Acf,
fhnf do nof confnIn sImIInr IncIudIng Inngungo.

I!SIISS t. SIII!I!S
fhoso cnsos Is fhnf fho vory snmo foxfunI IndIcnfIons fhnf
show fhIs Is no/ n fnx undor fho AnfI-InjuncfIon Acf show
fhnf If ie n fnx undor fho ConsfIfufIon. Thnf cnrrIos vor-
bnI wIznrdry foo fnr, doo Info fho forbIddon Innd of fho
sohIsfs.
IV
!"# -#'(8+(' 9/:+&;(2&
Wo now consIdor rosondonfs` socond chnIIongo fo fho
consfIfufIonnIIfy of fho ACA, nnmoIy, fhnf fho Acf`s drn-
mnfIc oxnnsIon of fho ModIcnId rogrnm oxcoods Con-
gross` owor fo nffnch condIfIons fo fodornI grnnfs fo fho
Sfnfos.
Tho ACA doos nof IognIIy comoI fho Sfnfos fo nrfIcI-
nfo In fho oxnndod ModIcnId rogrnm, buf fho Acf nu-
fhorIzos n sovoro snncfIon for nny Sfnfo fhnf rofusos fo go
nIong: formInnfIon of nII fho Sfnfo`s ModIcnId fundIng. Ior
fho nvorngo Sfnfo, fho nnnunI fodornI ModIcnId subsIdy Is
oqunI fo moro fhnn ono-fIffh of fho Sfnfo`s oxondIfuros.
?
A Sfnfo forcod ouf of fho rogrnm wouId nof onIy Ioso fhIs
hugo sum buf wouId nImosf corfnInIy fInd If nocossnry fo
Incronso Ifs own honIfh-cnro oxondIfuros subsfnnfInIIy,
roquIrIng oIfhor n drnsfIc roducfIon In fundIng for ofhor
rogrnms or n Inrgo Incronso In sfnfo fnxos. And fhoso
now fnxos wouId como on fo of fho fodornI fnxos nIrondy
nId by fho Sfnfo`s cIfIzons fo fund fho ModIcnId rogrnm
In ofhor Sfnfos.
Tho Sfnfos chnIIongIng fho consfIfufIonnIIfy of fho ACA`s
ModIcnId IxnnsIon confond fhnf, for fhoso rncfIcnI
ronsons, fho Acf ronIIy doos nof gIvo fhom nny choIco nf
nII. As roof of fhIs, fhoy oInf fo fho gonI nnd fho sfruc-

?
Sfnfo oxondIfuros Is usod horo fo monn nnnunI oxondIfuros from
fho Sfnfos` own fundIng sourcos, nnd If oxcIudos fodornI grnnfs unIoss
ofhorwIso nofod.

29 CIfo ns: 56? !. S. ____ (20l2)
furo of fho ACA. Tho gonI of fho Acf Is fo rovIdo nonr-
unIvorsnI modIcnI covorngo, 42 !. S. C. l809l(2)(), nnd
wIfhouf l00 Sfnfo nrfIcInfIon In fho ModIcnId ro-
grnm, nffnInmonf of fhIs gonI wouId bo fhwnrfod. Ivon If
Sfnfos couId oIocf fo romnIn In fho oId ModIcnId rogrnm,
whIIo docIInIng fo nrfIcInfo In fho IxnnsIon, fhoro
wouId bo n gnIng hoIo In covorngo. And If n subsfnnfInI
numbor of Sfnfos woro onfIroIy oxoIIod from fho rogrnm,
fho numbor of orsons wIfhouf covorngo wouId bo ovon
hIghor.
In IIghf of fho ACA`s gonI of nonr-unIvorsnI covorngo,
ofIfIonors nrguo, If Congross hnd fhoughf fhnf nnyfhIng
Ioss fhnn l00 sfnfo nrfIcInfIon wns n ronIIsfIc ossIbII-
Ify, Congross wouId hnvo rovIdod n bncku schomo. Iuf
no such schomo Is fo bo found nnywhoro In fho moro fhnn
900 ngos of fho Acf. ThIs shows, fhoy mnInfnIn, fhnf
Congross wns corfnIn fhnf fho ACA`s ModIcnId offor wns
ono fhnf no Sfnfo couId rofuso.
In rosonso fo fhIs nrgumonf, fho Covornmonf confonds
fhnf nny congrossIonnI nssumfIon nbouf unIform sfnfo
nrfIcInfIon wns bnsod on fho sImIo fncf fhnf fho offor
of fodornI funds nssocInfod wIfh fho oxnndod covorngo Is
such n gonorous gIff fhnf no Sfnfo wouId wnnf fo furn If
down.
To ovnIunfo fhoso nrgumonfs, wo consIdor fho oxfonf of
fho IodornI Covornmonf`s owor fo sond monoy nnd fo
nffnch condIfIons fo monoy grnnfod fo fho Sfnfos.
A
o ono hns ovor doubfod fhnf fho ConsfIfufIon nufhor-
Izos fho IodornI Covornmonf fo sond monoy, buf for
mnny yonrs fho scoo of fhIs owor wns unsoffIod. Tho
ConsfIfufIon grnnfs Congross fho owor fo coIIocf fnxos fo
. . . rovIdo for fho . . . gonornI WoIfnro of fho !nIfod
Sfnfos, Arf. I, 8, cI. l, nnd from fho foundnfIon of fho
nfIon shnr dIfforoncos of oInIon hnvo orsIsfod ns fo

I!SIISS t. SIII!I!S
fho fruo InforrofnfIon of fho hrnso fho gonornI woI-
fnro. Bu/ler, 29? !. S., nf 65. MndIson, If hns boon snId,
fhoughf fhnf fho hrnso nmounfod fo no moro fhnn n
roforonco fo fho ofhor owors onumornfod In fho subso-
quonf cInusos of fho snmo socfIon, whIIo HnmIIfon mnIn-
fnInod fho cInuso confors n owor sonrnfo nnd dIsfIncf
from fhoso Infor onumornfod |nnd] Is nof rosfrIcfod In
monnIng by fho grnnf of fhom. 1IiJ.
Tho Courf rosoIvod fhIs dIsufo In Bu/ler. WrIfIng for
fho Courf, JusfIco !oborfs oInod fhnf fho MndIsonInn
vIow wouId mnko ArfIcIo I`s grnnf of fho sondIng owor n
moro fnufoIogy. 1IiJ. To nvoId fhnf, ho ndofod HnmII-
fon`s nronch nnd found fhnf fho owor of Congross fo
nufhorIzo oxondIfuro of ubIIc monoys for ubIIc ur-
osos Is nof IImIfod by fho dIrocf grnnfs of IogIsInfIvo
owor found In fho ConsfIfufIon. 1J., nf 66. Insfond, ho
wrofo, fho sondIng owor`s confInos nro sof In fho cInuso
whIch confors If, nnd nof In fhoso of socfIon 8 whIch bo-
sfow nnd dofIno fho IogIsInfIvo owors of fho Congross.
1IiJ.; soo nIso S/euorJ Mocline Co. v. Dotie, 30l !. S.
548, 58658? (l93?); Heltering v. Dotie, 30l !. S. 6l9,
640 (l93?).
Tho owor fo mnko nny oxondIfuro fhnf furfhors fho
gonornI woIfnro Is obvIousIy vory brond, nnd shorfIy nffor
Bu/ler wns docIdod fho Courf gnvo Congross wIdo Ioowny
fo docIdo whofhor nn oxondIfuro qunIIfIos. Soo Heltering,
30l !. S., nf 64064l. Tho dIscrofIon boIongs fo Con-
gross, fho Courf wrofo, unIoss fho choIco Is cIonrIy
wrong, n dIsIny of nrbIfrnry owor, nof nn oxorcIso of
judgmonf. 1J., nf 640. SInco fhnf fImo, fho Courf hns
novor hoId fhnf n fodornI oxondIfuro wns nof for fho
gonornI woIfnro.
I
Ono wny In whIch Congross mny sond fo romofo fho
gonornI woIfnro Is by mnkIng grnnfs fo fho Sfnfos. Mono-

3l CIfo ns: 56? !. S. ____ (20l2)
fnry grnnfs, so-cnIIod grnnfs-In-nId, bocnmo moro froquonf
durIng fho l930`s, C. Sfohons & . WIksfrom, AmorI-
cnn InforgovornmonfnI !oInfIonsA Irngmonfod IodornI
IoIIfy 83 (200?), nnd by l950 fhoy hnd ronchod $20 bIIIIon
8
or ll.6 of sfnfo nnd IocnI govornmonf oxondIfuros from
fhoIr own sourcos.
9
Iy l9?0 fhIs numbor hnd grown fo
$l23.? bIIIIon
l0
or 29.l of sfnfo nnd IocnI govornmonf
oxondIfuros from fhoIr own sourcos.
ll
As of 20l0, fod-
ornI oufInys fo sfnfo nnd IocnI govornmonfs cnmo fo ovor
$608 bIIIIon or 3?.5 of sfnfo nnd IocnI govornmonf
oxondIfuros.
l2
Whon Congross mnkos grnnfs fo fho Sfnfos, If cusfomnr-
IIy nffnchos condIfIons, nnd fhIs Courf hns Iong hoId fhnf
fho ConsfIfufIon gonornIIy ormIfs Congross fo do fhIs.
Soo Pennlure/ S/o/e Sclool onJ Hoepi/ol v. HolJernon,
45l !. S. l, l? (l98l); Sou/l Do/o/o v. Dole, 483 !. S.
203, 206 (l98?); Iullilote v. Klu/cnic/, 448 !. S. 448, 4?4
(l980) (oInIon of Iurgor, C. J.); S/euorJ Mocline, eupro,
nf 593.
C
ThIs rncfIco of nffnchIng condIfIons fo fodornI funds

8
ThIs numbor Is oxrossod In bIIIIons of IIscnI Yonr 2005 doIInrs.
9
Soo OffIco of Mnnngomonf nnd Iudgof, HIsforIcnI TnbIos, Iudgof of
fho !. S. Covornmonf, IIscnI Yonr 20l3, TnbIo l2.lSummnry Com-
nrIson of TofnI OufInys for Crnnfs fo Sfnfo nnd !ocnI Covornmonfs:
l94020l? (horoInnffor TnbIo l2.l), hff://www.whIfohouso.gov/omb/
budgof/HIsforIcnIs; iJ., TnbIo l5.2TofnI Covornmonf IxondIfuros:
l94820ll (horoInnffor TnbIo l5.2).
l0
ThIs numbor Is oxrossod In bIIIIons of IIscnI Yonr 2005 doIInrs.
ll
Soo TnbIo l2.l; of. of Commorco, Iuronu of Consus, SfnfIsfIcnI
Absfrncf of fho !nIfod Sfnfos: 200l, . 262 (TnbIo 4l9, IodornI Crnnfs-
In-AId Summnry: l9?0 fo 200l).
l2
Soo SfnfIsfIcnI Absfrncf of fho !nIfod Sfnfos: 20l2, . 268 (TnbIo
43l, IodornI Crnnfs-In-AId fo Sfnfo nnd !ocnI Covornmonfs: l990 fo
20ll).

I!SIISS t. SIII!I!S
gronfIy Incronsos fodornI owor. |O]bjocfIvos nof fhoughf
fo bo wIfhIn ArfIcIo I`s onumornfod IogIsInfIvo fIoIds, mny
novorfhoIoss bo nffnInod fhrough fho uso of fho sondIng
owor nnd fho condIfIonnI grnnf of fodornI funds. Dole,
eupro, nf 20? (InfornnI quofnfIon mnrks nnd cIfnfIon omIf-
fod); soo nIso College Sotinge Bon/ v. IloriJo PrepoiJ
Poe/eeconJor, 1J. 1xpenee BJ., 52? !. S. 666, 686 (l999)
(by nffnchIng condIfIons fo fodornI funds, Congross mny
Induco fho Sfnfos fo fnk|o] corfnIn ncfIons fhnf Congross
couId nof roquIro fhom fo fnko).
ThIs formIdnbIo owor, If nof chockod In nny wny, wouId
rosonf n grnvo fhronf fo fho sysfom of fodornIIsm cronfod
by our ConsfIfufIon. If Congross` SondIng CInuso owor
fo ursuo objocfIvos oufsIdo of ArfIcIo I`s onumornfod
IogIsInfIvo fIoIds, Dotie v. Monroe Coun/, BJ. of 1J., 526
!. S. 629, 654 (l999) (KIIY, J., dIssonfIng) (InfornnI
quofnfIon mnrks omIffod), Is IImIfod onIy by Congross`
nofIon of fho gonornI woIfnro, fho ronIIfy, gIvon fho vnsf
fInnncInI rosourcos of fho IodornI Covornmonf, Is fhnf
fho SondIng CInuso gIvos 'owor fo fho Congross fo fonr
down fho bnrrIors, fo Invndo fho sfnfos` jurIsdIcfIon, nnd fo
bocomo n nrIInmonf of fho whoIo ooIo, subjocf fo no
rosfrIcfIons snvo such ns nro soIf-Imosod,` Dole, eupro, nf
2l? (O`Connor, J., dIssonfIng) (quofIng Bu/ler, 29? !. S.,
nf ?8). |T]ho SondIng CInuso owor, If wIoIdod wIfhouf
concorn for fho fodornI bnInnco, hns fho ofonfInI fo obIIfo-
rnfo dIsfIncfIons bofwoon nnfIonnI nnd IocnI shoros of
Inforosf nnd owor by ormIffIng fho IodornI Covornmonf
fo sof oIIcy In fho mosf sonsIfIvo nrons of frndIfIonnI
sfnfo concorn, nrons whIch ofhorwIso wouId IIo oufsIdo
Ifs ronch. Dotie, eupro, nf 654655 (KIIY, J.,
dIssonfIng).
!ocognIzIng fhIs ofonfInI for nbuso, our cnsos hnvo Iong
hoId fhnf fho owor fo nffnch condIfIons fo grnnfs fo fho
Sfnfos hns IImIfs. Soo, e.g., Dole, eupro, nf 20?208; iJ.,
nf 20? (sondIng owor Is subjocf fo sovornI gonornI ro-

33 CIfo ns: 56? !. S. ____ (20l2)
sfrIcfIons nrfIcuInfod In our cnsos). Ior ono fhIng, nny
such condIfIons musf bo unnmbIguous so fhnf n Sfnfo nf
Ionsf knows whnf If Is goffIng Info. Soo Pennlure/, eupro,
nf l?. CondIfIons musf nIso bo roInfod fo fho fodornI
Inforosf In nrfIcuInr nnfIonnI rojocfs or rogrnms,
Moeeocluee//e v. Ini/eJ S/o/ee, 435 !. S. 444, 46l (l9?8),
nnd fho condIfIonnI grnnf of fodornI funds mny nof Induco
fho Sfnfos fo ongngo In ncfIvIfIos fhnf wouId fhomsoIvos bo
unconsfIfufIonnI, Dole, eupro, nf 2l0; soo Lourence Coun/,
v. LeoJ-DeoJuooJ Sclool Die/. Ao. 401, 469 !. S.
256, 2692?0 (l985). IInnIIy, whIIo Congross mny sook fo
Induco Sfnfos fo nccof condIfIonnI grnnfs, Congross mny
nof cross fho oInf nf whIch rossuro furns Info comuI-
sIon, nnd consos fo bo Inducomonf. S/euorJ Mocline, 30l
!. S., nf 590. Accord, College Sotinge Bon/, eupro, nf 68?;
Me/ropoli/on Woeling/on Airpor/e Au/lori/, v. Ci/icene for
AIo/enen/ of Aircrof/ Aoiee, 1nc., 50l !. S. 252, 285 (l99l)
(WhIfo, J., dIssonfIng); Dole, eupro, nf 2ll.
Whon fodornI IogIsInfIon gIvos fho Sfnfos n ronI choIco
whofhor fo nccof or docIIno n fodornI nId nckngo, fho
fodornI-sfnfo roInfIonshI Is In fho nnfuro of n confrncfunI
roInfIonshI. Soo Bornee v. Gornon, 536 !. S. l8l, l86
(2002); Pennlure/, 45l !. S., nf l?. And jusf ns n confrncf
Is voIdnbIo If coorcod, |f]ho IogIfImncy of Congross` owor
fo IogIsInfo undor fho sondIng owor . . . rosfs on whofhor
fho Sfnfo tolun/oril, nnd knowIngIy nccofs fho forms
of fho 'confrncf.` 1IiJ. (omhnsIs nddod). If n fodornI
sondIng rogrnm coorcos nrfIcInfIon fho Sfnfos hnvo
nof oxorcIso|d] fhoIr choIcoIof nIono mndo nn Informod
choIco. 1J., nf l?, 25.
CoorcIng Sfnfos fo nccof condIfIons rIsks fho dosfruc-
fIon of fho unIquo roIo of fho Sfnfos In our sysfom.
Dotie, eupro, nf 685 (KIIY, J., dIssonfIng). |T]ho
ConsfIfufIon hns novor boon undorsfood fo confor uon
Congross fho nbIIIfy fo roquIro fho Sfnfos fo govorn nccord-
Ing fo Congross` InsfrucfIons. Aeu Yor/, 505 !. S., nf

I!SIISS t. SIII!I!S
l62. Congross mny nof sImIy commnndoor fho IogIsIn-
fIvo rocossos of fho Sfnfos by dIrocfIy comoIIIng fhom fo
onncf nnd onforco n fodornI roguInfory rogrnm. 1J.,
nf l6l (InfornnI quofnfIon mnrks nnd brnckofs omIffod).
Congross offocfIvoIy ongngos In fhIs ImormIssIbIo com-
uIsIon whon sfnfo nrfIcInfIon In n fodornI sondIng
rogrnm Is coorcod, so fhnf fho Sfnfos` choIco whofhor fo
onncf or ndmInIsfor n fodornI roguInfory rogrnm Is ron-
dorod IIIusory.
Whoro nII Congross hns dono Is fo oncourng|o] sfnfo
roguInfIon rnfhor fhnn como|I] If, sfnfo govornmonfs
romnIn rosonsIvo fo fho IocnI oIocfornfo`s roforoncos;
sfnfo offIcInIs romnIn nccounfnbIo fo fho ooIo. |Iuf]
whoro fho IodornI Covornmonf comoIs Sfnfos fo roguInfo,
fho nccounfnbIIIfy of bofh sfnfo nnd fodornI offIcInIs Is
dImInIshod. Aeu Yor/, eupro, nf l68.
Anici who suorf fho Covornmonf nrguo fhnf forcIng
sfnfo omIoyoos fo ImIomonf n fodornI rogrnm Is moro
rosocffuI of fodornIIsm fhnn usIng fodornI workors fo
ImIomonf fhnf rogrnm. Soo, e.g., IrIof for SorvIco Im-
Ioyoos InfornnfIonnI !nIon of nI. ns Anici Curioe In o.
ll398, . 2526. Thoy nofo fhnf Congross, Insfond of
oxnndIng ModIcnId, couId hnvo osfnbIIshod nn onfIroIy
fodornI rogrnm fo rovIdo covorngo for fho snmo grou of
ooIo. Iy choosIng fo sfrucfuro ModIcnId ns n cooornfIvo
fodornI-sfnfo rogrnm, fhoy confond, Congross nIIows for
moro sfnfo confroI. 1IiJ.
ThIs nrgumonf rofIocfs n vIow of fodornIIsm fhnf our
cnsos hnvo rojocfodnnd wIfh good ronson. Whon Con-
gross comoIs fho Sfnfos fo do Ifs bIddIng, If bIurs fho
IInos of oIIfIcnI nccounfnbIIIfy. If fho IodornI Covorn-
monf mnkos n confrovorsInI docIsIon whIIo ncfIng on Ifs
own, If Is fho IodornI Covornmonf fhnf mnkos fho docI-
sIon In fuII vIow of fho ubIIc, nnd If wIII bo fodornI offI-
cInIs fhnf suffor fho consoquoncos If fho docIsIon furns ouf
fo bo dofrImonfnI or unouInr. Aeu Yor/, 505 !. S., nf

35 CIfo ns: 56? !. S. ____ (20l2)
l68. Iuf whon fho IodornI Covornmonf comoIs fho
Sfnfos fo fnko unouInr ncfIons, If mny bo sfnfo offIcInIs
who wIII bonr fho brunf of ubIIc dIsnrovnI, whIIo fho
fodornI offIcInIs who dovIsod fho roguInfory rogrnm mny
romnIn InsuInfod from fho oIocfornI rnmIfIcnfIons of fhoIr
docIsIon. 1J., nf l69; soo Prin/c, eupro, nf 930. Ior fhIs
ronson, fodornI offIcohoIdors mny vIow fhIs donrfur|o]
from fho fodornI sfrucfuro fo bo In fhoIr orsonnI Inforosfs
. . . ns n monns of shIffIng rosonsIbIIIfy for fho ovonfunI
docIsIon. Aeu Yor/, 505 !. S., nf l82l83. And ovon sfnfo
offIcInIs mny fnvor such n donrfuro from fho consfIfu-
fIonnI Inn, sInco uncorfnInfy concornIng rosonsIbIIIfy
mny nIso ormIf fhom fo oscno nccounfnbIIIfy. 1J., nf
l82. If n rogrnm Is ouInr, sfnfo offIcInIs mny cInIm
crodIf; If If Is unouInr, fhoy mny rofosf fhnf fhoy woro
moroIy rosondIng fo n fodornI dIrocfIvo.
Onco If Is rocognIzod fhnf sondIng-owor IogIsInfIon
cnnnof coorco sfnfo nrfIcInfIon, fwo quosfIons romnIn:
(l) Whnf Is fho monnIng of coorcIon In fhIs confoxf (2) Is
fho ACA`s oxnndod ModIcnId covorngo coorcIvo Wo now
furn fo fhoso quosfIons.

l
Tho nnswor fo fho fIrsf of fhoso quosfIonsfho monnIng
of coorcIon In fho rosonf confoxfIs sfrnIghfforwnrd. As
wo hnvo oxInInod, fho IogIfImncy of nffnchIng condIfIons
fo fodornI grnnfs fo fho Sfnfos doonds on fho voIunfnrI-
noss of fho Sfnfos` choIco fo nccof or docIIno fho offorod
nckngo. Thoroforo, If Sfnfos ronIIy hnvo no choIco ofhor
fhnn fo nccof fho nckngo, fho offor Is coorcIvo, nnd fho
condIfIons cnnnof bo susfnInod undor fho sondIng owor.
And ns our docIsIon In Sou/l Do/o/o v. Dole mnkos cIonr,
fhoorofIcnI voIunfnrInoss Is nof onough.
In Sou/l Do/o/o v. Dole, wo consIdorod whofhor fho
sondIng owor ormIffod Congross fo condIfIon 5 of fho

I!SIISS t. SIII!I!S
Sfnfo`s fodornI hIghwny funds on fho Sfnfo`s ndofIon of
n mInImum drInkIng ngo of 2l yonrs. Soufh nkofn nr-
guod fhnf fho rogrnm wns ImormIssIbIy coorcIvo, buf wo
dIsngrood, ronsonIng fhnf Congross hn|d] dIrocfod onIy
fhnf n Sfnfo dosIrIng fo osfnbIIsh n mInImum drInkIng ngo
Iowor fhnn 2l Ioso n roInfIvoIy smnII orconfngo of corfnIn
fodornI hIghwny funds. 483 !. S., nf 2ll. Iocnuso nII
Soufh nkofn wouId Ioso If sho ndhoro|d] fo hor choson
courso ns fo n suIfnbIo mInImum drInkIng ngo |wns] 5
of fho funds ofhorwIso obfnInnbIo undor socIfIod hIgh-
wny grnnf rogrnms, wo found fhnf Congross hn|d] of-
forod roInfIvoIy mIId oncourngomonf fo fho Sfnfos fo onncf
hIghor mInImum drInkIng ngos fhnn fhoy wouId ofhorwIso
chooso. 1IiJ. Thus, fho docIsIon whofhor fo comIy wIfh
fho fodornI condIfIon romnIn|od] fho rorognfIvo of fho
Sfnfos no/ nerel, in /leor, Iu/ in foc/, nnd so fho ro-
grnm nf Issuo dId nof oxcood Congross` owor. 1J., nf 2ll
2l2 (omhnsIs nddod).
Tho quosfIon whofhor n Inw onncfod undor fho sondIng
owor Is coorcIvo In fncf wIII somofImos bo dIffIcuIf, buf
whoro Congross hns InInIy crossod fho IIno dIsfInguIsh-
Ing oncourngomonf from coorcIon, Aeu Yor/, eupro, nf
l?5, n fodornI rogrnm fhnf coofs fho Sfnfos` oIIfIcnI
rocossos musf bo docInrod unconsfIfufIonnI. |T]ho fod-
ornI bnInnco Is foo ossonfInI n nrf of our consfIfufIonnI
sfrucfuro nnd Inys foo vIfnI n roIo In socurIng froodom for
us fo ndmIf InnbIIIfy fo Inforvono. Lopec, 5l4 !. S., nf
5?8 (KIIY, J., concurrIng).
2
Tho IodornI Covornmonf`s nrgumonf In fhIs cnso nf bosf
nys II sorvIco fo fho nnfIcoorcIon rIncIIo. Tho IodornI
Covornmonf suggosfs fhnf If Is suffIcIonf If Sfnfos nro
froo, oe o no//er of lou, fo furn down fodornI funds.
IrIof for !osondonfs In o. ll400, . l? (omhnsIs
nddod); soo nIso iJ., nf 25. AccordIng fo fho IodornI Cov-

3? CIfo ns: 56? !. S. ____ (20l2)
ornmonf, noIfhor fho nmounf of fho offorod fodornI funds
nor fho nmounf of fho fodornI fnxos oxfrncfod from fho
fnxnyors of n Sfnfo fo ny for fho rogrnm In quosfIon Is
roIovnnf In doformInIng whofhor fhoro Is ImormIssIbIo
coorcIon. 1J., nf 4l46.
ThIs nrgumonf Ignoros ronIIfy. Whon n honvy fodornI
fnx Is IovIod fo suorf n fodornI rogrnm fhnf offors Inrgo
grnnfs fo fho Sfnfos, Sfnfos mny, ns n rncfIcnI mnffor, bo
unnbIo fo rofuso fo nrfIcInfo In fho fodornI rogrnm nnd
fo subsfIfufo n sfnfo nIfornnfIvo. Ivon If n Sfnfo boIIovos
fhnf fho fodornI rogrnm Is InoffocfIvo nnd InoffIcIonf,
wIfhdrnwnI wouId IIkoIy forco fho Sfnfo fo Imoso n hugo
fnx Incronso on Ifs rosIdonfs, nnd fhIs now sfnfo fnx wouId
como on fo of fho fodornI fnxos nIrondy nId by rosIdonfs
fo suorf subsIdIos fo nrfIcInfIng Sfnfos.
l3
Accofnnco of fho IodornI Covornmonf`s Inforrofn-
fIon of fho nnfIcoorcIon ruIo wouId ormIf Congross fo dIc-
fnfo oIIcy In nrons frndIfIonnIIy govornod rImnrIIy nf fho
sfnfo or IocnI IovoI. Suoso, for oxnmIo, fhnf Congross
onncfod IogIsInfIon offorIng onch Sfnfo n grnnf oqunI fo fho
Sfnfo`s onfIro nnnunI oxondIfuros for rImnry nnd soc-
ondnry oducnfIon. Suoso nIso fhnf fhIs fundIng cnmo
wIfh condIfIons govornIng such fhIngs ns schooI currIcu-
Ium, fho hIrIng nnd fonuro of fonchors, fho drnwIng of
schooI dIsfrIcfs, fho Iongfh nnd hours of fho schooI dny, fho

l3
J!STICI CISI!!C nrguos fhnf |n] Sfnfo . . . hns no cInIm on fho
monoy Ifs rosIdonfs ny In fodornI fnxos. An/e, nf 59, n. 26. ThIs Is
fruo ns n formnI mnffor. Whon fho !nIfod Sfnfos Covornmonf fnxos
!nIfod Sfnfos cIfIzons, If fnxos fhom 'In fhoIr IndIvIdunI cnncIfIos` ns
'fho ooIo of AmorIcn`nof ns rosIdonfs of n nrfIcuInr Sfnfo. An/e, nf
58, n. 26 (quofIng I. S. Tern Lini/e, 1nc. v. Tlorn/on, 5l4 !. S. ??9,
839 (l995) (KIIY, J., concurrIng)). Iuf unIoss J!STICI CISI!!C
fhInks fhnf fhoro Is no IImIf fo fho nmounf of monoy fhnf cnn bo
squoozod ouf of fnxnyors, honvy fodornI fnxnfIon dImInIshos fho
rncfIcnI nbIIIfy of Sfnfos fo coIIocf fhoIr own fnxos.

I!SIISS t. SIII!I!S
schooI cnIondnr, n dross codo for sfudonfs, nnd ruIos for
sfudonf dIscIIIno. Ae o no//er of lou, n Sfnfo couId furn
down fhnf offor, buf If If dId so, Ifs rosIdonfs wouId nof
onIy bo roquIrod fo ny fho fodornI fnxos noodod fo suorf
fhIs oxonsIvo now rogrnm, buf fhoy wouId nIso bo forcod
fo ny nn oquIvnIonf nmounf In sfnfo fnxos. And If fho
Sfnfo gnvo In fo fho fodornI Inw, fho Sfnfo nnd Ifs subdIvI-
sIons wouId surrondor fhoIr frndIfIonnI nufhorIfy In fho
fIoId of oducnfIon. Askod nf ornI nrgumonf whofhor such
n Inw wouId bo nIIowod undor fho sondIng owor, fho
SoIIcIfor ConornI rosondod fhnf If wouId. Tr. of OrnI Arg.
4445 (Mnr. 28, 20l2).
I
Whofhor fodornI sondIng IogIsInfIon crossos fho IIno
from onfIcomonf fo coorcIon Is offon dIffIcuIf fo doformIno,
nnd courfs shouId nof concIudo fhnf IogIsInfIon Is uncon-
sfIfufIonnI on fhIs ground unIoss fho coorcIvo nnfuro of nn
offor Is unmIsfnknbIy cIonr. In fhIs cnso, howovor, fhoro
cnn bo no doubf. In sfrucfurIng fho ACA, Congross unnm-
bIguousIy sIgnnIod Ifs boIIof fhnf ovory Sfnfo wouId hnvo
no ronI choIco buf fo go nIong wIfh fho ModIcnId Ixnn-
sIon. If fho nnfIcoorcIon ruIo doos nof nIy In fhIs cnso,
fhon fhoro Is no such ruIo.
l
Tho dImonsIons of fho ModIcnId rogrnm Iond sfrong
suorf fo fho ofIfIonor Sfnfos` nrgumonf fhnf rofusIng fo
nccodo fo fho condIfIons sof ouf In fho ACA Is nof n ronIIs-
fIc ofIon. Ioforo fho ACA`s onncfmonf, ModIcnId fundod
modIcnI cnro for rognnnf womon, fnmIIIos wIfh doond-
onfs, chIIdron, fho bIInd, fho oIdorIy, nnd fho dIsnbIod. Soo
42 !. S. C. l396n(n)(l0) (2006 od., Su. IV). Tho ACA
gronfIy oxnnds fho rogrnm`s ronch, mnkIng now funds
nvnIInbIo fo Sfnfos fhnf ngroo fo oxfond covorngo fo nII
IndIvIdunIs who nro undor ngo 65 nnd hnvo Incomos boIow

39 CIfo ns: 56? !. S. ____ (20l2)
l33 of fho fodornI ovorfy IIno. Soo l396n(n)
(l0)(A)(I)(VIII). Any Sfnfo fhnf rofusos fo oxnnd
Ifs ModIcnId rogrnms In fhIs wny Is fhronfonod wIfh n
sovoro snncfIon: fho Ioss of nII Ifs fodornI ModIcnId funds.
Soo l396c (2006 od.).
ModIcnId hns Iong boon fho Inrgosf fodornI rogrnm of
grnnfs fo fho Sfnfos. Soo IrIof for !osondonfs In o. ll
400, nf 3?. In 20l0, fho IodornI Covornmonf dIrocfod
moro fhnn $552 bIIIIon In fodornI funds fo fho Sfnfos. Soo
nf. Assn. of Sfnfo Iudgof OffIcors, 20l0 Sfnfo IxondI-
furo !oorf: IxnmInIng IIscnI 200920ll Sfnfo SondIng,
. ? (20ll) (ASIO !oorf). Of fhIs, moro fhnn $233
bIIIIon wonf fo ro-oxnnsIon ModIcnId. Soo iJ., nf 4?.
l4
Tlie onoun/ equole neorl, 22" of oll e/o/e expenJi/uree
conIineJ. Soo iJ., nf ?.
Tho Sfnfos dovofo n Inrgor orconfngo of fhoIr budgofs
fo ModIcnId fhnn fo nny ofhor Ifom. 1J., nf 5. IodornI
funds nccounf for nnywhoro from 50 fo 83 of onch
Sfnfo`s fofnI ModIcnId oxondIfuros, soo l396d(b) (2006 od.,
Su. IV); mosf Sfnfos rocoIvo moro fhnn $l bIIIIon In
fodornI ModIcnId fundIng; nnd n qunrfor rocoIvo moro fhnn

l4
Tho IodornI Covornmonf hns n hIghor numbor for fodornI sondIng
on ModIcnId. AccordIng fo fho OffIco of Mnnngomonf nnd Iudgof,
fodornI grnnfs fo fho Sfnfos for ModIcnId nmounfod fo nonrIy $2?3
bIIIIon In IIscnI Yonr 20l0. Soo OffIco of Mnnngomonf nnd Iud-
gof, HIsforIcnI TnbIos, Iudgof of fho !. S. Covornmonf, IIscnI Yonr
20l3, TnbIo l2.3TofnI OufInys for Crnnfs fo Sfnfo nnd !ocnI Cov-
ornmonfs by IuncfIon, Agoncy, nnd Irogrnm: l94020l3, hff://
www.whIfohouso.gov/omb/budgof/HIsforIcnIs. In fhnf IIscnI Yonr, fofnI
fodornI oufInys for grnnfs fo sfnfo nnd IocnI govornmonfs nmounfod fo
ovor $608 bIIIIon, soo TnbIo l2.l, nnd sfnfo nnd IocnI govornmonf
oxondIfuros from fhoIr own sourcos nmounfod fo $l.6 frIIIIon, soo
TnbIo l5.2. !sIng fhoso numbors, 44.8 of nII fodornI oufInys fo bofh
sfnfo nnd IocnI govornmonfs wns nIIocnfod fo ModIcnId, nmounfIng fo
l6.8 of nII sfnfo nnd IocnI oxondIfuros from fhoIr own sourcos.

I!SIISS t. SIII!I!S
$5 bIIIIon, ASIO !oorf 4?. Thoso fodornI doIInrs fofnI
nonrIy fwo fhIrds64.6of nII ModIcnId oxondIfuros
nnfIonwIdo.
l5
1J., nf 46.
Tho Courf of AonIs concIudod fhnf fho Sfnfos fnIIod fo
osfnbIIsh coorcIon In fhIs cnso In nrf bocnuso fho sfnfos
hnvo fho owor fo fnx nnd rnIso rovonuo, nnd fhoroforo cnn
cronfo nnd fund rogrnms of fhoIr own If fhoy do nof IIko
Congross`s forms. 648 I. 3d l235, l268 (CAll 20ll); soo
IrIof for Son. Hnrry !oId of nI. ns Anici Curioe In o. ll
400, . 2l (Sfnfos mny nIwnys chooso fo docronso oxondI-
furos on ofhor rogrnms or fo rnIso rovonuos). Iuf fho
shoor sIzo of fhIs fodornI sondIng rogrnm In roInfIon fo
sfnfo oxondIfuros monns fhnf n Sfnfo wouId bo vory hnrd
rossod fo comonsnfo for fho Ioss of fodornI funds by
cuffIng ofhor sondIng or rnIsIng nddIfIonnI rovonuo.
ArIzonn, for oxnmIo, commIfs l2 of Ifs sfnfo oxondI-
furos fo ModIcnId, nnd roIIos on fho IodornI Covornmonf
fo rovIdo fho rosf: $5.6 bIIIIon, oqunIIng roughIy ono-fhIrd
of ArIzonn`s nnnunI sfnfo oxondIfuros of $l? bIIIIon. Soo
ASIO !oorf ?, 4?. Thoroforo, If ArIzonn Iosf fodornI
ModIcnId fundIng, fho Sfnfo wouId hnvo fo commIf nn
nddIfIonnI 33 of nII Ifs sfnfo oxondIfuros fo fund nn
oquIvnIonf sfnfo rogrnm nIong fho IInos of ro-oxnnsIon
ModIcnId. ThIs monns fhnf fho Sfnfo wouId hnvo fo nIIo-
cnfo 45 of Ifs nnnunI oxondIfuros for fhnf ono uroso.
Soo iIiJ.
Tho Sfnfos nro fnr Ioss roIInnf on fodornI fundIng for nny
ofhor rogrnm. Affor ModIcnId, fho noxf bIggosf fodornI

l5
Tho IodornI Covornmonf roorfs n hIghor orconfngo. AccordIng
fo ModIcnId.gov, In IIscnI Yonr 20l0, fho IodornI Covornmonf mndo
ModIcnId nymonfs In fho nmounf of nonrIy $260 bIIIIon, roro-
sonfIng 6?.?9 of fofnI ModIcnId nymonfs of $383 bIIIIon. Soo
www.modIcnId.gov/ ModIcnId-CHII-Irogrnm-InformnfIon/ Iy-Sfnfo/ Iy-
Sfnfo.hfmI.

4l CIfo ns: 56? !. S. ____ (20l2)
fundIng Ifom Is nId fo suorf oIomonfnry nnd socondnry
oducnfIon, whIch nmounfs fo l2.8 of fofnI fodornI oufInys
fo fho Sfnfos, soo iJ., nf ?, l6, nnd oqunIs onIy 6.6 of
nII sfnfo oxondIfuros combInod. Soo iIiJ. In ArIzonn,
for oxnmIo, nIfhough fodornI ModIcnId oxondIfuros nro
oqunI fo 33 of nII sfnfo oxondIfuros, fodornI oducnfIon
funds nmounf fo onIy 9.8 of nII sfnfo oxondIfuros. Soo
iIiJ. And ovon In Sfnfos wIfh Ioss fhnn nvorngo fodornI
ModIcnId fundIng, fhnf fundIng Is nf Ionsf fwIco fho sIzo of
fodornI oducnfIon fundIng ns n orconfngo of sfnfo oxond-
Ifuros. 1J., nf ?, l6, 4?.
A Sfnfo forcod ouf of fho ModIcnId rogrnm wouId fnco
burdons In nddIfIon fo fho Ioss of fodornI ModIcnId fund-
Ing. Ior oxnmIo, n nonnrfIcInfIng Sfnfo mIghf bo found
fo bo InoIIgIbIo for ofhor mnjor fodornI fundIng sourcos,
such ns Tomornry AssIsfnnco for oody InmIIIos (TAI),
whIch Is romIsod on fho oxocfnfIon fhnf Sfnfos wIII
nrfIcInfo In ModIcnId. Soo 42 !. S. C. 602(n)(3) (2006
od.) (roquIrIng fhnf corfnIn bonofIcInrIos of TAI funds bo
oIIgIbIo for modIcnI nssIsfnnco undor fho Sfnfo|`s ModI-
cnId] Inn). And wIfhdrnwnI or oxuIsIon from fho ModI-
cnId rogrnm wouId nof roIIovo n Sfnfo`s hosIfnIs of fhoIr
obIIgnfIon undor fodornI Inw fo rovIdo cnro for nfIonfs
who nro unnbIo fo ny for modIcnI sorvIcos. Tho Imor-
goncy ModIcnI Tronfmonf nnd AcfIvo !nbor Acf, l395dd,
roquIros hosIfnIs fhnf rocoIvo nny fodornI fundIng fo
rovIdo sfnbIIIznfIon cnro for IndIgonf nfIonfs buf doos
nof offor fodornI fundIng fo nssIsf fncIIIfIos In cnrryIng ouf
Ifs mnndnfo. Mnny of fhoso nfIonfs nro now covorod by
ModIcnId. If rovIdors couId nof Iook fo fho ModIcnId
rogrnm fo ny for fhIs cnro, fhoy wouId fInd If oxcood-
IngIy dIffIcuIf fo comIy wIfh fodornI Inw unIoss fhoy woro
gIvon subsfnnfInI sfnfo suorf. Soo, e.g., IrIof for Icon-
omIsfs ns Anici Curioe In o ll400, . ll.
Ior fhoso ronsons, fho offor fhnf fho ACA mnkos fo fho
Sfnfosgo nIong wIfh n drnmnfIc oxnnsIon of ModIcnId or

I!SIISS t. SIII!I!S
ofonfInIIy Ioso nII fodornI ModIcnId fundIngIs quIfo
unIIko nnyfhIng fhnf wo hnvo soon In n rIor sondIng-
owor cnso. In Sou/l Do/o/o v. Dole, fho fofnI nmounf
fhnf fho Sfnfos wouId hnvo Iosf If ovory sIngIo Sfnfo
hnd rofusod fo comIy wIfh fho 2l-yonr-oId drInkIng
ngo wns nroxImnfoIy $6l4.? mIIIIonor nbouf 0.l9
of nII sfnfo oxondIfuros combInod. Soo nf. Assn.
of Sfnfo Iudgof OffIcors, l989 (IIscnI Yonrs l98?
l989 nfn) Sfnfo IxondIfuro !oorf l0, 84 (l989),
hff://www.nnsbo.org/ubIIcnfIons-dnfn/sfnfo-oxondIfuro-
roorf/nrchIvos. Soufh nkofn sfood fo Ioso, nf mosf,
fundIng fhnf nmounfod fo Ioss fhnn l of Ifs nnnunI sfnfo
oxondIfuros. Soo iIiJ. !ndor fho ACA, by confrnsf, fho
IodornI Covornmonf hns fhronfonod fo wIfhhoId 42.3 of
nII fodornI oufInys fo fho sfnfos, or nroxImnfoIy $233
bIIIIon. Soo ASIO !oorf ?, l0, 4?. Soufh nkofn
sfnnds fo Ioso fodornI fundIng oqunIIng 28.9 of Ifs nnnunI
sfnfo oxondIfuros. Soo iJ., nf ?, 4?. WIfhhoIdIng $6l4.?
mIIIIon, oqunIIng onIy 0.l9 of nII sfnfo oxondIfuros
combInod, Is nfIy chnrncforIzod ns roInfIvoIy mIId on-
courngomonf, buf fhronfonIng fo wIfhhoId $233 bIIIIon,
oqunIIng 2l.86 of nII sfnfo oxondIfuros combInod, Is n
dIfforonf mnffor.
2
Whnf fho sfnfIsfIcs suggosf Is confIrmod by fho gonI
nnd sfrucfuro of fho ACA. In crnffIng fho ACA, Congross
cIonrIy oxrossod Ifs Informod vIow fhnf no Sfnfo couId
ossIbIy rofuso fho offor fhnf fho ACA oxfonds.
Tho sfnfod gonI of fho ACA Is nonr-unIvorsnI honIfh cnro
covorngo. To nchIovo fhIs gonI, fho ACA mnndnfos fhnf
ovory orson obfnIn n mInImum IovoI of covorngo. If nf-
fomfs fo ronch fhIs gonI In sovornI dIfforonf wnys. Tho
gunrnnfood Issuo nnd communIfy-rnfIng rovIsIons nro
dosIgnod fo mnko qunIIfyIng Insurnnco nvnIInbIo nnd
nffordnbIo for orsons wIfh modIcnI condIfIons fhnf mny

43 CIfo ns: 56? !. S. ____ (20l2)
roquIro oxonsIvo cnro. Ofhor ACA rovIsIons sook fo
mnko such oIIcIos moro nffordnbIo for ooIo of modosf
monns. IInnIIy, for Iow-Incomo IndIvIdunIs who nro
sImIy nof nbIo fo obfnIn Insurnnco, Congross oxnndod
ModIcnId, frnnsformIng If from n rogrnm covorIng onIy
mombors of n IImIfod IIsf of vuInornbIo grous Info n ro-
grnm fhnf rovIdos nf Ionsf fho roquIsIfo mInImum IovoI
of covorngo for fho oor. Soo 42 !. S. C. l396n(n)
(l0)(A)(I)(VIII) (2006 od., Su. IV), l396u?(n), (b)(5),
l8022(n). ThIs dosIgn wns Infondod fo rovIdo nf Ionsf
n socIfIod mInImum IovoI of covorngo for nII AmorIcnns,
buf fho nchIovomonf of fhnf gonI obvIousIy doonds on
nrfIcInfIon by ovory sIngIo Sfnfo. If nny Sfnfonof
fo monfIon nII of fho 26 Sfnfos fhnf broughf fhIs suIf
choso fo docIIno fho fodornI offor, fhoro wouId bo n gnIng
hoIo In fho ACA`s covorngo.
If Is fruo fhnf somo orsons who nro oIIgIbIo for ModI-
cnId covorngo undor fho ACA mny bo nbIo fo socuro rIvnfo
Insurnnco, oIfhor fhrough fhoIr omIoyors or by obfnIn-
Ing subsIdIzod Insurnnco fhrough nn oxchnngo. Soo 26
!. S. C. 36I(n) (2006 od., Su. IV); IrIof for !osond-
onfs In o. ll400, nf l2. Iuf fho now fodornI subsIdIos
nro nof nvnIInbIo fo fhoso whoso Incomo Is boIow fho fod-
ornI ovorfy IovoI, nnd fho ACA rovIdos no monns, ofhor
fhnn ModIcnId, for fhoso IndIvIdunIs fo obfnIn covorngo
nnd comIy wIfh fho Mnndnfo. Tho Covornmonf counfors
fhnf fhoso ooIo wIII nof hnvo fo ny fho onnIfy, soo, e.g.,
Tr. of OrnI Arg. 68 (Mnr. 28, 20l2); IrIof for !osondonfs
In o. ll400, nf 4950, buf fhnf nrgumonf mIssos fho
oInf: WIfhouf ModIcnId, fhoso IndIvIdunIs wIII nof hnvo
covorngo nnd fho ACA`s gonI of nonr-unIvorsnI covorngo
wIII bo sovoroIy frusfrnfod.
If Congross hnd fhoughf fhnf Sfnfos mIghf ncfunIIy
rofuso fo go nIong wIfh fho oxnnsIon of ModIcnId, Con-
gross wouId suroIy hnvo dovIsod n bncku schomo so fhnf
fho mosf vuInornbIo grous In our socIofy, fhoso rovIousIy

I!SIISS t. SIII!I!S
oIIgIbIo for ModIcnId, wouId nof bo Ioff ouf In fho coId. Iuf
nowhoro In fho ovor 900-ngo Acf Is such n schomo fo bo
found. Iy confrnsf, bocnuso Congross fhoughf fhnf somo
Sfnfos mIghf docIIno fodornI fundIng for fho oornfIon of
n honIfh bonofIf oxchnngo, Congross rovIdod n bncku
schomo; If n Sfnfo docIInos fo nrfIcInfo In fho oornfIon
of nn oxchnngo, fho IodornI Covornmonf wIII sfo In
nnd oornfo nn oxchnngo In fhnf Sfnfo. Soo 42 !. S. C.
l804l(c)(l). !IkowIso, knowIng fhnf Sfnfos wouId nof
nocossnrIIy rovIdo nffordnbIo honIfh Insurnnco for nIIons
InwfuIIy rosonf In fho !nIfod Sfnfosbocnuso ModIcnId
doos nof roquIro Sfnfos fo rovIdo such covorngoCon-
gross oxfondod fho nvnIInbIIIfy of fho now fodornI Insur-
nnco subsIdIos fo nII nIIons. Soo 26 !. S. C. 36I(c)
(l)(I)(II) (oxcofIng from fho Incomo IImIf IndIvIdunIs
who nro nof oIIgIbIo for fho modIcnId rogrnm . . . by
ronson of |fhoIr] nIIon sfnfus). Congross dId nof mnko
fhoso subsIdIos nvnIInbIo for cIfIzons wIfh Incomos boIow
fho ovorfy IovoI bocnuso Congross obvIousIy nssumod
fhnf fhoy wouId bo covorod by ModIcnId. If Congross hnd
confomInfod fhnf somo of fhoso cIfIzons wouId bo Ioff
wIfhouf ModIcnId covorngo ns n rosuIf of n Sfnfo`s wIfh-
drnwnI or oxuIsIon from fho rogrnm, Congross suroIy
wouId hnvo mndo fhom oIIgIbIo for fho fnx subsIdIos ro-
vIdod for Iow-Incomo nIIons.
Thoso fonfuros of fho ACA convoy nn unmIsfnknbIo
mossngo: Congross novor dronmod fhnf nny Sfnfo wouId
rofuso fo go nIong wIfh fho oxnnsIon of ModIcnId. Con-
gross woII undorsfood fhnf rofusnI wns nof n rncfIcnI
ofIon.
Tho IodornI Covornmonf doos nof dIsufo fho Inforonco
fhnf Congross nnfIcInfod l00 sfnfo nrfIcInfIon, buf If
nrguos fhnf fhIs nssumfIon wns bnsod on fho fncf fhnf
ACA`s offor wns nn oxcoodIngIy gonorous gIff. IrIof for
!osondonfs In o. ll400, nf 50. As fho IodornI Cov-
ornmonf soos fhIngs, Congross Is IIko fho gonorous bono-

45 CIfo ns: 56? !. S. ____ (20l2)
fncfor who offors $l mIIIIon wIfh fow sfrIngs nffnchod fo
50 rnndomIy soIocfod IndIvIdunIs. Jusf ns fhIs bonofncfor
mIghf nssumo fhnf nII of fhoso 50 IndIvIdunIs wouId snn
u hIs offor, so Congross nssumod fhnf ovory Sfnfo wouId
grnfofuIIy nccof fho fodornI funds (nnd condIfIons) fo go
wIfh fho oxnnsIon of ModIcnId.
ThIs chnrncforIznfIon of fho ACA`s offor rnIsos obvIous
quosfIons. If fhnf offor Is oxcoodIngIy gonorous, ns fho
IodornI Covornmonf mnInfnIns, why hnvo moro fhnn hnIf
fho Sfnfos broughf fhIs InwsuIf, confondIng fhnf fho offor
Is coorcIvo And why dId Congross fInd If nocossnry fo
fhronfon fhnf nny Sfnfo rofusIng fo nccof fhIs oxcood-
IngIy gonorous gIff wouId rIsk IosIng nII ModIcnId funds
Congross couId hnvo mndo jusf fho neu fundIng rovIdod
undor fho ACA confIngonf on nccofnnco of fho forms of
fho ModIcnId IxnnsIon. Congross fook such nn nronch
In somo onrIIor nmondmonfs fo ModIcnId, sonrnfIng now
covorngo roquIromonfs nnd fundIng from fho rosf of fho
rogrnm so fhnf onIy now fundIng wns condIfIonod on now
oIIgIbIIIfy oxfonsIons. Soo, e.g., SocInI SocurIfy Amond-
monfs of l9?2, 86 Sfnf. l465.
Congross` docIsIon fo do ofhorwIso horo rofIocfs Ifs un-
dorsfnndIng fhnf fho ACA offor Is nof nn oxcoodIngIy
gonorous gIff fhnf no Sfnfo In Ifs rIghf mInd wouId do-
cIIno. Insfond, nccofnnco of fho offor wIII Imoso vory
subsfnnfInI cosfs on nrfIcInfIng Sfnfos. If Is fruo fhnf
fho IodornI Covornmonf wIII bonr mosf of fho InIfInI cosfs
nssocInfod wIfh fho ModIcnId IxnnsIon, fIrsf nyIng
l00 of fho cosfs of covorIng nowIy oIIgIbIo IndIvIdunIs
bofwoon 20l4 nnd 20l6. 42 !. S. C. l396d(y). Iuf fhnf
Is jusf nrf of fho Icfuro. InrfIcInfIng Sfnfos wIII bo
forcod fo shouIdor subsfnnfInI cosfs ns woII, bocnuso nffor
20l9 fho IodornI Covornmonf wIII covor onIy 90 of fho
cosfs nssocInfod wIfh fho IxnnsIon, soo iIiJ., wIfh sfnfo
sondIng rojocfod fo Incronso by nf Ionsf $20 bIIIIon by
2020 ns n consoquonco. Sfnfomonf of ougIns W. IImon-

I!SIISS t. SIII!I!S
dorf, CIO`s AnnIysIs of fho Mnjor HonIfh Cnro !ogIsInfIon
Inncfod In Mnrch 20l0, . 24 (Mnr. 30, 20ll); soo nIso !.
Iovbjorg, I. Ormond, & V. Chon, KnIsor CommIssIon on
ModIcnId nnd fho !nInsurod, Sfnfo Iudgofs undor IodornI
HonIfh !oform: Tho Ixfonf nnd Cnusos of VnrInfIons In
IsfImnfod Imncfs 4, n. 2? (Iob. 20ll) (osfImnfIng now
sfnfo sondIng nf $43.2 bIIIIon fhrough 20l9). Affor 20l9,
sfnfo sondIng Is oxocfod fo Incronso nf n fnsfor rnfo; fho
CIO osfImnfos now sfnfo sondIng nf $60 bIIIIon fhrough
202l. Sfnfomonf of ougIns W. IImondorf, eupro, nf 24.
And fhoso cosfs mny Incronso In fho fufuro bocnuso of
fho vory ronI ossIbIIIfy fhnf fho IodornI Covornmonf wIII
chnngo fundIng forms nnd roduco fho orconfngo of funds
If wIII covor. ThIs wouId Ionvo fho Sfnfos fo bonr nn In-
cronsIngIy Inrgo orconfngo of fho bIII. Soo Tr. of OrnI
Arg. ?4?6 (Mnr. 28, 20l2). IInnIIy, nffor 20l5, fho Sfnfos
wIII hnvo fo Ick u fho fnb for 50 of nII ndmInIsfrnfIvo
cosfs nssocInfod wIfh ImIomonfIng fho now rogrnm, soo
l396b(n)(2)(5), (?) (2006 od., Su. IV), cosfs fhnf couId
nronch $l2 bIIIIon bofwoon fIscnI yonrs 20l4 nnd 2020,
soo of. of HonIfh nnd Humnn SorvIcos, Confor for ModI-
cnId nnd ModIcnro SorvIcos, 20l0 AcfunrInI !oorf on fho
IInnncInI OufIook for ModIcnId 30.
In sum, If Is orfocfIy cIonr from fho gonI nnd sfrucfuro
of fho ACA fhnf fho offor of fho ModIcnId IxnnsIon wns
ono fhnf Congross undorsfood no Sfnfo couId rofuso. Tho
ModIcnId IxnnsIon fhoroforo oxcoods Congross` sondIng
owor nnd cnnnof bo ImIomonfod.
I
Sovon Mombors of fho Courf ngroo fhnf fho ModIcnId
IxnnsIon, ns onncfod by Congross, Is unconsfIfufIonnI.
Soo Inrf IVA fo IVI, eupro; Inrf IVA, on/e, nf 4555
(oInIon of !OII!TS, C. J., joInod by I!IYI! nnd KACA,
JJ.). Iocnuso fho ModIcnId IxnnsIon Is unconsfIfufIonnI,
fho quosfIon of romody nrIsos. Tho mosf nnfurnI romody

4? CIfo ns: 56? !. S. ____ (20l2)
wouId bo fo InvnIIdnfo fho ModIcnId IxnnsIon. Howovor,
fho Covornmonf roososIn fwo cursory sonfoncos nf
fho vory ond of Ifs brIofrosorvIng fho IxnnsIon. !ndor
Ifs roosnI, Sfnfos wouId rocoIvo fho nddIfIonnI ModI-
cnId funds If fhoy oxnnd oIIgIbIIIfy, buf Sfnfos wouId
koo fhoIr ro-oxIsfIng ModIcnId funds If fhoy do nof
oxnnd oIIgIbIIIfy. Wo cnnnof nccof fho Covornmonf`s
suggosfIon.
Tho ronIIfy fhnf Sfnfos woro gIvon no ronI choIco buf fo
oxnnd ModIcnId wns nof nn nccIdonf. Congross nssumod
Sfnfos wouId hnvo no choIco, nnd fho ACA doonds on
Sfnfos` hnvIng no choIco, bocnuso Ifs Mnndnfo roquIros
Iow-Incomo IndIvIdunIs fo obfnIn Insurnnco mnny of fhom
cnn nfford onIy fhrough fho ModIcnId IxnnsIon. Iur-
fhormoro, n Sfnfo`s wIfhdrnwnI mIghf subjocf ovoryono In
fho Sfnfo fo much hIghor Insurnnco romIums. Thnf Is
bocnuso fho ModIcnId IxnnsIon wIII no Iongor offsof fho
cosf fo fho Insurnnco Indusfry Imosod by fho ACA`s In-
surnnco roguInfIons nnd fnxos, n oInf fhnf Is oxInInod In
moro dofnII In fho sovornbIIIfy socfIon boIow. To mnko fho
ModIcnId IxnnsIon ofIonnI dosIfo fho ACA`s sfrucfuro
nnd dosIgn 'wouId bo fo mnko n now Inw, nof fo onforco
nn oId ono. ThIs Is no nrf of our dufy.` TroJe-Mor/
Coeee, l00 !. S. 82, 99 (l8?9).
Worso, fho Covornmonf`s roosod romody Infroducos n
now dynnmIc: Sfnfos musf chooso bofwoon oxnndIng
ModIcnId or nyIng hugo fnx sums fo fho fodornI fIsc for
fho soIo bonofIf of oxnndIng ModIcnId In ofhor Sfnfos. If
fhIs dIvIsIvo dynnmIc bofwoon nnd nmong Sfnfos cnn bo
Infroducod nf nII, If shouId bo by conscIous congrossIonnI
choIco, nof by Courf-Invonfod InforrofnfIon. Wo do nof
doubf fhnf Sfnfos nro cnnbIo of mnkIng docIsIons whon
uf In n fIghf sof. Wo do doubf fho nufhorIfy of fhIs
Courf fo uf fhom fhoro.
Tho Covornmonf cIfos n sovornbIIIfy cInuso codIfIod wIfh
ModIcnId In Chnfor ? of fho !nIfod Sfnfos Codo sfnfIng

I!SIISS t. SIII!I!S
fhnf If nny rovIsIon of fhIs chnfor, or fho nIIcnfIon
fhoroof fo nny orson or cIrcumsfnnco, Is hoId InvnIId, fho
romnIndor of fho chnfor, nnd fho nIIcnfIon of such
rovIsIon fo ofhor orsons or cIrcumsfnncos shnII nof bo
nffocfod fhoroby. 42 !. S. C. l303 (2006 od.). Iuf fhnf
cInuso foIIs us onIy fhnf ofhor rovIsIons In Chnfor ?
shouId nof bo InvnIIdnfod If l396c, fho nufhorIznfIon for
fho cuf-off of nII ModIcnId funds, Is unconsfIfufIonnI. If
doos nof foII us fhnf l396c cnn bo judIcInIIy rovIsod, fo
sny whnf If doos nof sny. Such n judIcInI owor wouId
nof bo cnIIod fho docfrIno of sovornbIIIfy buf orhns
fho docfrIno of nmondnfory InvnIIdnfIonsImIInr fo fho
nmondnfory vofo fhnf ormIfs fho Covornors of somo
Sfnfos fo roduco fho nmounfs nrorInfod In IogIsInfIon.
Tho roof fhnf such n owor doos nof oxIsf Is fho fncf fhnf
If wouId nof rosorvo ofhor congrossIonnI dIsosIfIons, buf
wouId Ionvo If u fo fho Courf whnf fho vnIIdnfod IogIs-
InfIon wIII confnIn. Tho Courf fodny ofs for ormIffIng
fho cuf-off of onIy IncromonfnI ModIcnId fundIng, buf If
mIghf jusf ns woII hnvo ormIffod, sny, fho cuf-off of funds
fhnf rorosonf no moro fhnn x orconf of fho Sfnfo`s bud-
gof. Tho Courf sovors nofhIng, buf sImIy rovIsos l396c fo
rond ns fho Courf wouId dosIro.
Wo shouId nof nccof fho Covornmonf`s InvIfnfIon fo
nffomf fo soIvo n consfIfufIonnI robIom by rowrIfIng fho
ModIcnId IxnnsIon so ns fo nIIow Sfnfos fhnf rojocf If
fo rofnIn fhoIr ro-oxIsfIng ModIcnId funds. Worso, fho
Covornmonf`s romody, now ndofod by fho Courf, fnkos
fho ACA nnd fhIs nfIon In n now dIrocfIon nnd chnrfs n
courso for fodornIIsm fhnf fho Courf, nof fho Congross, hns
choson; buf undor fho ConsfIfufIon, fhnf owor nnd nu-
fhorIfy do nof rosf wIfh fhIs Courf.
V
<#)#4+=(,(.>
Tho AffordnbIo Cnro Acf sooks fo nchIovo nonr-

49 CIfo ns: 56? !. S. ____ (20l2)
unIvorsnI honIfh Insurnnco covorngo. l809l(2)() (2006
od., Su. IV). Tho fwo IIInrs of fho Acf nro fho IndIvId-
unI Mnndnfo nnd fho oxnnsIon of covorngo undor ModIcnId.
In our vIow, bofh fhoso confrnI rovIsIons of fho Acffho
IndIvIdunI Mnndnfo nnd ModIcnId IxnnsIonnro InvnIId.
If foIIows, ns somo of fho nrfIos urgo, fhnf nII ofhor rovI-
sIons of fho Acf musf fnII ns woII. Tho foIIowIng socfIon
oxInIns fho sovornbIIIfy rIncIIos fhnf roquIro fhIs con-
cIusIon. ThIs nnnIysIs nIso shows how cIosoIy InforroInfod
fho Acf Is, nnd fhIs Is nII fho moro ronson why If Is judIcInI
usurnfIon fo Imoso nn onfIroIy now mochnnIsm for
wIfhdrnwnI of ModIcnId fundIng, soo Inrf IVI, eupro,
whIch Is ono of mnny oxnmIos of how rowrIfIng fho Acf
nIfors Ifs dynnmIcs.
A
Whon nn unconsfIfufIonnI rovIsIon Is buf n nrf of n
moro comrohonsIvo sfnfufo, fho quosfIon nrIsos ns fo fho
vnIIdIfy of fho romnInIng rovIsIons. Tho Courf`s nufhor-
Ify fo docInro n sfnfufo nrfInIIy unconsfIfufIonnI hns boon
woII osfnbIIshod sInco MorIur, v. MoJieon, l Crnnch l3?
(l803), whon fho Courf sovorod nn unconsfIfufIonnI rovI-
sIon from fho JudIcInry Acf of l?89. And whIIo fho Courf
hns somofImos nIIod nf Ionsf n modosf rosumfIon In
fnvor of . . . sovornbIIIfy, C. oIson, Sfnfufory Inforrofn-
fIon l44 (20l0), If hns nof nIwnys dono so, soo, e.g., Minne-
eo/o v. Mille Loce BonJ of Clippeuo 1nJione, 526 !. S.
l?2, l90l95 (l999).
An nufomnfIc or foo cursory sovornnco of sfnfufory
rovIsIons rIsks rowrIf|Ing] n sfnfufo nnd gIv|Ing] If nn
offocf nIfogofhor dIfforonf from fhnf soughf by fho mons-
uro vIowod ns n whoIo. IoilrooJ Ie/irenen/ BJ. v. Al/on
I. Co., 295 !. S. 330, 362 (l935). Tho JudIcInry, If If
ordors uncrIfIcnI sovornnco, fhon nssumos fho IogIsInfIvo
funcfIon; for If Imosos on fho nfIon, by fho Courf`s
docroo, Ifs own now sfnfufory rogImo, consIsfIng of oII-

I!SIISS t. SIII!I!S
cIos, rIsks, nnd dufIos fhnf Congross dId nof onncf. Thnf
cnn bo n moro oxfromo oxorcIso of fho judIcInI owor fhnn
sfrIkIng fho whoIo sfnfufo nnd nIIowIng Congross fo nd-
dross fho condIfIons fhnf orfnInod whon fho sfnfufo wns
consIdorod nf fho oufsof.
Tho Courf hns nIIod n fwo-nrf guIdo ns fho frnmo-
work for sovornbIIIfy nnnIysIs. Tho fosf hns boon doomod
woII osfnbIIshod. Aloe/o Airlinee, 1nc. v. Broc/, 480
!. S. 6?8, 684 (l98?). IIrsf, If fho Courf hoIds n sfnfufory
rovIsIon unconsfIfufIonnI, If fhon doformInos whofhor
fho now fruncnfod sfnfufo wIII oornfo In fho mnnnor Con-
gross Infondod. If nof, fho romnInIng rovIsIons musf bo
InvnIIdnfod. Soo iJ., nf 685. In Aloe/o Airlinee, fho Courf
cInrIfIod fhnf fhIs fIrsf InquIry roquIros moro fhnn nsk-
Ing whofhor fho bnInnco of fho IogIsInfIon Is IncnnbIo of
funcfIonIng IndoondonfIy. 1J., nf 684. Ivon If fho ro-
mnInIng rovIsIons wIII oornfo In somo cohoronf wny,
fhnf nIono doos nof snvo fho sfnfufo. Tho quosfIon Is
whofhor fho rovIsIons wIII work ns Congross Infondod.
Tho roIovnnf InquIry In ovnIunfIng sovornbIIIfy Is whofhor
fho sfnfufo wIII funcfIon In n nonner consIsfonf wIfh
fho Infonf of Congross. 1J., nf 685 (omhnsIs In orIgInnI).
Soo nIso Iree 1n/erpriee IunJ v. PuIlic Conpon, Accoun/-
ing Otereigl/ BJ., 56l !. S. ___, ___ (20l0) (sII o., nf
28) (fho Acf romnIns fuIIy oornfIvo ns n Inw wIfh fhoso
fonuro rosfrIcfIons oxcIsod) (InfornnI quofnfIon mnrks
omIffod); Ini/eJ S/o/ee v. Boo/er, 543 !. S. 220, 22?
(2005) (|T]wo rovIsIons . . . musf bo InvnIIdnfod In ordor
fo nIIow fho sfnfufo fo oornfo In n mnnnor consIsfonf
wIfh congrossIonnI Infonf); Mille Loce, eupro, nf l94 (|I]m-
bodyIng ns If dId ono cohoronf oIIcy, |fho onfIro ordor]
Is InsovornbIo).
Socond, ovon If fho romnInIng rovIsIons cnn oornfo ns
Congross dosIgnod fhom fo oornfo, fho Courf musf do-
formIno If Congross wouId hnvo onncfod fhom sfnndIng
nIono nnd wIfhouf fho unconsfIfufIonnI orfIon. If Con-

5l CIfo ns: 56? !. S. ____ (20l2)
gross wouId nof, fhoso rovIsIons, foo, musf bo InvnIIdnfod.
Soo Aloe/o Airlinee, eupro, nf 685 (|T]ho unconsfIfu-
fIonnI rovIsIon musf bo sovorod unIoss fho sfnfufo cro-
nfod In Ifs nbsonco Is IogIsInfIon fhnf Congross wouId nof
hnvo onncfod); soo nIso Iree 1n/erpriee IunJ, eupro, nf
___ (sII o., nf 29) (|]ofhIng In fho sfnfufo`s foxf or
hIsforIcnI confoxf mnkos If 'ovIdonf` fhnf Congross, fncod
wIfh fho IImIfnfIons Imosod by fho ConsfIfufIon, wouId
hnvo roforrod no Ionrd nf nII fo n Ionrd whoso mombors
nro romovnbIo nf wIII); A,o//e v. PlonneJ Poren/looJ of
Aor/lern Aeu 1ng., 546 !. S. 320, 330 (2006) (WouId fho
IogIsInfuro hnvo roforrod whnf Is Ioff of Ifs sfnfufo fo no
sfnfufo nf nII); Denter Areo 1J. Teleconnunico/ione
Coneor/iun, 1nc. v. ICC, 5l8 !. S. ?2?, ?6? (l996) (IurnI-
Ify oInIon) (WouId Congross sfIII hnvo nssod l0(n) hnd
If known fhnf fho romnInIng rovIsIons woro InvnIId
(InfornnI quofnfIon mnrks nnd brnckofs omIffod)).
Tho fwo InquIrIoswhofhor fho romnInIng rovIsIons
wIII oornfo ns Congross dosIgnod fhom, nnd whofhor
Congross wouId hnvo onncfod fho romnInIng rovIsIons
sfnndIng nIonooffon nro InforroInfod. In fho ordInnry
courso, If fho romnInIng rovIsIons cnnnof oornfo nccord-
Ing fo fho congrossIonnI dosIgn (fho fIrsf InquIry), If nImosf
nocossnrIIy foIIows fhnf Congross wouId nof hnvo onncfod
fhom (fho socond InquIry). ThIs cIoso InforncfIon mny
oxInIn why fho Courf hns nof nIwnys boon rocIso In
dIsfInguIshIng bofwoon fho fwo. Thoro nro, howovor,
occnsIons In whIch fho sovornbIIIfy sfnndnrd`s fIrsf InquIry
(sfnfufory funcfIonnIIfy) Is nof n roxy for fho socond
InquIry (whofhor fho !ogIsInfuro Infondod fho romnInIng
rovIsIons fo sfnnd nIono).
I
Tho Acf wns nssod fo onnbIo nffordnbIo, nonr-unIvorsnI
honIfh Insurnnco covorngo. 42 !. S. C. l809l(2)().
Tho rosuIfIng, comIox sfnfufo consIsfs of mnndnfos nnd

I!SIISS t. SIII!I!S
ofhor roquIromonfs; comrohonsIvo roguInfIon nnd onnI-
fIos; somo undoubfod fnxos; nnd Incronsos In somo gov-
ornmonfnI oxondIfuros, docronsos In ofhors. !ndor fho
sovornbIIIfy fosf sof ouf nbovo, If musf bo doformInod If
fhoso rovIsIons funcfIon In n cohoronf wny nnd ns Con-
gross wouId hnvo Infondod, ovon whon fho mnjor rovI-
sIons osfnbIIshIng fho IndIvIdunI Mnndnfo nnd ModIcnId
IxnnsIon nro fhomsoIvos InvnIId.
Congross dId nof Infond fo osfnbIIsh fho gonI of nonr-
unIvorsnI covorngo wIfhouf rognrd fo fIscnI consoquoncos.
Soo, e.g., ACA l563, l24 Sfnf. 2?0 (|T]hIs Acf wIII roduco
fho IodornI dofIcIf bofwoon 20l0 nnd 20l9). And If dId
nof Infond fo Imoso fho InovIfnbIo cosfs on nny ono Indus-
fry or grou of IndIvIdunIs. Tho whoIo dosIgn of fho Acf
Is fo bnInnco fho cosfs nnd bonofIfs nffocfIng onch sof
of roguInfod nrfIos. Thus, IndIvIdunIs nro roquIrod fo
obfnIn honIfh Insurnnco. Soo 26 !. S. C. 5000A(n). Insur-
nnco comnnIos nro roquIrod fo soII fhom Insurnnco ro-
gnrdIoss of nfIonfs` ro-oxIsfIng condIfIons nnd fo comIy
wIfh n hosf of ofhor roguInfIons. And fho comnnIos musf
ny now fnxos. Soo 4980I (hIgh-cosf Insurnnco Inns);
42 !. S. C. 300gg(n)(l), 300gg4(b) (communIfy rnfIng);
300ggl, 300gg3, 300gg4(n) (gunrnnfood Issuo);
300ggll (oIImInnfIon of covorngo IImIfs); 300ggl4(n)
(doondonf chIIdron u fo ngo 26); ACA 90l0, l0905,
l24 Sfnf. 865, l0l? (oxcIso fnx); HonIfh Cnro nnd Iducn-
fIon !oconcIIInfIon Acf of 20l0 (HCI!A) l40l, l24 Sfnf.
l059 (oxcIso fnx). Sfnfos nro oxocfod fo oxnnd ModIcnId
oIIgIbIIIfy nnd fo cronfo roguInfod mnrkofIncos cnIIod ox-
chnngos whoro IndIvIdunIs cnn urchnso Insurnnco. Soo
42 !. S. C. l396n(n)(l0)(A)(I)(VIII) (2006 od., Su. IV)
(ModIcnId IxnnsIon), l803l (oxchnngos). Somo orsons
who cnnnof nfford Insurnnco nro rovIdod If fhrough fho
ModIcnId IxnnsIon, nnd ofhors nro nIdod In fhoIr ur-
chnso of Insurnnco fhrough fodornI subsIdIos nvnIInbIo on
honIfh-Insurnnco oxchnngos. Soo 26 !. S. C. 36I (2006

53 CIfo ns: 56? !. S. ____ (20l2)
od., Su. IV), 42 !. S. C. l80?l (2006 od., Su. IV)
(fodornI subsIdIos). Tho IodornI Covornmonf`s Incronsod
sondIng Is offsof by now fnxos nnd cufs In ofhor fodornI
oxondIfuros, IncIudIng roducfIons In ModIcnro nnd In
fodornI nymonfs fo hosIfnIs. Soo, e.g., l395ww(r) (Mod-
Icnro cufs); ACA TIfIo IX, SubfIfIo A, l24 Sfnf. 84? (!ov-
onuo Offsof IrovIsIons). ImIoyors wIfh nf Ionsf 50
omIoyoos musf oIfhor rovIdo omIoyoos wIfh ndoqunfo
honIfh bonofIfs or ny n fInnncInI oxncfIon If nn omIoyoo
who qunIIfIos for fodornI subsIdIos urchnsos Insurnnco
fhrough nn oxchnngo. Soo 26 !. S. C. 4980H (2006 od.,
Su. IV).
In shorf, fho Acf nffomfs fo nchIovo nonr-unIvorsnI
honIfh Insurnnco covorngo by srondIng Ifs cosfs fo IndI-
vIdunIs, Insurors, govornmonfs, hosIfnIs, nnd omIoyors
whIIo, nf fho snmo fImo, offsoffIng sIgnIfIcnnf orfIons
of fhoso cosfs wIfh now bonofIfs fo onch grou. Ior ox-
nmIo, fho IodornI Covornmonf bonrs fho burdon of ny-
Ing bIIIIons for fho now onfIfIomonfs mnndnfod by fho
ModIcnId IxnnsIon nnd fodornI subsIdIos for Insurnnco
urchnsos on fho oxchnngos; buf If bonofIfs from roduc-
fIons In fho roImbursomonfs If nys fo hosIfnIs. HosI-
fnIs Ioso fhoso roImbursomonfs; buf fhoy bonofIf from fho
docronso In uncomonsnfod cnro, for undor fho Insurnnco
roguInfIons If Is onsIor for IndIvIdunIs wIfh ro-oxIsfIng
condIfIons fo urchnso covorngo fhnf Incronsos nymonfs
fo hosIfnIs. Insurnnco comnnIos bonr now cosfs Imosod
by n coIIocfIon of Insurnnco roguInfIons nnd fnxos, IncIudIng
gunrnnfood Issuo nnd communIfy rnfIng roquIromonfs
fo gIvo covorngo rognrdIoss of fho Insurod`s ro-oxIsfIng
condIfIons; buf fho Insurors bonofIf from fho now, honIfhy
urchnsors who nro forcod by fho IndIvIdunI Mnndnfo
fo buy fho Insurors` roducf nnd from fho now Iow-
Incomo ModIcnId rocIIonfs who wIII onroII In Insurnnco
comnnIos` ModIcnId-fundod mnnngod cnro rogrnms. In
summnry, fho IndIvIdunI Mnndnfo nnd ModIcnId Ixnn-

I!SIISS t. SIII!I!S
sIon offsof Insurnnco roguInfIons nnd fnxos, whIch offsof
roducod roImbursomonfs fo hosIfnIs, whIch offsof In-
cronsos In fodornI sondIng. So, fho Acf`s mnjor rovIsIons
nro Infordoondonf.
Tho Acf fhon rofors fo fhoso InfordoondoncIos ns
shnrod rosonsIbIIIfy. Soo ACA SubfIfIo I, TIfIo I, l24
Sfnf. 242 (Shnrod !osonsIbIIIfy); ACA l50l, iIiJ.
(snmo); ACA l5l3, iJ., nf 253 (snmo); ACA 4980H, iIiJ.
(snmo). In nf Ionsf sIx Incos, fho Acf doscrIbos fho IndI-
vIdunI Mnndnfo ns workIng fogofhor wIfh fho ofhor ro-
vIsIons of fhIs Acf. 42 !. S. C. l809l(2)(C) (2006 od.,
Su. IV) (workIng fogofhor fo ndd mIIIIons of now
consumors fo fho honIfh Insurnnco mnrkof); l809l(2)(I)
(workIng fogofhor fo sIgnIfIcnnfIy roduco fho oconomIc
cosf of fho ooror honIfh nnd shorfor IIfosnn of fho unIn-
surod); l809l(2)(I) (workIng fogofhor fo Iowor honIfh
Insurnnco romIums); l809l(2)(C) (workIng fogofhor fo
Imrovo fInnncInI socurIfy for fnmIIIos); l809l(2)(I)
(workIng fogofhor fo mInImIzo ndvorso soIocfIon nnd
brondon fho honIfh Insurnnco rIsk ooI fo IncIudo honIfhy
IndIvIdunIs); l809l(2)(J) (workIng fogofhor fo sIgnIf-
IcnnfIy roduco ndmInIsfrnfIvo cosfs nnd Iowor honIfh
Insurnnco romIums). Tho Acf cnIIs fho IndIvIdunI Mnn-
dnfo nn ossonfInI nrf of fodornI roguInfIon of honIfh
Insurnnco nnd wnrns fhnf fho nbsonco of fho roquIromonf
wouId undorcuf IodornI roguInfIon of fho honIfh Insurnnco
mnrkof. l809l(2)(H).
C
Ono roIImInnry oInf shouId bo nofod boforo nIyIng
sovornbIIIfy rIncIIos fo fho Acf. To bo suro, nn nrgumonf
cnn bo mndo fhnf fhoso orfIons of fho Acf fhnf nono of fho
nrfIos hns sfnndIng fo chnIIongo cnnnof bo hoId nonso-
vornbIo. Tho rosonso fo fhIs nrgumonf Is fhnf our cnsos
do nof suorf If. Soo, e.g., Willione v. S/onJorJ Oil Co.
of Lo., 2?8 !. S. 235, 242244 (l929) (hoIdIng nonsovor-

55 CIfo ns: 56? !. S. ____ (20l2)
nbIo sfnfufory rovIsIons fhnf dId nof burdon fho nrfIos).
If wouId bo nrfIcuInrIy dosfrucfIvo of sound govornmonf
fo nIy such n ruIo wIfh rognrd fo n muIfIfncofod Ioco of
IogIsInfIon IIko fho ACA. If wouId fnko yonrs, orhns
docndos, for onch of Ifs rovIsIons fo bo ndjudIcnfod son-
rnfoIynnd for somo of fhom (fhoso sImIy oxondIng
fodornI funds) no ono mny hnvo sonrnfo sfnndIng. Tho
IodornI Covornmonf, fho Sfnfos, nnd rIvnfo nrfIos oughf
fo know nf onco whofhor fho onfIro IogIsInfIon fnIIs.
Tho oInIon now oxInIns In Inrf VCl, infro, why fho
Acf`s mnjor rovIsIons nro nof sovornbIo from fho Mnndnfo
nnd ModIcnId IxnnsIon. If rocoods from fho Insurnnco
roguInfIons nnd fnxos (Cln), fo fho roducfIons In roIm-
bursomonfs fo hosIfnIs nnd ofhor ModIcnro roducfIons
(Clb), fho oxchnngos nnd fhoIr fodornI subsIdIos (Clc),
nnd fho omIoyor rosonsIbIIIfy nssossmonf (Cld).
Inrf VC2, infro, oxInIns why fho Acf`s mInor rovI-
sIons nIso nro nof sovornbIo.
l
!"# 58.?; -+724 142)(;(2&;
Mnjor rovIsIons of fho AffordnbIo Cnro Acfi.e., fho
Insurnnco roguInfIons nnd fnxos, fho roducfIons In fodornI
roImbursomonfs fo hosIfnIs nnd ofhor ModIcnro sond-
Ing roducfIons, fho oxchnngos nnd fhoIr fodornI subsIdIos,
nnd fho omIoyor rosonsIbIIIfy nssossmonfcnnnof romnIn
onco fho IndIvIdunI Mnndnfo nnd ModIcnId IxnnsIon nro
InvnIId. Thnf rosuIf foIIows from fho undoubfod InnbIIIfy
of fho ofhor mnjor rovIsIons fo oornfo ns Congross In-
fondod wIfhouf fho IndIvIdunI Mnndnfo nnd ModIcnId
IxnnsIon. Absonf fho InvnIId orfIons, fho ofhor mnjor
rovIsIons couId Imoso onormous rIsks of unoxocfod bur-
dons on nfIonfs, fho honIfh-cnro communIfy, nnd fho
fodornI budgof. Thnf consoquonco wouId bo In nbsoIufo
confIIcf wIfh fho ACA`s dosIgn of shnrod rosonsIbIIIfy,
nnd wouId oso n fhronf fo fho nfIon fhnf Congross dId

I!SIISS t. SIII!I!S
nof Infond.
n
"#$%&'#() *)+%,'-./#$ '#0 1'2)$
WIfhouf fho IndIvIdunI Mnndnfo nnd ModIcnId Ixnn-
sIon, fho AffordnbIo Cnro Acf`s Insurnnco roguInfIons nnd
Insurnnco fnxos Imoso rIsks on Insurnnco comnnIos nnd
fhoIr cusfomors fhnf fhIs Courf cnnnof monsuro. Thoso
rIsks wouId undormIno Congross` schomo of shnrod ro-
sonsIbIIIfy. Soo 26 !. S. C. 4980I (2006 od., Su.
IV) (hIgh-cosf Insurnnco Inns); 42 !. S. C. 300gg(n)(l)
(2006 od., Su. IV), 300gg4(b) (communIfy rnfIng);
300ggl, 300gg3, 300gg4(n) (gunrnnfood Issuo);
300ggll (oIImInnfIon of covorngo IImIfs); 300ggl4(n)
(doondonf chIIdron u fo ngo 26); ACA 90l0, l0905,
l24 Sfnf. 865, l0l? (oxcIso fnx); HCI!A l40l, l24 Sfnf.
l059 (oxcIso fnx).
Tho Courf hns boon Informod by dIsfInguIshod ocono-
mIsfs fhnf fho Acf`s IndIvIdunI Mnndnfo nnd ModIcnId
IxnnsIon wouId onch Incronso rovonuos fo fho Insurnnco
Indusfry by nbouf $350 bIIIIon ovor l0 yonrs; fhnf fhIs
combInod fIguro of $?00 bIIIIon Is nocossnry fo offsof fho
nroxImnfoIy $?00 bIIIIon In now cosfs fo fho Insurnnco
Indusfry Imosod by fho Acf`s Insurnnco roguInfIons nnd
fnxos; nnd fhnf fho now $?00-bIIIIon burdon wouId ofhor-
wIso dwnrf fho Indusfry`s curronf rofIf mnrgIn. Soo IrIof
for IconomIsfs ns Anici Curioe In o. ll393 ofc. (Sovor-
nbIIIfy), . 9l6, l0n.
If fhnf nnnIysIs Is corrocf, fho roguInfIons nnd fnxos wIII
monn hIghor cosfs for Insurnnco comnnIos. HIghor cosfs
mny monn hIghor romIums for consumors, dosIfo fho
Acf`s gonI of Iowor|Ing] honIfh Insurnnco romIums. 42
!. S. C. l809l(2)(I) (2006 od., Su. IV). HIghor cosfs
nIso couId fhronfon fho survIvnI of honIfh-Insurnnco com-
nnIos, dosIfo fho Acf`s gonI of offocfIvo honIfh Insurnnco
mnrkofs. l809l(2)(J).

5? CIfo ns: 56? !. S. ____ (20l2)
Tho ncfunI cosf of fho roguInfIons nnd fnxos mny bo
moro or Ioss fhnn rodIcfod. Whnf Is known, howovor, Is
fhnf sovorIng ofhor rovIsIons from fho IndIvIdunI Mnn-
dnfo nnd ModIcnId IxnnsIon nocossnrIIy wouId Imoso
sIgnIfIcnnf rIsks nnd ronI uncorfnInfIos on Insurnnco com-
nnIos, fhoIr cusfomors, nII ofhor mnjor ncfors In fho sys-
fom, nnd fho govornmonf fronsury. And whnf nIso Is
known Is fhIs: !nnocossnry rIsks nnd nvoIdnbIo uncorfnIn-
fIos nro hosfIIo fo oconomIc rogross nnd fIscnI sfnbIIIfy
nnd fhus fo fho snfofy nnd woIfnro of fho nfIon nnd fho
nfIon`s froodom. If fhoso rIsks nnd uncorfnInfIos nro fo
bo Imosod, If musf nof bo by fho JudIcInry.
b
*)0%(-./#$ .# *).34%&$)3)#-$ -/ 5/$6.-',$ '#0
7-8)& *)0%(-./#$ .# 9)0.('&) :26)#0.-%&)$
Tho AffordnbIo Cnro Acf roducos nymonfs by fho Iod-
ornI Covornmonf fo hosIfnIs by moro fhnn $200 bIIIIon
ovor l0 yonrs. Soo 42 !. S. C. l395ww(b)(3)(I)(xI)(xII)
(2006 od., Su. IV); l395ww(q); l395ww(r); l396r
4(f)(?).
Tho concof Is sfrnIghfforwnrd: onr-unIvorsnI covorngo
wIII roduco uncomonsnfod cnro, whIch wIII Incronso hos-
IfnIs` rovonuos, whIch wIII offsof fho govornmonf`s ro-
ducfIons In ModIcnro nnd ModIcnId roImbursomonfs fo
hosIfnIs. !osonsIbIIIfy wIII bo shnrod, ns burdons nnd
bonofIfs bnInnco onch ofhor. ThIs Is fyIcnI of fho whoIo
dynnmIc of fho Acf.
InvnIIdnfIng fho koy mochnnIsms for oxnndIng Insur-
nnco covorngo, such ns communIfy rnfIng nnd fho ModI-
cnId IxnnsIon, wIfhouf InvnIIdnfIng fho roducfIons In
ModIcnro nnd ModIcnId, dIsforfs fho ACA`s dosIgn of
shnrod rosonsIbIIIfy. Somo hosIfnIs mny bo forcod fo
rnIso fho cosf of cnro In ordor fo offsof fho roducfIons In
roImbursomonfs, whIch couId rnIso fho cosf of Insurnnco
romIums, In confrnvonfIon of fho Acf`s gonI of Iowor|Ing]

I!SIISS t. SIII!I!S
honIfh Insurnnco romIums. 42 !. S. C. l809l(2)(I)
(2006 od., Su. IV). Soo nIso l809l(2)(I) (gonI of
Iowor|Ing] honIfh Insurnnco romIums); l809l(2)(J)
(snmo). Ofhor hosIfnIs, nrfIcuInrIy snfofy-nof hosIfnIs fhnf
sorvo n Inrgo numbor of unInsurod nfIonfs, mny bo forcod
fo shuf down. Cf. nfIonnI Assn. of IubIIc HosIfnIs, 2009
AnnunI Survoy: Snfofy of HosIfnIs nnd HonIfh Sysfoms
IuIfIII MIssIon In !ncorfnIn TImos 56 (Iob. 20ll). !Iko
fho offocf of rosorvIng fho Insurnnco roguInfIons nnd
fnxos, fho rocIso dogroo of rIsk fo hosIfnIs Is unknow-
nbIo. If Is nof fho roor roIo of fho Courf, by sovorIng
nrf of n sfnfufo nnd nIIowIng fho rosf fo sfnnd, fo Imoso
unknownbIo rIsks fhnf Congross couId noIfhor monsuro
nor rodIcf. And Congross couId nof hnvo Infondod fhnf
rosuIf In nny ovonf.
Thoro Is n socond, Indoondonf ronson why fho roduc-
fIons In roImbursomonfs fo hosIfnIs nnd fho ACA`s ofhor
ModIcnro cufs musf bo InvnIIdnfod. Tho ACA`s $455 bII-
IIon In ModIcnro nnd ModIcnId snvIngs offsof fho $434-
bIIIIon cosf of fho ModIcnId IxnnsIon. Soo CIO IsfI-
mnfo, TnbIo 2 (Mnr. 20, 20l0). Tho roducfIons nIIowod
Congross fo fInd fhnf fho ACA wIII roduco fho IodornI
dofIcIf bofwoon 20l0 nnd 20l9 nnd wIII confInuo fo
roduco budgof dofIcIfs nffor 20l9. ACA l563(n)(l), (2),
l24 Sfnf. 2?0.
Thnf fIndIng wns crIfIcnI fo fho ACA. Tho Acf`s shnrod
rosonsIbIIIfy concof oxfonds fo fho fodornI budgof.
Congross choso fo offsof now fodornI oxondIfuros wIfh
budgof cufs nnd fnx Incronsos. Thnf Is why fho !nIfod
Sfnfos hns oxInInod In fho courso of fhIs IIfIgnfIon fhnf
|w]hon Congross nssod fho ACA, If wns cnrofuI fo onsuro
fhnf nny Incronsod sondIng, IncIudIng on ModIcnId, wns
offsof by ofhor rovonuo-rnIsIng nnd cosf-snvIng rovI-
sIons. Momornndum In Suorf of Covornmonf`s MofIon
for Summnry Judgmonf In o. 3l0cv9l, . 4l.
If fho ModIcnro nnd ModIcnId roducfIons wouId no Iongor

59 CIfo ns: 56? !. S. ____ (20l2)
bo noodod fo offsof fho cosfs of fho ModIcnId IxnnsIon,
fho roducfIons wouId no Iongor oornfo In fho mnnnor
Congross Infondod. Thoy wouId Ioso fhoIr jusfIfIcnfIon nnd
foundnfIon. In nddIfIon, fo rosorvo fhom wouId bo fo
oIImInnfo n sIgnIfIcnnf quiJ pro quo of fho IogIsInfIvo com-
romIso nnd cronfo n sfnfufo Congross dId nof onncf.
Legol Serticee Corporo/ion v. Velocquec, 53l !. S. 533,
56l (200l) (SCA!IA, J., dIssonfIng). If Is no socrof fhnf
cuffIng ModIcnro Is unouInr; nnd If Is mosf ImrobnbIo
Congross wouId hnvo dono so wIfhouf nf Ionsf fho nssur-
nnco fhnf If wouId rondor fho ACA dofIcIf-noufrnI. Soo
ACA l563(n)(l), (2), l24 Sfnf. 2?0.
c
5)',-8 "#$%&'#() :2(8'#+)$ '#0 18).& ;)0)&',
<%4$.0.)$
Tho ACA roquIros onch Sfnfo fo osfnbIIsh n honIfh-
Insurnnco oxchnngo. Inch oxchnngo Is n ono-sfo mnr-
kofInco for IndIvIdunIs nnd smnII busInossos fo comnro
communIfy-rnfod honIfh Insurnnco nnd urchnso fho
oIIcy of fhoIr choIco. Tho oxchnngos cnnnof oornfo In fho
mnnnor Congross Infondod If fho IndIvIdunI Mnndnfo,
ModIcnId IxnnsIon, nnd Insurnnco roguInfIons cnnnof
romnIn In forco.
Tho Acf`s dosIgn Is fo nIIocnfo bIIIIons of fodornI doIInrs
fo subsIdIzo IndIvIdunIs` urchnsos on fho oxchnngos. In-
dIvIdunIs wIfh Incomos bofwoon l00 nnd 400 orconf of
fho ovorfy IovoI rocoIvo fnx crodIfs fo offsof fho cosf of
Insurnnco fo fho IndIvIdunI urchnsor. 26 !. S. C. 36I
(2006 od., Su. IV); 42 !. S. C. l80?l (2006 od., Su.
IV). Iy 20l9, 20 mIIIIon of fho 24 mIIIIon ooIo who wIII
obfnIn Insurnnco fhrough nn oxchnngo nro oxocfod fo
rocoIvo nn nvorngo fodornI subsIdy of $6,460 or orson.
Soo CIO, AnnIysIs of fho Mnjor HonIfh Cnro !ogIsInfIon
Inncfod In Mnrch 20l0, . l8l9 (Mnr. 30, 20ll). WIfh-
ouf fho communIfy-rnfIng Insurnnco roguInfIon, howovor,

I!SIISS t. SIII!I!S
fho nvorngo fodornI subsIdy couId bo much hIghor; for
communIfy rnfIng gronfIy Iowors fho onormous romIums
unhonIfhy IndIvIdunIs wouId ofhorwIso ny. IodornI
subsIdIos wouId mnko u much of fho dIfforonco.
Tho rosuIf wouId bo nn unInfondod boon fo Insurnnco
comnnIos, nn unInfondod hnrm fo fho fodornI fIsc, nnd
n corrosondIng bronkdown of fho shnrod rosonsIbII-
Ify bofwoon fho Indusfry nnd fho fodornI budgof fhnf
Congross Infondod. Thus, fho fodornI subsIdIos musf bo
InvnIIdnfod.
In fho nbsonco of fodornI subsIdIos fo urchnsors, Insur-
nnco comnnIos wIII hnvo IIffIo InconfIvo fo soII Insurnnco
on fho oxchnngos. !ndor fho ACA`s schomo, fow, If nny,
IndIvIdunIs wouId wnnf fo buy IndIvIdunI Insurnnco oII-
cIos oufsIdo of nn oxchnngo, bocnuso fodornI subsIdIos
wouId bo unnvnIInbIo oufsIdo of nn oxchnngo. IffIcuIfy In
nffrncfIng IndIvIdunIs oufsIdo of fho oxchnngo wouId In
furn mofIvnfo Insurors fo onfor oxchnngos, dosIfo fho
oxchnngos` onorous roguInfIons. Soo 42 !. S. C. l803l.
Thnf sysfom of InconfIvos coIInsos If fho fodornI subsIdIos
nro InvnIIdnfod. WIfhouf fho fodornI subsIdIos, IndIvId-
unIs wouId Ioso fho mnIn InconfIvo fo urchnso Insurnnco
InsIdo fho oxchnngos, nnd somo Insurors mny bo unwIIIIng
fo offor Insurnnco InsIdo of oxchnngos. WIfh fowor buyors
nnd ovon fowor soIIors, fho oxchnngos wouId nof oornfo
ns Congross Infondod nnd mny nof oornfo nf nII.
Thoro Is n socond ronson why, If communIfy rnfIng Is
InvnIIdnfod by fho Mnndnfo nnd ModIcnId IxnnsIon`s
InvnIIdIfy, oxchnngos cnnnof bo ImIomonfod In n mnnnor
consIsfonf wIfh fho Acf`s dosIgn. A koy uroso of nn
oxchnngo Is fo rovIdo n mnrkofInco of Insurnnco ofIons
whoro rIcos nro sfnndnrdIzod rognrdIoss of fho buy-
or`s ro-oxIsfIng condIfIons. Soo iIiJ. An IndIvIdunI who
shos for Insurnnco fhrough nn oxchnngo wIII ovnIunfo
dIfforonf Insurnnco roducfs. Tho roducfs wIII offor
dIfforonf bonofIfs nnd rIcos. Congross dosIgnod fho ox-

6l CIfo ns: 56? !. S. ____ (20l2)
chnngos so fho shoor cnn comnro bonofIfs nnd rIcos.
Iuf fho comnrIson cnnnof bo mndo In fho wny Congross
dosIgnod If fho rIcos doond on fho shoor`s ro-oxIsfIng
honIfh condIfIons. Tho rIcos wouId vnry from orson fo
orson. So wIfhouf communIfy rnfIngwhIch rohIbIfs
Insurors from bnsIng fho rIco of Insurnnco on ro-oxIsfIng
condIfIonsfho oxchnngos cnnnof oornfo In fho mnnnor
Congross Infondod.
d
:36,/=)&>*)$6/#$.4.,.-= ?$$)$$3)#-
Tho omIoyor rosonsIbIIIfy nssossmonf rovIdos nn
InconfIvo for omIoyors wIfh nf Ionsf 50 omIoyoos fo
rovIdo fhoIr omIoyoos wIfh honIfh Insurnnco ofIons
fhnf moof mInImum crIforIn. Soo 26 !. S. C. 4980H
(2006 od., Su. IV). !nIIko fho IndIvIdunI Mnndnfo,
fho omIoyor-rosonsIbIIIfy nssossmonf doos nof roquIro
omIoyors fo rovIdo nn Insurnnco ofIon. Insfond, If ro-
quIros fhom fo mnko n nymonf fo fho IodornI Covorn-
monf If fhoy do nof offor Insurnnco fo omIoyoos nnd If
Insurnnco Is boughf on nn oxchnngo by nn omIoyoo who
qunIIfIos for fho oxchnngo`s fodornI subsIdIos. Soo iIiJ.
Ior fwo ronsons, fho omIoyor-rosonsIbIIIfy nssossmonf
musf bo InvnIIdnfod. IIrsf, fho ACA mnkos n dIrocf IInk
bofwoon fho omIoyor-rosonsIbIIIfy nssossmonf nnd fho
oxchnngos. Tho fInnncInI nssossmonf ngnInsf omIoyors
occurs onIy undor corfnIn condIfIons. Ono of fhom Is fho
urchnso of Insurnnco by nn omIoyoo on nn oxchnngo.
WIfh no oxchnngos, fhoro nro no urchnsos on fho ox-
chnngos; nnd wIfh no urchnsos on fho oxchnngos, fhoro Is
nofhIng fo frIggor fho omIoyor-rosonsIbIIIfy nssossmonf.
Socond, nffor fho InvnIIdnfIon of burdons on IndIvIdunIs
(fho IndIvIdunI Mnndnfo), Insurors (fho Insurnnco rogu-
InfIons nnd fnxos), Sfnfos (fho ModIcnId IxnnsIon), fho
IodornI Covornmonf (fho fodornI subsIdIos for oxchnngos
nnd for fho ModIcnId IxnnsIon), nnd hosIfnIs (fho roduc-

I!SIISS t. SIII!I!S
fIons In roImbursomonfs), fho rosorvnfIon of fho omIoyor-
rosonsIbIIIfy nssossmonf wouId usof fho ACA`s dosIgn
of shnrod rosonsIbIIIfy. If wouId Ionvo omIoyors ns fho
onIy nrfIos bonrIng nny sIgnIfIcnnf rosonsIbIIIfy. Thnf
wns nof fho congrossIonnI Infonf.
2
!"# 58.?; -(&24 142)(;(2&;
Tho noxf quosfIon Is whofhor fho InvnIIdnfIon of fho
ACA`s mnjor rovIsIons roquIros fho Courf fo InvnIIdnfo
fho ACA`s ofhor rovIsIons. If doos.
Tho ACA Is ovor 900 ngos Iong. Ifs roguInfIons IncIudo
roquIromonfs rnngIng from n bronk fImo nnd socIudod
Inco nf work for nursIng mofhors, soo 29 !. S. C. 20?(r)(l)
(2006 od., Su. IV), fo dIsInys of nufrIfIonnI confonf
nf chnIn rosfnurnnfs, soo 2l !. S. C. 343(q)(5)(H).
Tho Acf rnIsos bIIIIons of doIInrs In fnxos nnd foos, IncIud-
Ing oxncfIons Imosod on hIgh-Incomo fnxnyors, soo ACA
90l5, l0906; HCI!A l402, modIcnI dovIcos, soo 26
!. S. C. 4l9l (2006 od., Su. IV), nnd fnnnIng boofhs,
soo 5000I. If sonds govornmonf monoy on, nmong ofhor
fhIngs, fho sfudy of how fo sond Ioss govornmonf monoy.
42 !. S. C. l3l5n. And If IncIudos n numbor of rovIsIons
fhnf rovIdo bonofIfs fo fho Sfnfo of n nrfIcuInr IogIsInfor.
Ior oxnmIo, l0323, l24 Sfnf. 954, oxfonds ModIcnro
covorngo fo IndIvIdunIs oxosod fo nsbosfos from n mIno In
!Ibby, Monfnnn. Anofhor rovIsIon, 2006, iJ., nf 284,
Incronsos ModIcnId nymonfs onIy In !ouIsInnn.
Such rovIsIons vnIIdnfo fho Sonnfo MnjorIfy !ondor`s
sfnfomonf, 'I don`f know If fhoro Is n sonnfor fhnf doosn`f
hnvo somofhIng In fhIs bIII fhnf wns Imorfnnf fo fhom.
. . . |And] If fhoy don`f hnvo somofhIng In If Imorfnnf fo
fhom, fhon If doosn`f sonk woII of fhom. Thnf`s whnf fhIs
IogIsInfIon Is nII nbouf: If`s fho nrf of comromIso.` Ionr,
In HonIfh IIII for Ivoryono, IrovIsIons for n Iow, . Y.
TImos, Jnn. 4, 20l0, . Al0 (quofIng Son. !oId). Offon, n

63 CIfo ns: 56? !. S. ____ (20l2)
mInor rovIsIon wIII bo fho rIco nId for suorf of n
mnjor rovIsIon. So, If fho mnjor rovIsIon woro unconsfI-
fufIonnI, Congross wouId nof hnvo nssod fho mInor ono.
WIfhouf fho ACA`s mnjor rovIsIons, mnny of fhoso
mInor rovIsIons wIII nof oornfo In fho mnnnor Congross
Infondod. Ior oxnmIo, fho fnx Incronsos nro !ovonuo
Offsof IrovIsIons dosIgnod fo hoI offsof fho cosf fo fho
IodornI Covornmonf of rogrnms IIko fho ModIcnId Ix-
nnsIon nnd fho oxchnngos` fodornI subsIdIos. Soo TIfIo
IX, SubfIfIo A!ovonuo Offsof IrovIsIons, l24 Sfnf. 84?.
WIfh fho ModIcnId IxnnsIon nnd fho oxchnngos InvnII-
dnfod, fho fnx Incronsos no Iongor oornfo fo offsof cosfs,
nnd fhoy no Iongor sorvo fho uroso In fho Acf`s schomo
of shnrod rosonsIbIIIfy fhnf Congross Infondod.
Somo rovIsIons, such ns roquIrIng chnIn rosfnurnnfs fo
dIsIny nufrIfIonnI confonf, nonr IIkoIy fo oornfo ns
Congross Infondod, buf fhoy fnII fho socond fosf for sovor-
nbIIIfy. Thoro Is no ronson fo boIIovo fhnf Congross wouId
hnvo onncfod fhom IndoondonfIy. Tho Courf hns nof
rovIousIy hnd occnsIon fo consIdor sovornbIIIfy In fho con-
foxf of nn omnIbus onncfmonf IIko fho ACA, whIch In-
cIudos nof onIy mnny rovIsIons fhnf nro nncIIInry fo Ifs
confrnI rovIsIons buf nIso mnny fhnf nro onfIroIy unro-
InfodhIfchod on bocnuso If wns n quIck wny fo gof fhom
nssod dosIfo oosIfIon, or bocnuso fhoIr roononfs
couId oxncf fhoIr onncfmonf ns fho quiJ pro quo for fhoIr
noodod suorf. Whon wo nro confronfod wIfh such n so-
cnIIod ChrIsfmns froo, n Inw fo whIch mnny nongormnno
ornnmonfs hnvo boon nffnchod, wo fhInk fho roor ruIo
musf bo fhnf whon fho froo no Iongor oxIsfs fho ornnmonfs
nro suorfIuous. Wo hnvo no roIInbIo bnsIs for knowIng
whIch Iocos of fho Acf wouId hnvo nssod on fhoIr own. If
Is corfnIn fhnf mnny of fhom wouId nof hnvo, nnd If Is nof
n roor funcfIon of fhIs Courf fo guoss whIch. To sovor
fho sfnfufo In fhnf mnnnor 'wouId bo fo mnko n now Inw,
nof fo onforco nn oId ono. ThIs Is nof nrf of our dufy.`

I!SIISS t. SIII!I!S
TroJe-Mor/ Coeee, l00 !. S., nf 99.
ThIs Courf musf nof Imoso rIsks unInfondod by Con-
gross or roduco IogIsInfIon Congross mny hnvo Inckod fho
suorf fo onncf. Ior fhoso ronsons, fho unconsfIfufIon-
nIIfy of bofh fho IndIvIdunI Mnndnfo nnd fho ModIcnId
IxnnsIon roquIros fho InvnIIdnfIon of fho AffordnbIo Cnro
Acf`s ofhor rovIsIons.
* * *
Tho Courf fodny docIdos fo snvo n sfnfufo Congross dId
nof wrIfo. If ruIos fhnf whnf fho sfnfufo docInros fo bo n
roquIromonf wIfh n onnIfy Is Insfond nn ofIon subjocf
fo n fnx. And If chnngos fho InfonfIonnIIy coorcIvo snnc-
fIon of n fofnI cuf-off of ModIcnId funds fo n suosodIy
noncoorcIvo cuf-off of onIy fho IncromonfnI funds fhnf fho
Acf mnkos nvnIInbIo.
Tho Courf rognrds Ifs sfrnInod sfnfufory InforrofnfIon
ns judIcInI modosfy. If Is nof. If nmounfs Insfond fo n vnsf
judIcInI ovorronchIng. If cronfos n dobIIIfnfod, InoornbIo
vorsIon of honIfh-cnro roguInfIon fhnf Congross dId nof
onncf nnd fho ubIIc doos nof oxocf. If mnkos onncfmonf
of sonsIbIo honIfh-cnro roguInfIon moro dIffIcuIf, sInco
Congross cnnnof sfnrf nfrosh buf musf fnko ns Ifs oInf of
donrfuro n jumbIo of now sonsoIoss rovIsIons, rovIsIons
fhnf corfnIn Inforosfs fnvorod undor fho Courf`s now do-
sIgn wIII sfruggIo fo rofnIn. And If Ionvos fho ubIIc nnd
fho Sfnfos fo oxond vnsf sums of monoy on roquIromonfs
fhnf mny or mny nof survIvo fho nocossnry congrossIonnI
rovIsIon.
Tho Courf`s dIsosIfIon, Invonfod nnd nfoxfunI ns If Is,
doos nof ovon hnvo fho morIf of nvoIdIng consfIfufIonnI
dIffIcuIfIos. If cronfos fhom. Tho hoIdIng fhnf fho IndI-
vIdunI Mnndnfo Is n fnx rnIsos n dIffIcuIf consfIfufIonnI
quosfIon (whnf Is n dIrocf fnx) fhnf fho Courf rosoIvos
wIfh Inndoqunfo doIIbornfIon. And fho judgmonf on fho
ModIcnId IxnnsIon Issuo ushors In now fodornIIsm con-

65 CIfo ns: 56? !. S. ____ (20l2)
corns nnd Incos nn unnccusfomod sfrnIn uon fho !nIon.
Thoso Sfnfos fhnf docIIno fho ModIcnId IxnnsIon musf
subsIdIzo, by fho fodornI fnx doIInrs fnkon from fhoIr
cIfIzons, vnsf grnnfs fo fho Sfnfos fhnf nccof fho ModIcnId
IxnnsIon. If fhnf dosfnbIIIzIng oIIfIcnI dynnmIc, so
nnfngonIsfIc fo n hnrmonIous !nIon, Is fo bo Infroducod nf
nII, If shouId bo by Congross, nof by fho JudIcInry.
Tho vnIuos fhnf shouId hnvo doformInod our courso fo-
dny nro cnufIon, mInImnIIsm, nnd fho undorsfnndIng fhnf
fho IodornI Covornmonf Is ono of IImIfod owors. Iuf
fho Courf`s ruIIng undormInos fhoso vnIuos nf ovory furn.
In fho nnmo of rosfrnInf, If ovorronchos. In fho nnmo of
consfIfufIonnI nvoIdnnco, If cronfos now consfIfufIonnI
quosfIons. In fho nnmo of cooornfIvo fodornIIsm, If un-
dormInos sfnfo sovoroIgnfy.
Tho ConsfIfufIon, fhough If dnfos from fho foundIng of
fho !oubIIc, hns oworfuI monnIng nnd vIfnI roIovnnco
fo our own fImos. Tho consfIfufIonnI rofocfIons fhnf fhIs
cnso InvoIvos nro rofocfIons of sfrucfuro. SfrucfurnI
rofocfIonsnofnbIy, fho rosfrnInfs Imosod by fodornIIsm
nnd sonrnfIon of oworsnro Ioss romnnfIc nnd hnvo Ioss
obvIous n connocfIon fo orsonnI froodom fhnn fho rovI-
sIons of fho IIII of !Ighfs or fho CIvII Wnr Amondmonfs.
Honco fhoy fond fo bo undorvnIuod or ovon forgoffon by
our cIfIzons. If shouId bo fho rosonsIbIIIfy of fho Courf fo
fonch ofhorwIso, fo romInd our ooIo fhnf fho Irnmors
consIdorod sfrucfurnI rofocfIons of froodom fho mosf Im-
orfnnf onos, for whIch ronson fhoy nIono woro ombod-
Iod In fho orIgInnI ConsfIfufIon nnd nof Ioff fo Infor
nmondmonf. Tho frngmonfnfIon of owor roducod by fho
sfrucfuro of our Covornmonf Is confrnI fo IIborfy, nnd
whon wo dosfroy If, wo Inco IIborfy nf orII. Todny`s
docIsIon shouId hnvo vIndIcnfod, shouId hnvo fnughf, fhIs
frufh; Insfond, our judgmonf fodny hns dIsrognrdod If.
Ior fho ronsons horo sfnfod, wo wouId fInd fho Acf In-
vnIId In Ifs onfIrofy. Wo rosocffuIIy dIssonf.

_________________

_________________

l CIfo ns: 56? !. S. ____ (20l2)
THOMAS, J., dIssonfIng
ll393 t.
ll398 t.
I!O!IA IT A!.
ll400
t.
|Juno 28, 20l2]
J!STICI THOMAS, dIssonfIng.
I dIssonf for fho ronsons sfnfod In our joInf oInIon, buf
I wrIfo sonrnfoIy fo sny n word nbouf fho Commorco
CInuso. Tho joInf dIssonf nnd THI CHIII J!STICI cor-
rocfIy nIy our rocodonfs fo concIudo fhnf fho IndIvIdunI
Mnndnfo Is boyond fho owor grnnfod fo Congross un-
dor fho Commorco CInuso nnd fho ocossnry nnd Iroor
CInuso. !ndor fhoso rocodonfs, Congross mny roguInfo
oconomIc ncfIvIfy |fhnf] subsfnnfInIIy nffocfs Inforsfnfo
commorco. Ini/eJ S/o/ee v. Lopec, 5l4 !. S. 549, 560
(l995). I ndhoro fo my vIow fhnf fho vory nofIon of n

I!SIISS t. SIII!I!S
THOMAS, J., dIssonfIng
'subsfnnfInI offocfs` fosf undor fho Commorco CInuso Is
InconsIsfonf wIfh fho orIgInnI undorsfnndIng of Congross`
owors nnd wIfh fhIs Courf`s onrIy Commorco CInuso
cnsos. Ini/eJ S/o/ee v. Morrieon, 529 !. S. 598, 62?
(2000) (THOMAS, J., concurrIng); soo nIso Lopec, eupro, nf
584602 (THOMAS, J., concurrIng); Goncolee v. Ioicl, 545
!. S. l, 6?69 (2005) (THOMAS, J., dIssonfIng). As I hnvo
oxInInod, fho Courf`s confInuod uso of fhnf fosf hns
oncourngod fho IodornI Covornmonf fo orsIsf In Ifs vIow
fhnf fho Commorco CInuso hns vIrfunIIy no IImIfs. Morri-
eon, eupro, nf 62?. Tho Covornmonf`s unrocodonfod
cInIm In fhIs suIf fhnf If mny roguInfo nof onIy oconomIc
ncfIvIfy buf nIso inoc/iti/, fhnf subsfnnfInIIy nffocfs Infor-
sfnfo commorco Is n cnso In oInf.

SCOTUS Slip Opinion On Obama Care

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

SCOTUS Slip Opinion On Obama Care

Uploaded by

Copyright:

Available Formats

l (SII OInIon) OCTOII! TI!

You might also like