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Scotus Opinion on ACA

Scotus Opinion on ACA

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Supreme Court Upholds Health insurance Law
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l (SIIµ OµInIon) OCTOII! TI!

M, 20ll
SyIInbus
ÞOTI: Whoro If Is fonsIbIo, n syIInbus (hondnofo) wIII bo roIonsod, ns Is
boIng dono In connocfIon wIfh fhIs cnso, nf fho fImo fho oµInIon Is Issuod.
Tho syIInbus consfIfufos no µnrf of fho oµInIon of fho Courf buf hns boon
µroµnrod by fho !oµorfor of ÐocIsIons 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
ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS IT A!. t. SIII!I!S, SIC!ITA!Y OI
HIA!TH AÞÐ H!MAÞ SI!VICIS, IT A!.
CI!TIO!A!I TO THI !ÞITIÐ STATIS CO!!T OI AIIIA!S IO!
THI I!IVIÞTH CI!C!IT
Þo. ll393. Arguod Mnrch 26, 2?, 28, 20l2ÐocIdod 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 µrovIsIon Is
fho IndIvIdunI mnndnfo, whIch roquIros mosf AmorIcnns fo mnInfnIn
¨mInImum ossonfInI¨ honIfh Insurnnco covorngo. 26 !. S. C. §5000A.
Ior IndIvIdunIs who nro nof oxomµf, nnd who do nof rocoIvo honIfh
Insurnnco fhrough nn omµIoyor or govornmonf µrogrnm, fho monns of
snfIsfyIng fho roquIromonf Is fo µurchnso Insurnnco from n µrIvnfo
comµnny. IogInnIng In 20l4, fhoso who do nof comµIy wIfh fho
mnndnfo musf mnko n ¨|s]hnrod rosµonsIbIIIfy µnymonf¨ fo fho Iod-
ornI Covornmonf. §5000A(b)(l). Tho Acf µrovIdos fhnf fhIs ¨µonnIfy¨
wIII bo µnId fo fho InfornnI !ovonuo SorvIco wIfh nn IndIvIdunI`s fnx-
os, nnd ¨shnII bo nssossod nnd coIIocfod In fho snmo mnnnor¨ ns fnx
µonnIfIos. §§5000A(c), (g)(l).
Anofhor koy µrovIsIon of fho Acf Is fho ModIcnId oxµnnsIon. Tho
curronf ModIcnId µrogrnm offors fodornI fundIng fo Sfnfos fo nssIsf
µrognnnf womon, chIIdron, noody fnmIIIos, fho bIInd, fho oIdorIy, nnd
fho dIsnbIod In obfnInIng modIcnI cnro. 42 !. S. C. §l396d(n). Tho
AffordnbIo Cnro Acf oxµnnds fho scoµo of fho ModIcnId µrogrnm nnd
Incronsos fho numbor of IndIvIdunIs fho Sfnfos musf covor. Ior ox-

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
























2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SyIInbus
nmµIo, fho Acf roquIros sfnfo µrogrnms fo µrovIdo ModIcnId covorngo
by 20l4 fo nduIfs wIfh Incomos uµ fo l33 µorconf of fho fodornI µov-
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 oxµnndIng ModIcnId covorngo. §l396d(y)(l).
Iuf If n Sfnfo doos nof comµIy 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 ÞnfIonnI Iodorn-
fIon of Indoµondonf IusInoss broughf suIf In IodornI ÐIsfrIcf Courf,
chnIIongIng fho consfIfufIonnIIfy of fho IndIvIdunI mnndnfo nnd fho
ModIcnId oxµnnsIon. Tho Courf of AµµonIs for fho IIovonfh CIrcuIf
uµhoId fho ModIcnId oxµnnsIon ns n vnIId oxorcIso of Congross`s
sµondIng µowor, buf concIudod fhnf Congross Inckod nufhorIfy fo on-
ncf fho IndIvIdunI mnndnfo. IIndIng fho mnndnfo sovornbIo from fho
Acf`s ofhor µrovIsIons, fho IIovonfh CIrcuIf Ioff fho rosf of fho Acf In-
fncf.
HelJ. Tho judgmonf Is nffIrmod In µnrf nnd rovorsod In µnrf.
648 I. 3d l235, nffIrmod In µnrf nnd rovorsod In µnrf.
l. CHIII J!STICI !OII!TS doIIvorod fho oµInIon of fho Courf wIfh
rosµocf fo Inrf II, concIudIng fhnf fho AnfI-InjuncfIon Acf doos nof
bnr fhIs suIf.
Tho AnfI-InjuncfIon Acf µrovIdos fhnf ¨no suIf for fho µurµoso of
rosfrnInIng fho nssossmonf or coIIocfIon of nny fnx shnII bo mnIn-
fnInod In nny courf by nny µorson,¨ 26 !. S. C. §?42l(n), so fhnf fhoso
subjocf fo n fnx musf fIrsf µny If nnd fhon suo for n rofund. Tho µro-
sonf chnIIongo sooks fo rosfrnIn fho coIIocfIon of fho shnrod rosµonsI-
bIIIfy µnymonf from fhoso who do nof comµIy wIfh fho IndIvIdunI
mnndnfo. Iuf Congross dId nof Infond fho µnymonf fo bo fronfod ns
n ¨fnx¨ for µurµosos of fho AnfI-InjuncfIon Acf. Tho AffordnbIo Cnro
Acf doscrIbos fho µnymonf ns n ¨µonnIfy,¨ nof n ¨fnx.¨ Thnf InboI
cnnnof confroI whofhor fho µnymonf Is n fnx for µurµosos of fho Con-
sfIfufIon, buf If doos doformIno fho nµµIIcnfIon of fho AnfI-InjuncfIon
Acf. Tho AnfI-InjuncfIon Acf fhoroforo doos nof bnr fhIs suIf. Iµ. 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 µowor undor fho
Commorco CInuso nnd fho Þocossnry nnd Iroµor CInuso. Iµ. l630.
(n) Tho ConsfIfufIon grnnfs Congross fho µowor fo ¨regulo/e
Commorco.¨ Arf. I, §8, cI. 3 (omµhnsIs nddod). Tho µowor fo regulo/e
commorco µrosuµµosos fho oxIsfonco of commorcInI ncfIvIfy fo bo rog-
uInfod. ThIs Courf`s µrocodonf rofIocfs fhIs undorsfnndIng: As ox-
µnnsIvo ns fhIs Courf`s cnsos consfruIng fho scoµo of fho commorco
































3 CIfo ns: 56? !. S. ____ (20l2)
SyIInbus
µowor hnvo boon, fhoy unIformIy doscrIbo fho µowor 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 comµoIs IndIvIdunIs fo Iecone ncfIvo In commorco by
µurchnsIng n µroducf, on fho ground fhnf fhoIr fnIIuro fo do so nffocfs
Inforsfnfo commorco.
ConsfruIng fho Commorco CInuso fo µormIf Congross fo roguInfo
IndIvIdunIs µrocIsoIy Iecouee fhoy nro doIng nofhIng wouId oµon n
now nnd µofonfInIIy vnsf domnIn fo congrossIonnI nufhorIfy. Con-
gross nIrondy µossossos oxµnnsIvo µowor fo roguInfo whnf µooµIo do.
!µhoIdIng fho AffordnbIo Cnro Acf undor fho Commorco CInuso
wouId gIvo Congross fho snmo IIconso fo roguInfo whnf µooµIo do nof
do. Tho Irnmors know fho dIfforonco bofwoon doIng somofhIng nnd
doIng nofhIng. Thoy gnvo Congross fho µowor fo regulo/e commorco,
nof fo conpel If. IgnorIng fhnf dIsfIncfIon wouId undormIno fho µrIn-
cIµIo fhnf fho IodornI Covornmonf Is n govornmonf of IImIfod nnd
onumornfod µowors. Tho IndIvIdunI mnndnfo fhus cnnnof bo sus-
fnInod undor Congross`s µowor fo ¨roguInfo Commorco.¨ Iµ. l62?.
(b) Þor cnn fho IndIvIdunI mnndnfo bo susfnInod undor fho Þoc-
ossnry nnd Iroµor CInuso ns nn InfogrnI µnrf of fho AffordnbIo Cnro
Acf`s ofhor roforms. Inch of fhIs Courf`s µrIor cnsos uµhoIdIng Inws
undor fhnf CInuso InvoIvod oxorcIsos of nufhorIfy dorIvnfIvo of, nnd
In sorvIco fo, n grnnfod µowor. 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 µrodIcnfo fo fho ox-
orcIso of nn onumornfod µowor nnd drnw wIfhIn Ifs roguInfory scoµo
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 oxµnnsIon of fodornI µowor Is nof n ¨µroµor¨ monns for mnk-
Ing fhoso roforms offocfIvo. Iµ. 2?30.
3. CHIII J!STICI !OII!TS concIudod In Inrf IIII fhnf fho IndIvId-
unI mnndnfo musf bo consfruod ns ImµosIng 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 µurchnso Insurnnco. Iuf, for fho ronsons
oxµInInod, fho Commorco CInuso doos nof gIvo Congross fhnf µowor.
If Is fhoroforo nocossnry fo furn fo fho Covornmonf`s nIfornnfIvo nr-
gumonf: fhnf fho mnndnfo mny bo uµhoId ns wIfhIn Congross`s µowor
fo ¨Iny nnd coIIocf Tnxos.¨ Arf. I, §8, cI. l. In µrossIng Ifs fnxIng
µowor nrgumonf, fho Covornmonf nsks fho Courf fo vIow fho mnn-
dnfo ns ImµosIng n fnx on fhoso who do nof buy fhnf µroducf. 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 µossIbIo¨ fo Infor-


























4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SyIInbus
µrof fho mnndnfo ns ImµosIng such n fnx, Crouell v. Beneon, 285
!. S. 22, 62. Iµ. 3l32.
4. CHIII J!STICI !OII!TS doIIvorod fho oµInIon of fho Courf wIfh
rosµocf fo Inrf IIIC, concIudIng fhnf fho IndIvIdunI mnndnfo mny bo
uµhoId ns wIfhIn Congross`s µowor undor fho TnxIng CInuso. Iµ. 33
44.
(n) Tho AffordnbIo Cnro Acf doscrIbos fho ¨|s]hnrod rosµonsIbIIIfy
µnymonf¨ ns n ¨µonnIfy,¨ nof n ¨fnx.¨ Thnf InboI Is fnfnI fo fho nµµII-
cnfIon of fho AnfI-InjuncfIon Acf. If doos nof, howovor, confroI
whofhor nn oxncfIon Is wIfhIn Congross`s µowor fo fnx. In nnsworIng
fhnf consfIfufIonnI quosfIon, fhIs Courf foIIows n funcfIonnI nµµronch,
¨|d]IsrognrdIng fho dosIgnnfIon of fho oxncfIon, nnd vIowIng Ifs sub-
sfnnco nnd nµµIIcnfIon.¨ Ini/eJ S/o/ee v. Cone/on/ine, 296 !. S. 28?,
294. Iµ. 3335.
(b) Such nn nnnIysIs suggosfs fhnf fho shnrod rosµonsIbIIIfy
µnymonf mny for consfIfufIonnI µurµosos bo consIdorod n fnx. Tho
µnymonf Is nof so hIgh fhnf fhoro Is ronIIy no choIco buf fo buy honIfh
Insurnnco; fho µnymonf Is nof IImIfod fo wIIIfuI vIoInfIons, ns µonnI-
fIos for unInwfuI ncfs offon nro; nnd fho µnymonf Is coIIocfod soIoIy by
fho I!S fhrough fho normnI monns of fnxnfIon. Cf. Boile, v. Drexel
Iurni/ure Co., 259 !. S. 20, 363?. Þono of fhIs Is fo sny fhnf µny-
monf Is nof Infondod fo Induco fho µurchnso of honIfh Insurnnco. Iuf
fho mnndnfo nood nof bo rond fo docInro fhnf fnIIIng fo do so Is un-
InwfuI. ÞoIfhor fho AffordnbIo Cnro Acf nor nny ofhor Inw nffnchos
nognfIvo IognI consoquoncos fo nof buyIng honIfh Insurnnco, boyond
roquIrIng n µnymonf fo fho I!S. And Congross`s choIco of Inngungo
sfnfIng fhnf IndIvIdunIs ¨shnII¨ obfnIn Insurnnco or µny n ¨µonnIfy¨
doos nof roquIro rondIng §5000A ns µunIshIng unInwfuI conducf. If
mny nIso bo rond ns ImµosIng n fnx on fhoso who go wIfhouf Insur-
nnco. Soo Aeu Yor/ v. Ini/eJ S/o/ee, 505 !. S. l44, l69l?4.
Iµ. 3540.
(c) Ivon If fho mnndnfo mny ronsonnbIy bo chnrncforIzod ns n
fnx, If musf sfIII comµIy wIfh fho ÐIrocf Tnx CInuso, whIch µrovIdos:
¨Þo CnµIfnfIon, or ofhor dIrocf, Tnx shnII bo InId, unIoss In IroµorfIon
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
cnµIfnfIon or ofhor dIrocf fnx undor fhIs Courf`s µrocodonfs. If fhoro-
foro nood nof bo nµµorfIonod so fhnf onch Sfnfo µnys In µroµorfIon fo
Ifs µoµuInfIon. Iµ. 404l.
5. CHIII J!STICI !OII!TS, joInod by J!STICI I!IYI! nnd J!STICI
KACAÞ, concIudod In Inrf IV fhnf fho ModIcnId oxµnnsIon vIoInfos
fho ConsfIfufIon by fhronfonIng Sfnfos wIfh fho Ioss of fhoIr oxIsfIng
ModIcnId fundIng If fhoy docIIno fo comµIy wIfh fho oxµnnsIon.
Iµ. 4558.
























5 CIfo ns: 56? !. S. ____ (20l2)
SyIInbus
(n) Tho SµondIng CInuso grnnfs Congross fho µowor ¨fo µny fho
Ðobfs nnd µrovIdo for fho . . . gonornI WoIfnro of fho !nIfod Sfnfos.¨
Arf. I, §8, cI. l. Congross mny uso fhIs µowor fo osfnbIIsh cooµornfIvo
sfnfo-fodornI SµondIng CInuso µrogrnms. Tho IogIfImncy of SµondIng
CInuso IogIsInfIon, howovor, doµonds on whofhor n Sfnfo voIunfnrIIy
nnd knowIngIy nccoµfs fho forms of such µrogrnms. Pennlure/ S/o/e
Sclool onJ Hoepi/ol v. HolJernon, 45l !. S. l, l?. ¨|T]ho ConsfIfu-
fIon sImµIy 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 µrossur-
Ing fho Sfnfos fo nccoµf n SµondIng CInuso µrogrnm, fho IogIsInfIon
runs counfor fo fhIs ÞnfIon`s sysfom of fodornIIsm. Cf. Sou/l Do/o/o
v. Dole, 483 !. S. 203, 2ll. Iµ. 455l.
(b) SocfIon l396c gIvos fho Socrofnry of HonIfh nnd Humnn Sor-
vIcos fho nufhorIfy fo µonnIIzo Sfnfos fhnf chooso nof fo µnrfIcIµnfo In
fho ModIcnId oxµnnsIon by fnkIng nwny fhoIr oxIsfIng ModIcnId fund-
Ing. 42 !. S. C. §l396c. Tho fhronfonod Ioss of ovor l0 µorconf of n
Sfnfo`s ovornII budgof Is oconomIc drngoonIng fhnf Ionvos fho Sfnfos
wIfh no ronI oµfIon buf fo ncquIosco In fho ModIcnId oxµnnsIon. Tho
Covornmonf cInIms fhnf fho oxµnnsIon Is µroµorIy vIowod ns onIy n
modIfIcnfIon of fho oxIsfIng µrogrnm, nnd fhnf fhIs modIfIcnfIon Is
µormIssIbIo bocnuso Congross rosorvod fho ¨rIghf fo nIfor, nmond, or
roµonI nny µrovIsIon¨ of ModIcnId. §l304. Iuf fho oxµnnsIon nccom-
µIIshos n shIff In kInd, nof moroIy dogroo. Tho orIgInnI µrogrnm wns
dosIgnod fo covor modIcnI sorvIcos for µnrfIcuInr cnfogorIos of vuInor-
nbIo IndIvIdunIs. !ndor fho AffordnbIo Cnro Acf, ModIcnId Is frnns-
formod Info n µrogrnm fo moof fho honIfh cnro noods of fho onfIro
nonoIdorIy µoµuInfIon wIfh Incomo boIow l33 µorconf of fho µovorfy
IovoI. A Sfnfo couId hnrdIy nnfIcIµnfo fhnf Congross`s rosorvnfIon of
fho rIghf fo ¨nIfor¨ or ¨nmond¨ fho ModIcnId µrogrnm IncIudod fho
µowor fo frnnsform If so drnmnfIcnIIy. Tho ModIcnId oxµnnsIon fhus
vIoInfos fho ConsfIfufIon by fhronfonIng Sfnfos wIfh fho Ioss of fhoIr
oxIsfIng ModIcnId fundIng If fhoy docIIno fo comµIy wIfh fho oxµnn-
sIon. Iµ. 5l55.
(c) Tho consfIfufIonnI vIoInfIon Is fuIIy romodIod by µrocIudIng
fho Socrofnry from nµµIyIng §l396c fo wIfhdrnw oxIsfIng ModIcnId
funds for fnIIuro fo comµIy wIfh fho roquIromonfs sof ouf In fho ox-
µnnsIon. Soo §l303. Tho ofhor µrovIsIons 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 µnrfIcIµnfo In fho ModIcnId oxµnnsIon. Iµ. 5558.
6. J!STICI CIÞSI!!C, joInod by J!STICI SOTOMAYO!, Is of fho vIow
fhnf fho SµondIng CInuso doos nof µrocIudo fho Socrofnry from wIfh-
hoIdIng ModIcnId funds bnsod on n Sfnfo`s rofusnI fo comµIy wIfh fho



















6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SyIInbus
oxµnndod ModIcnId µrogrnm. 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
nµµroµrInfo romody. Iocnuso THI CHIII J!STICI fInds fho wIfhhoId-
Ingnof fho grnnfIngof fodornI funds IncomµnfIbIo wIfh fho Sµond-
Ing CInuso, Congross` oxfonsIon of ModIcnId romnIns nvnIInbIo fo nny
Sfnfo fhnf nffIrms Ifs wIIIIngnoss fo µnrfIcIµnfo. Ivon nbsonf §l303`s
commnnd, fho Courf wouId hnvo no wnrrnnf fo InvnIIdnfo fho fundIng
offorod by fho ModIcnId oxµnnsIon, 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. Iµ. 606l.
!OII!TS, C. J., nnnouncod fho judgmonf of fho Courf nnd doIIvorod
fho oµInIon of fho Courf wIfh rosµocf fo Inrfs I, II, nnd IIIC, In whIch
CIÞSI!!C, I!IYI!, SOTOMAYO!, nnd KACAÞ, JJ., joInod; nn oµInIon wIfh
rosµocf fo Inrf IV, In whIch I!IYI! nnd KACAÞ, JJ., joInod; nnd nn
oµInIon wIfh rosµocf fo Inrfs IIIA, IIII, nnd IIIÐ. CIÞSI!!C, J.,
fIIod nn oµInIon concurrIng In µnrf, concurrIng In fho judgmonf In µnrf,
nnd dIssonfIng In µnrf, In whIch SOTOMAYO!, J., joInod, nnd In whIch
I!IYI! nnd KACAÞ, JJ., joInod ns fo Inrfs I, II, III, nnd IV. SCA!IA,
KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., fIIod n dIssonfIng oµInIon. THOMAS,
J., fIIod n dIssonfIng oµInIon.








_________________

_________________





















l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
ÞOTICI: ThIs oµInIon Is subjocf fo formnI rovIsIon boforo µubIIcnfIon In fho
µroIImInnry µrInf of fho !nIfod Sfnfos !oµorfs. !ondors nro roquosfod fo
nofIfy fho !oµorfor of ÐocIsIons, Suµromo Courf of fho !nIfod Sfnfos, Wnsh-
Ingfon, Ð. C. 20543, of nny fyµogrnµhIcnI or ofhor formnI orrors, In ordor
fhnf corrocfIons mny bo mndo boforo fho µroIImInnry µrInf goos fo µross.
SUPREME COURT OF THE UNITED STATES
Þos. ll393, ll398 nnd ll400
ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS, IT A!., IITITIOÞI!S
ll393 t.
KATH!IIÞ SIII!I!S, SIC!ITA!Y OI HIA!TH
AÞÐ H!MAÞ SI!VICIS, IT A!.
ÐIIA!TMIÞT OI HIA!TH AÞÐ H!MAÞ
SI!VICIS, IT A!., IITITIOÞI!S
ll398 t.
I!O!IÐA IT A!.
I!O!IÐA, IT A!., IITITIOÞI!S
ll400 t.
ÐIIA!TMIÞT OI HIA!TH AÞÐ
H!MAÞ SI!VICIS IT A!.
OÞ W!ITS OI CI!TIO!A!I TO THI !ÞITIÐ STATIS CO!!T OI
AIIIA!S IO! THI I!IVIÞTH CI!C!IT
|Juno 28, 20l2]
CHIII J!STICI !OII!TS nnnouncod fho judgmonf of fho
Courf nnd doIIvorod fho oµInIon of fho Courf wIfh rosµocf
fo Inrfs I, II, nnd IIIC, nn oµInIon wIfh rosµocf fo Inrf
IV, In whIch J!STICI I!IYI! nnd J!STICI KACAÞ joIn,
nnd nn oµInIon wIfh rosµocf fo Inrfs IIIA, IIII, nnd
IIIÐ.
Todny wo rosoIvo consfIfufIonnI chnIIongos fo fwo µrovI-
sIons of fho InfIonf IrofocfIon nnd AffordnbIo Cnro Acf of

















2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
20l0: fho IndIvIdunI mnndnfo, whIch roquIros IndIvIdunIs
fo µurchnso n honIfh Insurnnco µoIIcy µrovIdIng n mInI-
mum IovoI of covorngo; nnd fho ModIcnId oxµnnsIon, whIch
gIvos funds fo fho Sfnfos on fho condIfIon fhnf fhoy µro-
vIdo sµocIfIod honIfh cnro fo nII cIfIzons whoso Incomo fnIIs
boIow n corfnIn fhroshoId. Wo do nof consIdor whofhor fho
Acf ombodIos sound µoIIcIos. Thnf judgmonf Is onfrusfod
fo fho ÞnfIon`s oIocfod Iondors. Wo nsk onIy whofhor
Congross hns fho µowor undor fho ConsfIfufIon fo onncf
fho chnIIongod µrovIsIons.
In our fodornI sysfom, fho ÞnfIonnI Covornmonf µos-
sossos onIy IImIfod µowors; fho Sfnfos nnd fho µooµIo
rofnIn fho romnIndor. ÞonrIy fwo confurIos ngo, ChIof
JusfIco MnrshnII obsorvod fhnf ¨fho quosfIon rosµocfIng
fho oxfonf of fho µowors ncfunIIy grnnfod¨ fo fho IodornI
Covornmonf ¨Is µorµofunIIy nrIsIng, nnd wIII µrobnbIy
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 µowors If now nssorfs, buf whIch mnny
Sfnfos nnd IndIvIdunIs boIIovo If doos nof µossoss. !osoIv-
Ing fhIs confrovorsy roquIros us fo oxnmIno bofh fho IImIfs
of fho Covornmonf`s µowor, nnd our own IImIfod roIo In
µoIIcIng fhoso boundnrIos.
Tho IodornI Covornmonf ¨Is ncknowIodgod by nII fo
bo ono of onumornfod µowors.¨ 1IiJ. Thnf Is, rnfhor
fhnn grnnfIng gonornI nufhorIfy fo µorform nII fho concoIv-
nbIo funcfIons of govornmonf, fho ConsfIfufIon IIsfs, or
onumornfos, fho IodornI Covornmonf`s µowors. Congross
mny, for oxnmµIo, ¨coIn Monoy,¨ ¨osfnbIIsh Iosf OffIcos,¨
nnd ¨rnIso nnd suµµorf ArmIos.¨ Arf. I, §8, cIs. 5, ?, l2.
Tho onumornfIon of µowors Is nIso n IImIfnfIon of µow-
ors, bocnuso ¨|f]ho onumornfIon µrosuµµosos somofhIng nof
onumornfod.¨ GiIIone v. OgJen, 9 Whonf. l, l95 (l824).
Tho ConsfIfufIon`s oxµross conforrnI of somo µowors
mnkos cIonr fhnf If doos nof grnnf ofhors. And fho IodornI


















3 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
Covornmonf ¨cnn oxorcIso onIy fho µowors grnnfod fo If.¨
McCullocl, eupro, nf 405.
Todny, fho rosfrIcfIons on govornmonf µowor foromosf In
mnny AmorIcnns` mInds nro IIkoIy fo bo nffIrmnfIvo µro-
hIbIfIons, such ns confnInod In fho IIII of !Ighfs. Thoso
nffIrmnfIvo µrohIbIfIons como Info µIny, howovor, onIy whoro
fho Covornmonf µossossos nufhorIfy fo ncf In fho fIrsf
µInco. If no onumornfod µowor nufhorIzos Congross fo
µnss n corfnIn Inw, fhnf Inw mny nof bo onncfod, ovon If If
wouId nof vIoInfo nny of fho oxµross µrohIbIfIons In fho
IIII of !Ighfs or oIsowhoro In fho ConsfIfufIon.
Indood, fho ConsfIfufIon dId nof InIfInIIy IncIudo n IIII
of !Ighfs nf Ionsf µnrfIy bocnuso fho Irnmors foIf fho onu-
mornfIon of µowors suffIcod fo rosfrnIn fho Covornmonf.
As AIoxnndor HnmIIfon µuf If, ¨fho ConsfIfufIon Is IfsoIf,
In ovory rnfIonnI sonso, nnd fo ovory usofuI µurµoso,
A II!! OI !ICHTS.¨ Tho IodornIIsf Þo. 84, µ. 5l5 (C. !os-
sIfor od. l96l). And whon fho IIII of !Ighfs wns rnfIfIod,
If mndo oxµross whnf fho onumornfIon of µowors nocos-
snrIIy ImµIIod: ¨Tho µowors nof doIognfod fo fho !nIfod
Sfnfos by fho ConsfIfufIon . . . nro rosorvod fo fho Sfnfos
rosµocfIvoIy, or fo fho µooµIo.¨ !. S. Consf., Amdf. l0.
Tho IodornI Covornmonf hns oxµnndod drnmnfIcnIIy ovor
fho µnsf fwo confurIos, buf If sfIII musf show fhnf n consfI-
fufIonnI grnnf of µowor nufhorIzos onch of Ifs ncfIons. Soo,
e.g., Ini/eJ S/o/ee v. Cone/oc/, 560 !. S. ___ (20l0).
Tho snmo doos nof nµµIy fo fho Sfnfos, bocnuso fho Con-
sfIfufIon Is nof fho sourco of fhoIr µowor. Tho ConsfI-
fufIon mny rosfrIcf sfnfo govornmonfsns If doos, for
oxnmµIo, by forbIddIng fhom fo dony nny µorson fho oqunI
µrofocfIon of fho Inws. Iuf whoro such µrohIbIfIons do
nof nµµIy, sfnfo govornmonfs do nof nood consfIfufIonnI nu-
fhorIznfIon fo ncf. Tho Sfnfos fhus cnn nnd do µorform
mnny of fho vIfnI funcfIons of modorn govornmonf
µunIshIng sfroof crImo, runnIng µubIIc schooIs, nnd zonIng
µroµorfy for dovoIoµmonf, fo nnmo buf n fowovon fhough



















4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
fho ConsfIfufIon`s foxf doos nof nufhorIzo nny govornmonf
fo do so. Our cnsos rofor fo fhIs gonornI µowor of govorn-
Ing, µossossod by fho Sfnfos buf nof by fho IodornI Cov-
ornmonf, ns fho ¨µoIIco µowor.¨ 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 µowor.¨ Aeu Yor/ v. Ini/eJ
S/o/ee, 505 !. S. l44, l8l (l992) (InfornnI quofnfIon
mnrks omIffod). Iocnuso fho µoIIco µowor 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 µowors
whIch ¨In fho ordInnry courso of nffnIrs, concorn fho IIvos,
IIborfIos, nnd µroµorfIos of fho µooµIo¨ woro hoId by gov-
ornmonfs moro IocnI nnd moro nccounfnbIo fhnn n dIs-
fnnf fodornI buronucrncy. Tho IodornIIsf Þo. 45, nf 293
(J. MndIson). Tho Indoµondonf µowor of fho Sfnfos nIso
sorvos ns n chock on fho µowor of fho IodornI Covornmonf:
¨Iy donyIng nny ono govornmonf comµIofo jurIsdIcfIon
ovor nII fho concorns of µubIIc IIfo, fodornIIsm µrofocfs fho
IIborfy of fho IndIvIdunI from nrbIfrnry µowor.¨ BonJ v.
Ini/eJ S/o/ee, 564 !. S. ___, ___ (20ll) (sIIµ oµ., nf 9l0).
ThIs cnso concorns fwo µowors fhnf fho ConsfIfufIon
doos grnnf fho IodornI Covornmonf, buf whIch musf bo
rond cnrofuIIy fo nvoId cronfIng n gonornI fodornI nufhorIfy
nkIn fo fho µoIIco µowor. Tho ConsfIfufIon nufhorIzos
Congross fo ¨roguInfo Commorco wIfh foroIgn ÞnfIons, nnd
nmong fho sovornI Sfnfos, nnd wIfh fho IndInn TrIbos.¨
Arf. I, §8, cI. 3. Our µrocodonfs rond fhnf fo monn fhnf
Congross mny roguInfo ¨fho chnnnoIs of Inforsfnfo com-
morco,¨ ¨µorsons or fhIngs In Inforsfnfo commorco,¨ nnd
¨fhoso ncfIvIfIos fhnf subsfnnfInIIy nffocf Inforsfnfo com-
morco.¨ Morrieon, eupro, nf 609 (InfornnI quofnfIon mnrks
omIffod). Tho µowor ovor ncfIvIfIos fhnf subsfnnfInIIy






















5 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
nffocf Inforsfnfo commorco cnn bo oxµnnsIvo. Thnf µowor
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 shoµ.
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, ÐufIos, Im-
µosfs nnd IxcIsos, fo µny fho Ðobfs nnd µrovIdo for fho
common Ðofonco nnd gonornI WoIfnro of fho !nIfod
Sfnfos.¨ !. S. Consf., Arf. I, §8, cI. l. Iuf sImµIy, Con-
gross mny fnx nnd sµond. 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 sµondIng µowor,
Congross mny offor funds fo fho Sfnfos, nnd mny condIfIon
fhoso offors on comµIInnco wIfh sµocIfIod 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 ndoµf µoIIcIos fhnf
fho IodornI Covornmonf IfsoIf couId nof Imµoso. 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
µowors Is brondor sfIII bocnuso fho ConsfIfufIon nufhorIzos
Congross fo ¨mnko nII !nws whIch shnII bo nocossnry nnd
µroµor for cnrryIng Info IxocufIon fho forogoIng Iowors.¨
Arf. I, §8, cI. l8. Wo hnvo Iong rond fhIs µrovIsIon fo gIvo
Congross gronf InfIfudo In oxorcIsIng Ifs µowors: ¨!of fho
ond bo IogIfImnfo, Iof If bo wIfhIn fho scoµo of fho consfIfu-
fIon, nnd nII monns whIch nro nµµroµrInfo, whIch nro
µInInIy ndnµfod fo fhnf ond, whIch nro nof µrohIbIfod, buf
consIsf wIfh fho Ioffor nnd sµIrIf of fho consfIfufIon, nro




















6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
consfIfufIonnI.¨ McCullocl, 4 Whonf., nf 42l.
Our µormIssIvo rondIng of fhoso µowors Is oxµInInod In
µnrf by n gonornI rofIconco fo InvnIIdnfo fho ncfs of fho
ÞnfIon`s oIocfod Iondors. ¨Iroµor rosµocf 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 µnss |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
Inforµrof fho Inw; wo µossoss noIfhor fho oxµorfIso nor
fho µrorognfIvo fo mnko µoIIcy judgmonfs. Thoso docIsIons
nro onfrusfod fo our ÞnfIon`s oIocfod Iondors, who cnn bo
fhrown ouf of offIco If fho µooµIo dIsngroo wIfh fhom. If Is
nof our job fo µrofocf fho µooµIo from fho consoquoncos of
fhoIr µoIIfIcnI choIcos.
Our doforonco In mnffors of µoIIcy cnnnof, howovor,
bocomo nbdIcnfIon In mnffors of Inw. ¨Tho µowors 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 rosµocf for Congross`s µoIIcy judgmonfs fhus cnn
novor oxfond so fnr ns fo dIsnvow rosfrnInfs on fodornI
µowor fhnf fho ConsfIfufIon cnrofuIIy consfrucfod. ¨Tho
µocuIInr 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 Þo. V, AIoxnndrIn Cnzoffo, JuIy
5, l8l9, In John MnrshnII`s Ðofonso of McCullocl v. Mor,-
lonJ l90l9l (C. Cunfhor od. l969). And fhoro cnn bo no
quosfIon fhnf If Is fho rosµonsIbIIIfy of fhIs Courf fo on-
forco fho IImIfs on fodornI µowor 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 µrIncIµIos.


OµInIon of !OII!TS, C. J.














? CIfo ns: 56? !. S. ____ (20l2)
OµInIon 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 µngos nnd confnIn hundrods of
µrovIsIons. ThIs cnso concorns consfIfufIonnI chnIIongos fo
fwo koy µrovIsIons, commonIy roforrod fo ns fho IndIvIdunI
mnndnfo nnd fho ModIcnId oxµnnsIon.
Tho IndIvIdunI mnndnfo roquIros mosf AmorIcnns fo
mnInfnIn ¨mInImum ossonfInI¨ honIfh Insurnnco covorngo.
26 !. S. C. §5000A. Tho mnndnfo doos nof nµµIy fo somo
IndIvIdunIs, such ns µrIsonors nnd undocumonfod nIIons.
§5000A(d). Mnny IndIvIdunIs wIII rocoIvo fho roquIrod cov-
orngo fhrough fhoIr omµIoyor, or from n govornmonf µro-
grnm such ns ModIcnId or ModIcnro. Soo §5000A(f). Iuf
for IndIvIdunIs who nro nof oxomµf nnd do nof rocoIvo
honIfh Insurnnco fhrough n fhIrd µnrfy, fho monns of
snfIsfyIng fho roquIromonf Is fo µurchnso Insurnnco from n
µrIvnfo comµnny.
IogInnIng In 20l4, fhoso who do nof comµIy wIfh fho
mnndnfo musf mnko n ¨|s]hnrod rosµonsIbIIIfy µnymonf¨
fo fho IodornI Covornmonf. §5000A(b)(l). Thnf µnymonf,
whIch fho Acf doscrIbos ns n ¨µonnIfy,¨ Is cnIcuInfod ns n
µorconfngo of housohoId Incomo, subjocf fo n fIoor bnsod on
n sµocIfIod doIInr nmounf nnd n coIIIng bnsod on fho nvor-
ngo nnnunI µromIum fho IndIvIdunI wouId hnvo fo µny for
qunIIfyIng µrIvnfo honIfh Insurnnco. §5000A(c). In 20l6,
for oxnmµIo, fho µonnIfy wIII bo 2.5 µorconf of nn IndIvId-
unI`s housohoId Incomo, buf no Ioss fhnn $695 nnd no moro
fhnn fho nvorngo yonrIy µromIum for Insurnnco fhnf co-
vors 60 µorconf of fho cosf of l0 sµocIfIod sorvIcos (e.g.,
µroscrIµfIon drugs nnd hosµIfnIIznfIon). 1IiJ.; 42 !. S. C.
§l8022. Tho Acf µrovIdos fhnf fho µonnIfy wIII bo µnId fo
fho InfornnI !ovonuo SorvIco wIfh nn IndIvIdunI`s fnxos,
nnd ¨shnII bo nssossod nnd coIIocfod In fho snmo mnnnor¨

OµInIon of !OII!TS, C. J.














8 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
ns fnx µonnIfIos, such ns fho µonnIfy 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 µrosocufIons nnd
IovIos. §5000A(g)(2). And somo IndIvIdunIs who nro sub-
jocf fo fho mnndnfo nro nonofhoIoss oxomµf from fho
µonnIfyfor oxnmµIo, 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 comµInInf In fho IodornI
ÐIsfrIcf Courf for fho Þorfhorn ÐIsfrIcf of IIorIdn. Thoso
µInInfIffswho nro bofh rosµondonfs nnd µofIfIonors horo,
doµondIng on fho Issuoworo subsoquonfIy joInod by l3
moro Sfnfos, sovornI IndIvIdunIs, nnd fho ÞnfIonnI Iod-
ornfIon of Indoµondonf IusInoss. Tho µInInfIffs nIIogod,
nmong ofhor fhIngs, fhnf fho IndIvIdunI mnndnfo µrovI-
sIons of fho Acf oxcoodod Congross`s µowors undor ArfIcIo
I of fho ConsfIfufIon. Tho ÐIsfrIcf Courf ngrood, hoIdIng
fhnf Congross Inckod consfIfufIonnI µowor fo onncf fho
IndIvIdunI mnndnfo. ?80 I. Suµµ. 2d l256 (ÞÐ IIn. 20ll).
Tho ÐIsfrIcf 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 AµµonIs for fho IIovonfh CIrcuIf nffIrmod
In µnrf nnd rovorsod In µnrf. Tho courf nffIrmod fho ÐIs-
frIcf Courf`s hoIdIng fhnf fho IndIvIdunI mnndnfo oxcoods
Congross`s µowor. 648 I. 3d l235 (20ll). Tho µnnoI
unnnImousIy ngrood fhnf fho IndIvIdunI mnndnfo dId nof
Imµoso n fnx, nnd fhus couId nof bo nufhorIzod by Con-
gross`s µowor fo ¨Iny nnd coIIocf Tnxos.¨ !. S. Consf.,
Arf. I, §8, cI. l. A mnjorIfy nIso hoId fhnf fho IndIvIdunI
mnndnfo wns nof suµµorfod by Congross`s µowor fo ¨rogu-
Info Commorco . . . nmong fho sovornI Sfnfos.¨ 1J., cI. 3.
AccordIng fo fho mnjorIfy, fho Commorco CInuso doos nof
omµowor fho IodornI Covornmonf fo ordor IndIvIdunIs fo


OµInIon of !OII!TS, C. J.














9 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
ongngo In commorco, nnd fho Covornmonf`s offorfs fo cnsf
fho IndIvIdunI mnndnfo In n dIfforonf IIghf woro unµorsun-
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 µrovIsIon
couId bo sovorod from fho romnIndor of fho Acf. Tho mn-
jorIfy doformInod fhnf, confrnry fo fho ÐIsfrIcf Courf`s
vIow, If couId. Tho courf fhus sfruck down onIy fho IndI-
vIdunI mnndnfo, IonvIng fho Acf`s ofhor µrovIsIons Infncf.
648 I. 3d, nf l328.
Ofhor Courfs of AµµonIs hnvo nIso honrd chnIIongos fo
fho IndIvIdunI mnndnfo. Tho SIxfh CIrcuIf nnd fho Ð. C.
CIrcuIf uµhoId fho mnndnfo ns n vnIId oxorcIso of Con-
gross`s commorco µowor. Soo Tlonoe More Lou Cen/er v.
OIono, 65l I. 3d 529 (CA6 20ll); Seten-S/, v. HolJer,
66l I. 3d l (CAÐC 20ll). Tho Iourfh CIrcuIf doformInod
fhnf fho AnfI-InjuncfIon Acf µrovonfs 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 µurµoso of rosfrnInIng fho nssossmonf or coIIocfIon
of nny fnx.¨ 26 !. S. C. §?42l(n). A mnjorIfy of fho Iourfh
CIrcuIf µnnoI ronsonod fhnf fho IndIvIdunI mnndnfo`s
µonnIfy 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 µInInfIffs couId nof chnI-
Iongo fho IndIvIdunI mnndnfo unfII nffor fhoy µnId fho
µonnIfy.
l

l
Tho IIovonfh CIrcuIf dId nof consIdor whofhor fho AnfI-InjuncfIon
Acf bnrs chnIIongos fo fho IndIvIdunI mnndnfo. Tho ÐIsfrIcf Courf hnd
doformInod fhnf If dId nof, nnd noIfhor sIdo chnIIongod fhnf hoIdIng on
nµµonI. 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


OµInIon of !OII!TS, C. J.















l0 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
Tho socond µrovIsIon of fho AffordnbIo Cnro Acf dIrocfIy
chnIIongod horo Is fho ModIcnId oxµnnsIon. Inncfod In
l965, ModIcnId offors fodornI fundIng fo Sfnfos fo nssIsf
µrognnnf 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 comµIy wIfh fodornI crIforIn govornIng mnf-
fors such ns who rocoIvos cnro nnd whnf sorvIcos nro µro-
vIdod nf whnf cosf. Iy l982 ovory Sfnfo hnd choson fo
µnrfIcIµnfo In ModIcnId. IodornI funds rocoIvod fhrough
fho ModIcnId µrogrnm hnvo bocomo n subsfnnfInI µnrf of
sfnfo budgofs, now consfIfufIng ovor l0 µorconf of mosf
Sfnfos` fofnI rovonuo.
Tho AffordnbIo Cnro Acf oxµnnds fho scoµo of fho ModI-
cnId µrogrnm nnd Incronsos fho numbor of IndIvIdunIs fho
Sfnfos musf covor. Ior oxnmµIo, fho Acf roquIros sfnfo
µrogrnms fo µrovIdo ModIcnId covorngo fo nduIfs wIfh
Incomos uµ fo l33 µorconf of fho fodornI µovorfy 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
oxµnndIng ModIcnId covorngo, nIfhough Sfnfos wIII bonr n
µorfIon of fho cosfs on fhoIr own. §l396d(y)(l). If n Sfnfo
doos nof comµIy 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 µInInfIffs In fho IIovonfh CIrcuIf nrguod fhnf fho
ModIcnId oxµnnsIon oxcoods Congross`s consfIfufIonnI

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


OµInIon of !OII!TS, C. J.





















ll CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
µowors. Tho Courf of AµµonIs unnnImousIy hoId fhnf fho
ModIcnId oxµnnsIon Is n vnIId oxorcIso of Congross`s µowor
undor fho SµondIng 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 comµIyIng wIfh
fho ModIcnId oxµnnsIon. 648 I. 3d, nf l264, l268.
Wo grnnfod corfIornrI fo rovIow fho judgmonf of fho
Courf of AµµonIs for fho IIovonfh CIrcuIf wIfh rosµocf fo
bofh fho IndIvIdunI mnndnfo nnd fho ModIcnId oxµnnsIon.
565 !. S. ___ (20ll). Iocnuso no µnrfy suµµorfs fho IIov-
onfh CIrcuIf`s hoIdIng fhnf fho IndIvIdunI mnndnfo cnn
bo comµIofoIy sovorod from fho romnIndor of fho AffordnbIo
Cnro Acf, wo nµµoInfod nn onicue curioe fo dofond fhnf
nsµocf of fho judgmonf boIow. And bocnuso fhoro Is n
ronsonnbIo nrgumonf fhnf fho AnfI-InjuncfIon Acf do-
µrIvos us of jurIsdIcfIon fo honr chnIIongos fo fho IndIvId-
unI mnndnfo, buf no µnrfy suµµorfs fhnf µroµosIfIon, wo
nµµoInfod 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 µrovIdos
fhnf ¨no suIf for fho µurµoso of rosfrnInIng fho nssossmonf
or coIIocfIon of nny fnx shnII bo mnInfnInod In nny courf
by nny µorson, whofhor or nof such µorson Is fho µor-
son ngnInsf whom such fnx wns nssossod.¨ 26 !. S. C.
§?42l(n). ThIs sfnfufo µrofocfs 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 nµµoInfod H. Inrfow Inrr III fo brIof nnd nrguo In suµµorf of fho
IIovonfh CIrcuIf`s judgmonf wIfh rosµocf fo sovornbIIIfy, nnd !oborf A.
!ong fo brIof nnd nrguo fho µroµosIfIon fhnf fho AnfI-InjuncfIon Acf
bnrs fho curronf chnIIongos fo fho IndIvIdunI mnndnfo. 565 !. S. ___
(20ll). Iofh onici hnvo nbIy dIschnrgod fhoIr nssIgnod rosµonsIbIIIfIos.


OµInIon of !OII!TS, C. J.






















OµInIon of fho Courf
l2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
chnIIongod onIy nffor fhoy nro µnId, by suIng for n rofund.
Soo 1nocle v. Willione Poc/ing & Aot. Co., 3?0 !. S. l,
?8 (l962).
Tho µonnIfy for nof comµIyIng wIfh fho AffordnbIo Cnro
Acf`s IndIvIdunI mnndnfo fIrsf bocomos onforconbIo In
20l4. Tho µrosonf chnIIongo fo fho mnndnfo fhus sooks fo
rosfrnIn fho µonnIfy`s fufuro coIIocfIon. Anicue confonds
fhnf fho InfornnI !ovonuo Codo fronfs fho µonnIfy ns n
fnx, nnd fhnf fho AnfI-InjuncfIon Acf fhoroforo bnrs fhIs
suIf.
Tho foxf of fho µorfInonf sfnfufos suggosfs ofhorwIso.
Tho AnfI-InjuncfIon Acf nµµIIos fo suIfs ¨for fho µurµoso
of rosfrnInIng fho nssossmonf or coIIocfIon of nny /ox.¨
§?42l(n) (omµhnsIs nddod). Congross, howovor, choso fo
doscrIbo fho ¨|s]hnrod rosµonsIbIIIfy µnymonf¨ Imµosod on
fhoso who forgo honIfh Insurnnco nof ns n ¨fnx,¨ buf ns n
¨µonnIfy.¨ §§5000A(b), (g)(2). Thoro Is no ImmodInfo
ronson fo fhInk fhnf n sfnfufo nµµIyIng fo ¨nny fnx¨ wouId
nµµIy fo n ¨µonnIfy.¨
Congross`s docIsIon fo InboI fhIs oxncfIon n ¨µonnIfy¨
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 µnrf of n sfnfufo
nnd dIfforonf Inngungo In nnofhor, If Is gonornIIy µro-
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 rosµonsIbIIIfy µnymonf 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 µonnIfy for cone/i/u/ionol µur-
µosos sImµIy by doscrIbIng If ns ono or fho ofhor. Congross
mny nof, for oxnmµIo, oxµnnd Ifs µowor undor fho TnxIng
CInuso, or oscnµo fho ÐoubIo Jooµnrdy CInuso`s consfrnInf
on crImInnI snncfIons, by InboIIng n sovoro fInnncInI µun-



















l3 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
Ishmonf n ¨fnx.¨ Soo Boile, v. Drexel Iurni/ure Co., 259
!. S. 20, 363? (l922); Depor/nen/ of Ietenue of Mon/. v.
Kur/l Ioncl, 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 uµ fo Congross, nnd fho bosf
ovIdonco of Congross`s Infonf Is fho sfnfufory foxf. Wo
hnvo fhus nµµIIod fho AnfI-InjuncfIon Acf fo sfnfuforIIy
doscrIbod ¨fnxos¨ ovon whoro fhnf InboI wns Innccurnfo.
Soo Boile, v. George, 259 !. S. l6 (l922) (AnfI-InjuncfIon
Acf nµµIIos fo ¨ChIId !nbor Tnx¨ sfruck down ns oxcoodIng
Congross`s fnxIng µowor In Drexel Iurni/ure).
Congross cnn, of courso, doscrIbo somofhIng ns n µonnIfy
buf dIrocf fhnf If nonofhoIoss bo fronfod ns n fnx for µur-
µosos of fho AnfI-InjuncfIon Acf. Ior oxnmµIo, 26 !. S. C.
§66?l(n) µrovIdos fhnf ¨nny roforonco In fhIs fIfIo fo 'fnx`
Imµosod by fhIs fIfIo shnII bo doomod nIso fo rofor fo fho
µonnIfIos nnd IInbIIIfIos µrovIdod by¨ subchnµfor 68I of
fho InfornnI !ovonuo Codo. IonnIfIos In subchnµfor 68I
nro fhus fronfod ns fnxos undor TIfIo 26, whIch IncIudos
fho AnfI-InjuncfIon Acf. Tho IndIvIdunI mnndnfo, how-
ovor, Is nof In subchnµfor 68I of fho Codo. Þor doos nny
ofhor µrovIsIon sfnfo fhnf roforoncos fo fnxos In TIfIo 26
shnII nIso bo ¨doomod¨ fo nµµIy fo fho IndIvIdunI mnndnfo.
Anicue nffomµfs fo show fhnf Congross dId rondor fho
AnfI-InjuncfIon Acf nµµIIcnbIo fo fho IndIvIdunI mnndnfo,
nIboIf by n moro cIrcuIfous roufo. SocfIon 5000A(g)(l) sµoc-
IfIos fhnf fho µonnIfy for nof comµIyIng wIfh fho mnn-
dnfo ¨shnII bo nssossod nnd coIIocfod In fho snmo mnnnor
ns nn nssossnbIo µonnIfy undor subchnµfor I of chnµfor
68.¨ AssossnbIo µonnIfIos In subchnµfor 68I, In furn,
¨shnII bo nssossod nnd coIIocfod In fho snmo mnnnor ns
fnxos.¨ §66?l(n). AccordIng fo onicue, by dIrocfIng fhnf
fho µonnIfy bo ¨nssossod nnd coIIocfod In fho snmo mnn-
nor ns fnxos,¨ §5000A(g)(l) mndo fho AnfI-InjuncfIon Acf
nµµIIcnbIo fo fhIs µonnIfy.


OµInIon of !OII!TS, C. J.





















l4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
Tho Covornmonf dIsngroos. If nrguos fhnf §5000A(g)(l)
doos nof dIrocf courfs fo nµµIy fho AnfI-InjuncfIon Acf,
bocnuso §5000A(g) Is n dIrocfIvo onIy fo fho Socrofnry of
fho Tronsury fo uso fho snmo ¨ 'mofhodoIogy nnd µroco-
duros` ¨ fo coIIocf fho µonnIfy 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 chnµfors of
fho InfornnI !ovonuo Codo µrovIdIng fho Socrofnry nufhor-
Ify fo nssoss nnd coIIocf fnxos, nnd gonornIIy sµocIfyIng
fho monns by whIch ho shnII do so. Soo §620l (nssoss-
monf nufhorIfy); §630l (coIIocfIon nufhorIfy). SocfIon
5000A(g)(l)`s commnnd fhnf fho µonnIfy bo ¨nssossod nnd
coIIocfod In fho snmo mnnnor¨ ns fnxos Is bosf rond ns
roforrIng fo fhoso chnµfors nnd gIvIng fho Socrofnry fho
snmo nufhorIfy nnd guIdnnco wIfh rosµocf fo fho µonnIfy.
Thnf InforµrofnfIon Is consIsfonf wIfh fho romnIndor of
§5000A(g), whIch Insfrucfs fho Socrofnry on fho fooIs ho
mny uso fo coIIocf fho µonnIfy. Soo §5000A(g)(2)(A) (bnr-
rIng crImInnI µrosocufIons); §5000A(g)(2)(I) (µrohIbIfIng
fho Socrofnry from usIng nofIcos of IIon nnd IovIos). Tho
AnfI-InjuncfIon Acf, by confrnsf, snys nofhIng nbouf fho
µrocoduros 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
µonnIfy 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).¨ (ImµhnsIs nddod.)
Anicue confonds fhnf fho µonnIfy musf bo n fnx, bocnuso
If Is nn nssossnbIo µonnIfy nnd §620l(n) snys fhnf fnxos
IncIudo nssossnbIo µonnIfIos.
Thnf nrgumonf hns forco onIy If §620l(n) Is rond In
IsoInfIon. Tho Codo confnIns mnny µrovIsIons fronfIng
fnxos nnd nssossnbIo µonnIfIos ns dIsfIncf forms. Soo, e.g.,


















l5 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
§§860(h)(l), 6324A(n), 660l(o)(l)(2), 6602, ?l22(b). Thoro
wouId, for oxnmµIo, bo no nood for §66?l(n) fo doom ¨fnx¨
fo rofor fo corfnIn nssossnbIo µonnIfIos If fho Codo nI-
rondy IncIudod nII such µonnIfIos In fho form ¨fnx.¨ In-
dood, onicue`s onrIIor obsorvnfIon fhnf fho Codo roquIros
nssossnbIo µonnIfIos fo bo nssossod nnd coIIocfod ¨In fho
snmo mnnnor ns fnxos¨ mnkos IIffIo sonso If nssossnbIo
µonnIfIos nro fhomsoIvos fnxos. In IIghf of fho Codo`s
consIsfonf dIsfIncfIon bofwoon fho forms ¨fnx¨ nnd ¨ns-
sossnbIo µonnIfy,¨ wo musf nccoµf fho Covornmonf`s In-
forµrofnfIon: §620l(n) Insfrucfs fho Socrofnry fhnf hIs
nufhorIfy fo nssoss fnxos IncIudos fho nufhorIfy fo nssoss
µonnIfIos, buf If doos nof oqunfo nssossnbIo µonnIfIos fo
fnxos for ofhor µurµosos.
Tho AffordnbIo Cnro Acf doos nof roquIro fhnf fho µon-
nIfy for fnIIIng fo comµIy wIfh fho IndIvIdunI mnndnfo bo
fronfod ns n fnx for µurµosos of fho AnfI-InjuncfIon Acf.
Tho AnfI-InjuncfIon Acf fhoroforo doos nof nµµIy fo fhIs
suIf, nnd wo mny µrocood fo fho morIfs.
III
Tho Covornmonf ndvnncos fwo fhoorIos for fho µroµosI-
fIon fhnf Congross hnd consfIfufIonnI nufhorIfy fo onncf
fho IndIvIdunI mnndnfo. IIrsf, fho Covornmonf nrguos
fhnf Congross hnd fho µowor 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 µowor doos
nof suµµorf fho mnndnfo, wo shouId nonofhoIoss uµhoId If
ns nn oxorcIso of Congross`s µowor fo fnx. AccordIng fo fho
Covornmonf, ovon If Congross Incks fho µowor 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 uµhoId ns n fnx.





















l6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
A
Tho Covornmonf`s fIrsf nrgumonf Is fhnf fho IndIvIdunI
mnndnfo Is n vnIId oxorcIso of Congross`s µowor undor fho
Commorco CInuso nnd fho Þocossnry nnd Iroµor CInuso.
AccordIng fo fho Covornmonf, fho honIfh cnro mnrkof Is
chnrncforIzod by n sIgnIfIcnnf cosf-shIffIng µrobIom. Ivory-
ono wIII ovonfunIIy nood honIfh cnro nf n fImo nnd fo nn
oxfonf fhoy cnnnof µrodIcf, buf If fhoy do nof hnvo Insur-
nnco, fhoy offon wIII nof bo nbIo fo µny for If. Iocnuso
sfnfo nnd fodornI Inws nonofhoIoss roquIro hosµIfnIs fo
µrovIdo n corfnIn dogroo of cnro fo IndIvIdunIs wIfhouf
rognrd fo fhoIr nbIIIfy fo µny, soo, e.g., 42 !. S. C. §l395dd;
IIn. Sfnf. Ann. §395.l04l, hosµIfnIs ond uµ rocoIvIng
comµonsnfIon for onIy n µorfIon of fho sorvIcos fhoy µro-
vIdo. To rocouµ fho Iossos, hosµIfnIs µnss on fho cosf fo
Insurors fhrough hIghor rnfos, nnd Insurors, In furn, µnss
on fho cosf fo µoIIcy hoIdors In fho form of hIghor µro-
mIums. Congross osfImnfod fhnf fho cosf of uncomµon-
snfod cnro rnIsos fnmIIy honIfh Insurnnco µromIums, on
nvorngo, by ovor $l,000 µor yonr. 42 !. S. C. §l809l(2)(I).
In fho AffordnbIo Cnro Acf, Congross nddrossod fho
µrobIom of fhoso who cnnnof obfnIn Insurnnco covorngo
bocnuso of µrooxIsfIng condIfIons or ofhor honIfh Issuos. If
dId so fhrough fho Acf`s ¨gunrnnfood-Issuo¨ nnd ¨communIfy-
rnfIng¨ µrovIsIons. Thoso µrovIsIons fogofhor µrohIbIf In-
surnnco comµnnIos from donyIng covorngo fo fhoso wIfh
such condIfIons or chnrgIng unhonIfhy IndIvIdunIs hIghor
µromIums 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 µurchnso Insurnnco fo covor µofonfInI honIfh
cnro noods. In fncf, fho roforms shnrµIy oxncorbnfo fhnf
µrobIom, by µrovIdIng nn InconfIvo for IndIvIdunIs fo doIny
µurchnsIng honIfh Insurnnco unfII fhoy bocomo sIck, roIy-
Ing on fho µromIso of gunrnnfood nnd nffordnbIo covorngo.



















l? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
Tho roforms nIso fhronfon fo Imµoso mnssIvo now cosfs on
Insurors, who nro roquIrod fo nccoµf unhonIfhy IndIvIdunIs
buf µrohIbIfod from chnrgIng fhom rnfos nocossnry fo µny
for fhoIr covorngo. ThIs wIII Iond Insurors fo sIgnIfIcnnfIy
Incronso µromIums on ovoryono. Soo IrIof for AmorIcn`s
HonIfh Insurnnco IInns of nI. ns Anici Curioe In Þo. ll
393 ofc. 89.
Tho IndIvIdunI mnndnfo wns Congross`s soIufIon fo
fhoso µrobIoms. Iy roquIrIng fhnf IndIvIdunIs µurchnso
honIfh Insurnnco, fho mnndnfo µrovonfs cosf-shIffIng by
fhoso who wouId ofhorwIso go wIfhouf If. In nddIfIon, fho
mnndnfo forcos Info fho Insurnnco rIsk µooI moro honIfhy
IndIvIdunIs, whoso µromIums on nvorngo wIII bo hIghor
fhnn fhoIr honIfh cnro oxµonsos. ThIs nIIows Insurors fo
subsIdIzo fho cosfs of covorIng fho unhonIfhy IndIvIdunIs
fho roforms roquIro fhom fo nccoµf. Tho Covornmonf
cInIms fhnf Congross hns µowor undor fho Commorco nnd
Þocossnry nnd Iroµor CInusos fo onncf fhIs soIufIon.
l
Tho Covornmonf confonds fhnf fho IndIvIdunI mnndnfo
Is wIfhIn Congross`s µowor bocnuso fho fnIIuro fo µur-
chnso Insurnnco ¨hns n subsfnnfInI nnd doIoforIous offocf
on Inforsfnfo commorco¨ by cronfIng fho cosf-shIffIng µrob-
Iom. IrIof for !nIfod Sfnfos 34. Tho µnfh 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 oxnmµIo,
fhnf ¨|f]ho µowor 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 µowor, moro-
ovor, Is nof IImIfod fo roguInfIon of nn ncfIvIfy fhnf by IfsoIf
subsfnnfInIIy nffocfs Inforsfnfo commorco, buf nIso oxfonds


























l8 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
fo ncfIvIfIos fhnf do so onIy whon nggrognfod wIfh sImIInr
ncfIvIfIos of ofhors. Soo Wic/orJ, 3l? !. S., nf l2?l28.
CIvon Ifs oxµnnsIvo scoµo, If Is no surµrIso fhnf Con-
gross hns omµIoyod fho commorco µowor In n wIdo vnrIofy
of wnys fo nddross fho µrossIng noods of fho fImo. Iuf
Congross hns novor nffomµfod fo roIy on fhnf µowor fo
comµoI IndIvIdunIs nof ongngod In commorco fo µurchnso
nn unwnnfod µroducf.
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 µrobIom . . . Is fho Inck of hIsforIcnI µrocodonf¨
for Congross`s ncfIon. Iree 1n/erpriee IunJ v. PuIlic Con-
pon, Accoun/ing Otereigl/ BJ., 56l !. S. ___, ___ (20l0)
(sIIµ oµ., nf 25) (InfornnI quofnfIon mnrks omIffod). Af fho
vory Ionsf, wo shouId ¨µnuso fo consIdor fho ImµIIcnfIons of
fho Covornmonf`s nrgumonfs¨ whon confronfod wIfh such
now concoµfIons of fodornI µowor. Lopec, eupro, nf 564.
Tho ConsfIfufIon grnnfs Congross fho µowor fo ¨regulo/e
Commorco.¨ Arf. I, §8, cI. 3 (omµhnsIs nddod). Tho µowor
fo regulo/e commorco µrosuµµosos fho oxIsfonco of com-
morcInI ncfIvIfy fo bo roguInfod. If fho µowor fo ¨roguInfo¨
somofhIng IncIudod fho µowor fo cronfo If, mnny of fho
µrovIsIons In fho ConsfIfufIon wouId bo suµorfIuous. Ior
oxnmµIo, fho ConsfIfufIon gIvos Congross fho µowor fo
¨coIn Monoy,¨ In nddIfIon fo fho µowor fo ¨roguInfo fho
VnIuo fhoroof.¨ 1J., cI. 5. And If gIvos Congross fho µowor

3
Tho oxnmµIos of ofhor congrossIonnI mnndnfos cIfod by J!STICI
CIÞSI!!C, poe/, nf 35, n. l0 (oµInIon concurrIng In µnrf, concurrIng In
judgmonf In µnrf, nnd dIssonfIng In µnrf), nro nof fo fho confrnry. Inch
of fhoso mnndnfosfo roµorf for jury dufy, fo rogIsfor for fho drnff, fo
µurchnso fIronrms In nnfIcIµnfIon of mIIIfIn sorvIco, fo oxchnngo goId
curroncy for µnµor curroncy, nnd fo fIIo n fnx rofurnnro bnsod on
consfIfufIonnI µrovIsIons ofhor fhnn fho Commorco CInuso. Soo Arf. I,
§8, cI. 9 (fo ¨consfIfufo TrIbunnIs InforIor fo fho suµromo Courf¨); iJ.,
cI. l2 (fo ¨rnIso nnd suµµorf ArmIos¨); iJ., cI. l6 (fo ¨µrovIdo for orgnnIz-
Ing, nrmIng, nnd dIscIµIInIng, fho MIIIfIn¨); iJ., cI. 5 (fo ¨coIn Monoy¨);
iJ., cI. l (fo ¨Iny nnd coIIocf Tnxos¨).





















l9 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
fo ¨rnIso nnd suµµorf ArmIos¨ nnd fo ¨µrovIdo nnd mnIn-
fnIn n Þnvy,¨ In nddIfIon fo fho µowor fo ¨mnko !uIos
for fho Covornmonf nnd !oguInfIon of fho Innd nnd nnvnI
Iorcos.¨ 1J., cIs. l2l4. If fho µowor fo roguInfo fho
nrmod forcos or fho vnIuo of monoy IncIudod fho µowor fo
brIng fho subjocf of fho roguInfIon Info oxIsfonco, fho
sµocIfIc grnnf of such µowors wouId hnvo boon unnocos-
snry. Tho Inngungo of fho ConsfIfufIon rofIocfs fho nnfu-
rnI undorsfnndIng fhnf fho µowor fo roguInfo nssumos
fhoro Is nIrondy somofhIng fo bo roguInfod. Soo GiIIone, 9
Whonf., nf l88 (¨|T]ho onIIghfonod µnfrIofs who frnmod
our consfIfufIon, nnd fho µooµIo who ndoµfod If, musf bo
undorsfood fo hnvo omµIoyod words In fhoIr nnfurnI sonso,
nnd fo hnvo Infondod whnf fhoy hnvo snId¨).
4
Our µrocodonf nIso rofIocfs fhIs undorsfnndIng. As
oxµnnsIvo ns our cnsos consfruIng fho scoµo of fho com-
morco µowor hnvo boon, fhoy nII hnvo ono fhIng In com-
mon: Thoy unIformIy doscrIbo fho µowor ns ronchIng
¨ncfIvIfy.¨ If Is nonrIy ImµossIbIo 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 CIÞSI!!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 (CAÐC 20ll);
brnckofs nnd somo InfornnI quofnfIon mnrks omIffod). Iuf fo ronch
fhIs concIusIon, fho cnso cIfod by J!STICI CIÞSI!!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, ÐIcfIon-
nry of fho IngIIsh !nngungo (4fh od. l??3) (roµrInfod 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 µrosuµµosos somofhIng fo
ndjusf. 2 Johnson, eupro, nf l6l9; soo nIso GiIIone, 9 Whonf., nf l96
(dofInIng fho commorco µowor ns fho µowor ¨fo µroscrIbo fho ruIo by
whIch commorco Is fo bo govornod¨).























20 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
fnInod¨); Perec, 402 !. S., nf l54 (¨Whoro fho cloee of
oc/iti/iee Is roguInfod nnd fhnf cloee Is wIfhIn fho ronch of
fodornI µowor, fho courfs hnvo no µowor fo oxcIso, ns frIv-
InI, IndIvIdunI Insfnncos of fho cInss¨ (omµhnsIs In orIgInnI;
InfornnI quofnfIon mnrks omIffod)); Wic/orJ, eupro, nf
l25 (¨|I]von If nµµoIIoo`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
soµnrnfoIy consIdorod, If fhoy hnvo such n cIoso nnd sub-
sfnnfInI roInfIon fo Inforsfnfo commorco fhnf fhoIr confroI
Is ossonfInI or nµµroµrInfo fo µrofocf fhnf commorco from
burdons nnd obsfrucfIons, Congross cnnnof bo donIod fho
µowor fo oxorcIso fhnf confroI¨); soo nIso poe/, nf l5, 2526,
28, 32 (CIÞSI!!C, J., concurrIng In µnrf, concurrIng In
judgmonf In µnrf, nnd dIssonfIng In µnrf).
5
Tho IndIvIdunI mnndnfo, howovor, doos nof roguInfo
oxIsfIng commorcInI ncfIvIfy. If Insfond comµoIs IndIvId-
unIs fo Iecone ncfIvo In commorco by µurchnsIng n µroducf,
on fho ground fhnf fhoIr fnIIuro fo do so nffocfs Inforsfnfo
commorco. ConsfruIng fho Commorco CInuso fo µormIf Con-
gross fo roguInfo IndIvIdunIs µrocIsoIy Iecouee fhoy nro
doIng nofhIng wouId oµon n now nnd µofonfInIIy vnsf do-
mnIn fo congrossIonnI nufhorIfy. Ivory dny IndIvIdunIs do
nof do nn InfInIfo numbor of fhIngs. In somo cnsos fhoy

5
J!STICI CIÞSI!!C cIfos fwo omInonf domnIn cnsos from fho l890s fo
suµµorf fho µroµosIfIon 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 µnymonf of jusf comµonsnfIon
whon fho Covornmonf oxorcIsos Ifs µowor of omInonf domnIn doos nof
furn fho fnkIng Info n commorcInI frnnsncfIon bofwoon fho Inndownor
nnd fho Covornmonf, Iof nIono n govornmonf-comµoIIod frnnsncfIon
bofwoon fho Inndownor nnd n fhIrd µnrfy.


















2l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
docIdo nof fo do somofhIng; In ofhors fhoy sImµIy fnII fo
do If. AIIowIng Congross fo jusfIfy fodornI roguInfIon by
µoInfIng fo fho offocf of InncfIon on commorco wouId brIng
counfIoss docIsIons nn IndIvIdunI couId po/en/ioll, mnko
wIfhIn fho scoµo of fodornI roguInfIon, nndundor fho
Covornmonf`s fhooryomµowor Congross fo mnko fhoso
docIsIons for hIm.
AµµIyIng 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 µowors. In
Wic/orJ, fho Courf fnmousIy uµhoId n fodornI µonnIfy Im-
µosod on n fnrmor for growIng whonf for consumµfIon
on hIs own fnrm. 3l? !. S., nf ll4ll5, l28l29. Thnf
nmounf of whonf cnusod fho fnrmor fo oxcood hIs quofn
undor n µrogrnm dosIgnod fo suµµorf fho µrIco of whonf by
IImIfIng suµµIy. Tho Courf rojocfod fho fnrmor`s nrgumonf
fhnf growIng whonf for homo consumµfIon wns boyond fho
ronch of fho commorco µowor. If dId so on fho ground fhnf
fho fnrmor`s docIsIon fo grow whonf for hIs own uso nI-
Iowod hIm fo nvoId µurchnsIng 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 ¨µorhnµs fho mosf
fnr ronchIng oxnmµIo 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 µowor fo roguInfo
fho mnrkof for whonf by suµµorfIng Ifs µrIco. Iuf µrIco
cnn bo suµµorfod by IncronsIng domnnd ns woII ns by
docronsIng suµµIy. Tho nggrognfod docIsIons of somo
consumors nof fo µurchnso whonf hnvo n subsfnnfInI offocf
on fho µrIco of whonf, jusf ns docIsIons nof fo µurchnso
honIfh Insurnnco hnvo on fho µrIco 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











22 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
buyIng honIfh Insurnnco do so. Tho fnrmor In Wic/orJ
wns nf Ionsf ncfIvoIy ongngod In fho µroducfIon 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 µurchnso fo soIvo nImosf nny µrobIom. Soo Seten-S/,,
66l I. 3d, nf l4l5 (nofIng fho Covornmonf`s InnbIIIfy
fo ¨IdonfIfy nny mnndnfo fo µurchnso n µroducf or sor-
vIco In Inforsfnfo commorco fhnf wouId bo unconsfIfu-
fIonnI¨ undor Ifs fhoory of fho commorco µowor). To
consIdor n dIfforonf oxnmµIo In fho honIfh cnro mnrkof, mnny
AmorIcnns do nof onf n bnInncod dIof. Thnf grouµ mnkos
uµ n Inrgor µorconfngo of fho fofnI µoµuInfIon fhnn fhoso
wIfhouf honIfh Insurnnco. Soo, e.g., Ðoµf. of AgrIcuIfuro
nnd Ðoµf. of HonIfh nnd Humnn SorvIcos, ÐIofnry CuIdo-
IInos for AmorIcnns l (20l0). Tho fnIIuro of fhnf grouµ
fo hnvo n honIfhy dIof Incronsos honIfh cnro cosfs, fo n
gronfor oxfonf fhnn fho fnIIuro of fho unInsurod fo µur-
chnso Insurnnco. Soo, e.g., IInkoIsfoIn, Trogdon, Cohon, &
ÐIofz, AnnunI ModIcnI SµondIng AffrIbufnbIo fo ObosIfy:
Inyor- nnd SorvIco-SµocIfIc IsfImnfos, 28 HonIfh AffnIrs
w822 (2009) (dofnIIIng fho ¨undonInbIo IInk bofwoon rIs-
Ing rnfos of obosIfy nnd rIsIng modIcnI sµondIng,¨ nnd osfI-
mnfIng fhnf ¨fho nnnunI modIcnI burdon of obosIfy hns
rIson fo nImosf l0 µorconf of nII modIcnI sµondIng nnd
couId nmounf fo $l4? bIIIIon µor yonr In 2008¨). Thoso In-
cronsod cosfs nro borno In µnrf by ofhor AmorIcnns who
musf µny moro, jusf ns fho unInsurod shIff cosfs fo fho
Insurod. Soo Confor for AµµIIod IfhIcs, VoIunfnry HonIfh
!Isks: Who ShouId Iny¨, 6 Issuos In IfhIcs 6 (l993) (nof-
Ing ¨ovorwhoImIng ovIdonco fhnf IndIvIdunIs wIfh un-
honIfhy hnbIfs µny onIy n frncfIon of fho cosfs nssocInfod
















23 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
wIfh fhoIr bohnvIors; mosf of fho oxµonso Is borno by fho
rosf of socIofy In fho form of hIghor Insurnnco µromIums,
govornmonf oxµondIfuros for honIfh cnro, nnd dIsnbIIIfy
bonofIfs¨). Congross nddrossod fho Insurnnco µrobIom by
ordorIng ovoryono fo buy Insurnnco. !ndor fho Cov-
ornmonf`s fhoory, Congross couId nddross fho dIof µrobIom
by ordorIng ovoryono fo buy vogofnbIos. Soo ÐIofnry
CuIdoIInos, eupro, nf l9 (¨Imµrovod nufrIfIon, nµµroµrInfo
onfIng bohnvIors, nnd Incronsod µhysIcnI ncfIvIfy hnvo fro-
mondous µofonfInI fo . . . roduco honIfh cnro cosfs¨).
IooµIo, 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 µowor fo comµoI cIfIzons fo ncf ns fho
Covornmonf wouId hnvo fhom ncf.
Thnf Is nof fho counfry fho Irnmors of our ConsfIfufIon
onvIsIonod. Jnmos MndIson oxµInInod fhnf fho Commorco
CInuso wns ¨nn nddIfIon whIch fow oµµoso nnd from whIch
no nµµrohonsIons nro onforfnInod.¨ Tho IodornIIsf Þo. 45,
nf 293. WhIIo Congross`s nufhorIfy undor fho Commorco
CInuso hns of courso oxµnndod wIfh fho growfh of fho
nnfIonnI oconomy, our cnsos hnvo ¨nIwnys rocognIzod fhnf
fho µowor 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, µormIffIng
Congross fo ronch boyond fho nnfurnI oxfonf of Ifs nufhor-
Ify, ¨ovorywhoro oxfondIng fho sµhoro of Ifs ncfIvIfy nnd
drnwIng nII µowor Info Ifs Imµofuous vorfox.¨ Tho Iodor-
nIIsf Þo. 48, nf 309 (J. MndIson). Congross nIrondy onjoys
vnsf µowor fo roguInfo much of whnf wo do. AccoµfIng
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



















24 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
Covornmonf.
6
To nn oconomIsf, µorhnµs, 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 ¨µrncfIcnI sfnfosmon,¨ nof mofn-
µhysIcnI µhIIosoµhors. 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-
µInInod, ¨fho frnmors of fho ConsfIfufIon woro nof moro
vIsIonnrIos, foyIng wIfh sµocuInfIons or fhoorIos, buf
µrncfIcnI mon, donIIng wIfh fho fncfs of µoIIfIcnI IIfo ns
fhoy undorsfood fhom, µuffIng Info form fho govornmonf
fhoy woro cronfIng, nnd µroscrIbIng In Inngungo cIonr
nnd InfoIIIgIbIo fho µowors fhnf govornmonf wns fo fnko.¨
Sou/l Corolino v. Ini/eJ S/o/ee, l99 !. S. 43?, 449 (l905).
Tho Irnmors gnvo Congross fho µowor 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 doµnrf from fhnf un-
dorsfnndIng now.
Tho Covornmonf soos fhIngs dIfforonfIy. If nrguos fhnf
bocnuso sIcknoss nnd Injury nro unµrodIcfnbIo 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 µny for fhnf

6
In nn nffomµf fo rocnsf fho IndIvIdunI mnndnfo ns n roguInfIon of
commorcInI ncfIvIfy, J!STICI CIÞSI!!C suggosfs fhnf ¨|n]n IndIvIdunI
who oµfs nof fo µurchnso Insurnnco from n µrIvnfo 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-
scrIµfIon of fho fnIIuro fo µurchnso Insurnnco. IndIvIdunIs nro no moro
¨ncfIv|o] In fho soIf-Insurnnco mnrkof¨ whon fhoy fnII fo µurchnso
Insurnnco, iIiJ., fhnn fhoy nro ncfIvo In fho ¨rosf¨ mnrkof whon doIng
nofhIng.




























25 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
ncfIvo µnrfIcIµnfIonroquIrIng fhnf fhoy do so fhrough
Insurnnco, rnfhor fhnn fhrough nffomµfod soIf-Insurnnco
wIfh fho bnck-sfoµ of shIffIng cosfs fo ofhors.¨ 1IiJ.
Tho Covornmonf roµonfs fho µhrnso ¨ncfIvo In fho mnr-
kof for honIfh cnro¨ fhroughouf Ifs brIof, soo iJ., nf ?, l8,
34, 50, buf fhnf concoµf 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 µorfInonf sonso. Tho µhrnso ¨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 µrocodonfs rocognIzo Con-
gross`s µowor fo roguInfo ¨cInss|os] of oc/iti/iee,¨ Goncolee
v. Ioicl, 545 !. S. l, l? (2005) (omµhnsIs nddod), nof
cInssos of inJitiJuole, nµnrf 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` . . .¨ (omµhnsIs doIofod)).
Tho IndIvIdunI mnndnfo`s roguInfIon of fho unInsurod ns
n cInss Is, In fncf, µnrfIcuInrIy dIvorcod from nny IInk fo
oxIsfIng commorcInI ncfIvIfy. Tho mnndnfo µrImnrIIy
nffocfs honIfhy, offon young nduIfs who nro Ioss IIkoIy fo
nood sIgnIfIcnnf honIfh cnro nnd hnvo ofhor µrIorIfIos for
sµondIng fhoIr monoy. If Is µrocIsoIy bocnuso fhoso IndI-
vIdunIs, ns nn ncfunrInI cInss, Incur roInfIvoIy Iow honIfh
cnro cosfs fhnf fho mnndnfo hoIµs counfor fho offocf of
forcIng Insurnnco comµnnIos fo covor ofhors who Imµoso
gronfor cosfs fhnn fhoIr µromIums nro nIIowod fo rofIocf.
Soo 42 !. S. C. §l809l(2)(I) (rocognIzIng fhnf fho mnndnfo
wouId ¨brondon fho honIfh Insurnnco rIsk µooI fo IncIudo
honIfhy IndIvIdunIs, whIch wIII Iowor honIfh Insurnnco
µromIums¨). If fho IndIvIdunI mnndnfo Is fnrgofod nf n
cInss, If Is n cInss whoso commorcInI InncfIvIfy rnfhor fhnn
ncfIvIfy Is Ifs dofInIng fonfuro.






















26 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
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 µoInf In fho fufuro, ongngo
In n honIfh cnro frnnsncfIon. AssorfIng fhnf ¨|f]horo Is no
fomµornI 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 µroµosIfIon fhnf Congross mny dIcfnfo fho conducf
of nn IndIvIdunI fodny bocnuso of µroµhosIod fufuro nc-
fIvIfy fInds no suµµorf In our µrocodonf. Wo hnvo snId fhnf
Congross cnn nnfIcIµnfo 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 µrncfIcos of
ufIIIfy comµnnIos); Heor/ of A/lon/o Mo/el, 1nc. v. Ini/eJ
S/o/ee, 3?9 !. S. 24l (l964) (µrohIbIfIng dIscrImInnfIon by
hofoI oµornfors); Ko/cenIocl v. McClung, 3?9 !. S. 294
(l964) (µrohIbIfIng dIscrImInnfIon by rosfnurnnf ownors).
Iuf wo hnvo novor µormIffod Congross fo nnfIcIµnfo fhnf
ncfIvIfy IfsoIf In ordor fo roguInfo IndIvIdunIs nof curronfIy
ongngod In commorco. Inch ono of our cnsos, IncIudIng
fhoso cIfod by J!STICI CIÞSI!!C, poe/, nf 202l, InvoIvod
µrooxIsfIng oconomIc ncfIvIfy. Soo, e.g., Wic/orJ, 3l?
!. S., nf l2?l29 (µroducIng whonf); Ioicl, eupro, nf 25
(growIng mnrIjunnn).
Ivoryono wIII IIkoIy µnrfIcIµnfo In fho mnrkofs for food,
cIofhIng, frnnsµorfnfIon, shoIfor, or onorgy; fhnf doos nof
nufhorIzo Congross fo dIrocf fhom fo µurchnso µnrfIcuInr
µroducfs In fhoso or ofhor mnrkofs fodny. Tho Commorco
CInuso Is nof n gonornI IIconso fo roguInfo nn IndIvIdunI
from crndIo fo grnvo, sImµIy bocnuso ho wIII µrodIcfnbIy
ongngo In µnrfIcuInr frnnsncfIons. Any µoIIco µowor fo
roguInfo IndIvIdunIs ns such, ns oµµosod fo fhoIr ncfIvIfIos,
romnIns vosfod In fho Sfnfos.


















2? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
Tho Covornmonf nrguos fhnf fho IndIvIdunI mnndnfo
cnn bo susfnInod ns n sorf of oxcoµfIon fo fhIs ruIo, bocnuso
honIfh Insurnnco Is n unIquo µroducf. AccordIng fo fho
Covornmonf, uµhoIdIng fho IndIvIdunI mnndnfo wouId
nof jusfIfy mnndnfory µurchnsos of Ifoms such ns cnrs or
broccoII bocnuso, ns fho Covornmonf µufs If, ¨|h]onIfh In-
surnnco Is nof µurchnsod for Ifs own snko IIko n cnr or
broccoII; If Is n monns of fInnncIng honIfh-cnro consumµ-
fIon nnd covorIng unIvorsnI rIsks.¨ !oµIy IrIof for !nIfod
Sfnfos l9. Iuf cnrs nnd broccoII nro no moro µurchnsod
for fhoIr ¨own snko¨ fhnn honIfh Insurnnco. Thoy nro
µurchnsod fo covor fho nood for frnnsµorfnfIon 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 comµoIIod µurchnso
of fho fIrsf Is µroµorIy rognrdod ns n roguInfIon of fho
socond. Þo mnffor how ¨InhoronfIy Infogrnfod¨ honIfh
Insurnnco nnd honIfh cnro consumµfIon mny bo, fhoy nro
nof fho snmo fhIng: Thoy InvoIvo dIfforonf frnnsncfIons,
onforod Info nf dIfforonf fImos, wIfh dIfforonf µrovIdors.
And for mosf of fhoso fnrgofod by fho mnndnfo, sIgnIfIcnnf
honIfh cnro noods wIII bo yonrs, or ovon docndos, nwny.
Tho µroxImIfy nnd dogroo of connocfIon bofwoon fho
mnndnfo nnd fho subsoquonf commorcInI ncfIvIfy Is foo Inck-
Ing fo jusfIfy nn oxcoµfIon of fho sorf urgod by fho Cov-
ornmonf. Tho IndIvIdunI mnndnfo forcos IndIvIdunIs
Info commorco µrocIsoIy 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
µowor undor fho Þocossnry nnd Iroµor CInuso fo onncf fho
IndIvIdunI mnndnfo bocnuso fho mnndnfo Is nn ¨InfogrnI
µnrf of n comµrohonsIvo schomo of oconomIc roguInfIon¨





















28 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
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 µowor fo ¨mnko nII !nws whIch shnII bo nocossnry
nnd µroµor for cnrryIng Info IxocufIon¨ fho µowors onu-
mornfod In fho ConsfIfufIon, Arf. I, §8, cI. l8, vosfs Con-
gross wIfh nufhorIfy fo onncf µrovIsIons ¨IncIdonfnI fo fho
|onumornfod] µowor, 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 µowors whIch musf bo InvoIvod In fho con-
sfIfufIon,¨ If doos nof IIconso fho oxorcIso of nny ¨gronf
subsfnnfIvo nnd Indoµondonf µowor|s]¨ boyond fhoso sµocIfI-
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 |µowors]
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 jurIsµrudonco undor fho Þocossnry nnd Iroµor
CInuso hns dovoIoµod, wo hnvo boon vory doforonfInI fo
Congross`s doformInnfIon fhnf n roguInfIon Is ¨nocossnry.¨
Wo hnvo fhus uµhoId Inws fhnf nro ¨ 'convonIonf, or uso-
fuI` or 'conducIvo` fo fho nufhorIfy`s 'bonofIcInI oxorcIso.` ¨
Cone/oc/, 560 !. S., nf ___ (sIIµ oµ., nf 5) (quofIng McCul-
locl, eupro, nf 4l3, 4l8). Iuf wo hnvo nIso cnrrIod ouf our
rosµonsIbIIIfy 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 sµIrIf of fho consfIfufIon,¨ McCullocl, eupro,
nf 42l, nro nof ¨proper |monns] for cnrryIng Info Ixocu-
fIon¨ Congross`s onumornfod µowors. !nfhor, fhoy nro, ¨In
















29 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
fho words of Tho IodornIIsf, 'moroIy ncfs of usurµnfIon`
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 Þo. 33, nf 204 (A. HnmIIfon)); soo
nIso Aeu Yor/, 505 !. S., nf l??; Cone/oc/, eupro, nf ___
(sIIµ oµ., nf 5) (KIÞÞIÐY, J., concurrIng In judgmonf) (¨If
Is of fundnmonfnI Imµorfnnco fo consIdor whofhor osson-
fInI nffrIbufos of sfnfo sovoroIgnfy nro comµromIsod by fho
nssorfIon of fodornI µowor undor fho Þocossnry nnd Iroµor
CInuso . . .¨).
AµµIyIng fhoso µrIncIµIos, fho IndIvIdunI mnndnfo cnn-
nof bo susfnInod undor fho Þocossnry nnd Iroµor CInuso
ns nn ossonfInI comµononf of fho Insurnnco roforms. Inch
of our µrIor cnsos uµhoIdIng Inws undor fhnf CInuso In-
voIvod oxorcIsos of nufhorIfy dorIvnfIvo of, nnd In sorvIco
fo, n grnnfod µowor. Ior oxnmµIo, wo hnvo uµhoId µrovI-
sIons µormIffIng confInuod confInomonf of fhoso olreoJ,
in feJerol cue/oJ, whon fhoy couId nof bo snfoIy roIonsod,
Cone/oc/, eupro, nf ___ (sIIµ oµ., 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 µrodIcnfo fo fho oxorcIso of nn onu-
mornfod µowor.
ThIs Is In no wny nn nufhorIfy fhnf Is ¨nnrrow In scoµo,¨
Cone/oc/, eupro, nf ___ (sIIµ oµ., nf 20), or ¨IncIdonfnI¨ fo
fho oxorcIso of fho commorco µowor, McCullocl, eupro, nf
4l8. !nfhor, such n concoµfIon of fho Þocossnry nnd
Iroµor CInuso wouId work n subsfnnfInI oxµnnsIon of
fodornI nufhorIfy. Þo Iongor wouId Congross bo IImIfod fo
roguInfIng undor fho Commorco CInuso fhoso who by somo
µrooxIsfIng ncfIvIfy brIng fhomsoIvos wIfhIn fho sµhoro of
fodornI roguInfIon. Insfond, Congross couId ronch boyond





















30 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
fho nnfurnI IImIf of Ifs nufhorIfy nnd drnw wIfhIn Ifs
roguInfory scoµo fhoso who ofhorwIso wouId bo oufsIdo of
If. Ivon If fho IndIvIdunI mnndnfo Is ¨nocossnry¨ fo fho
Acf`s Insurnnco roforms, such nn oxµnnsIon of fodornI
µowor Is nof n ¨µroµor¨ monns for mnkIng fhoso roforms
offocfIvo.
Tho Covornmonf roIIos µrImnrIIy on our docIsIon In
Goncolee v. Ioicl. In Ioicl, wo consIdorod ¨comµrohon-
sIvo IogIsInfIon fo roguInfo fho Inforsfnfo mnrkof¨ In mnrI-
junnn. 545 !. S., nf 22. CorfnIn IndIvIdunIs soughf nn
oxomµfIon from fhnf roguInfIon on fho ground fhnf fhoy
ongngod In onIy Infrnsfnfo µossossIon nnd consumµfIon.
Wo donIod nny oxomµfIon, on fho ground fhnf mnrIjunnn
Is n fungIbIo commodIfy, so fhnf nny mnrIjunnn couId
bo rondIIy dIvorfod Info fho Inforsfnfo mnrkof. Congross`s
nffomµf fo roguInfo fho Inforsfnfo mnrkof for mnrIjunnn
wouId fhoroforo hnvo boon subsfnnfInIIy undorcuf If If
couId nof nIso roguInfo Infrnsfnfo µossossIon nnd con-
sumµfIon. 1J., nf l9. AccordIngIy, wo rocognIzod fhnf
¨Congross wns ncfIng woII wIfhIn Ifs nufhorIfy¨ undor fho
Þocossnry nnd Iroµor CInuso ovon fhough Ifs ¨roguInfIon
onsnnro|d] somo µuroIy Infrnsfnfo ncfIvIfy.¨ 1J., nf 22; soo
nIso Perec, 402 !. S., nf l54. Ioicl fhus dId nof InvoIvo
fho oxorcIso of nny ¨gronf subsfnnfIvo nnd Indoµondonf
µowor,¨ 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 (omµhnsIs nddod).
Jusf ns fho IndIvIdunI mnndnfo cnnnof bo susfnInod ns
n Inw roguInfIng fho subsfnnfInI offocfs of fho fnIIuro fo
µurchnso honIfh Insurnnco, noIfhor cnn If bo uµhoId ns
n ¨nocossnry nnd µroµor¨ comµononf of fho Insurnnco ro-
forms. Tho commorco µowor fhus doos nof nufhorIzo fho
mnndnfo. Accord, poe/, nf 4l6 (joInf oµInIon of SCA!IA,
KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng).
















3l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
I
Thnf Is nof fho ond of fho mnffor. Iocnuso fho Com-
morco CInuso doos nof suµµorf fho IndIvIdunI mnndnfo, If
Is nocossnry fo furn fo fho Covornmonf`s socond nrgumonf:
fhnf fho mnndnfo mny bo uµhoId ns wIfhIn Congross`s
onumornfod µowor fo ¨Iny nnd coIIocf Tnxos.¨ Arf. I, §8,
cI. l.
Tho Covornmonf`s fnx µowor nrgumonf nsks us fo vIow
fho sfnfufo dIfforonfIy fhnn wo dId In consIdorIng Ifs com-
morco µowor fhoory. In mnkIng Ifs Commorco CInuso
nrgumonf, fho Covornmonf dofondod fho mnndnfo ns n
roguInfIon roquIrIng IndIvIdunIs fo µurchnso honIfh In-
surnnco. Tho Covornmonf doos nof cInIm fhnf fho fnxIng
µowor 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 ImµosIng n
fnx on fhoso who do nof buy fhnf µroducf.
Tho foxf of n sfnfufo cnn somofImos hnvo moro fhnn ono
µossIbIo monnIng. To fnko n fnmIIInr oxnmµIo, n Inw fhnf
ronds ¨no vohIcIos In fho µnrk¨ mIghf, or mIghf nof, bnn
bIcycIos In fho µnrk. And If Is woII osfnbIIshod fhnf If
n sfnfufo hns fwo µossIbIo monnIngs, ono of whIch vIoInfos
fho ConsfIfufIon, courfs shouId ndoµf fho monnIng fhnf
doos nof do so. JusfIco Sfory snId fhnf l80 yonrs ngo: ¨Þo
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 µoInf n confury Infor: ¨|T]ho ruIo Is
soffIod fhnf ns bofwoon fwo µossIbIo InforµrofnfIons of n
sfnfufo, by ono of whIch If wouId bo unconsfIfufIonnI nnd
by fho ofhor vnIId, our µInIn dufy Is fo ndoµf fhnf whIch
wIII snvo fho Acf.¨ BloJge// v. HolJen, 2?5 !. S. l42, l48
(l92?) (concurrIng oµInIon).
Tho mosf sfrnIghfforwnrd rondIng of fho mnndnfo Is
fhnf If commnnds IndIvIdunIs fo µurchnso Insurnnco.


















32 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
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 µrImnrIIy dofondod fho Inw on fhnf
bnsIs. Iuf, for fho ronsons oxµInInod nbovo, fho Com-
morco CInuso doos nof gIvo Congross fhnf µowor. !ndor
our µrocodonf, If Is fhoroforo nocossnry fo nsk whofhor fho
Covornmonf`s nIfornnfIvo rondIng of fho sfnfufofhnf If
onIy Imµosos 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 µnymonf fo fho I!S whon ho µnys 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 µnymonf 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 fnxµnyors who do nof hnvo honIfh Insurnnco, If
mny bo wIfhIn Congross`s consfIfufIonnI µowor fo fnx.
Tho quosfIon Is nof whofhor fhnf Is fho mosf nnfurnI
InforµrofnfIon of fho mnndnfo, buf onIy whofhor If Is n
¨fnIrIy µossIbIo¨ ono. Crouell v. Beneon, 285 !. S. 22, 62
(l932). As wo hnvo oxµInInod, ¨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 Inforµrof fho
mnndnfo ns ImµosIng 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.


OµInIon of !OII!TS, C. J.





















33 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
C
Tho oxncfIon fho AffordnbIo Cnro Acf Imµosos on fhoso
wIfhouf honIfh Insurnnco Iooks IIko n fnx In mnny ro-
sµocfs. Tho ¨|s]hnrod rosµonsIbIIIfy µnymonf,¨ ns fho
sfnfufo onfIfIos If, Is µnId Info fho Tronsury by ¨fnx-
µnyor|s]¨ whon fhoy fIIo fhoIr fnx rofurns. 26 !. S. C.
§5000A(b). If doos nof nµµIy fo IndIvIdunIs who do nof
µny fodornI Incomo fnxos bocnuso fhoIr housohoId Incomo
Is Ioss fhnn fho fIIIng fhroshoId In fho InfornnI !ovonuo
Codo. §5000A(o)(2). Ior fnxµnyors who do owo fho µny-
monf, Ifs nmounf Is doformInod by such fnmIIInr fncfors ns
fnxnbIo Incomo, numbor of doµondonfs, nnd joInf fIIIng
sfnfus. §§5000A(b)(3), (c)(2), (c)(4). Tho roquIromonf fo
µny Is found In fho InfornnI !ovonuo Codo nnd onforcod by
fho I!S, whIchns wo µrovIousIy oxµInInodmusf nssoss
nnd coIIocf If ¨In fho snmo mnnnor ns fnxos.¨ Supro, nf
l3l4. ThIs µrocoss yIoIds fho ossonfInI fonfuro of nny fnx:
If µroducos nf Ionsf somo rovonuo for fho Covornmonf.
Ini/eJ S/o/ee v. Kolriger, 345 !. S. 22, 28, n. 4 (l953).
Indood, fho µnymonf Is oxµocfod fo rnIso nbouf $4 bIIIIon
µor yonr by 20l?. CongrossIonnI Iudgof OffIco, Inymonfs
of IonnIfIos for IoIng !nInsurod !ndor fho InfIonf Iro-
focfIon nnd AffordnbIo Cnro Acf (Aµr. 30, 20l0), In SoIocfod
CIO IubIIcnfIons !oInfod fo HonIfh Cnro !ogIsInfIon,
200920l0, µ. ?l (rov. 20l0).
If Is of courso fruo fhnf fho Acf doscrIbos fho µnymonf ns
n ¨µonnIfy,¨ nof n ¨fnx.¨ Iuf whIIo fhnf InboI Is fnfnI fo fho
nµµIIcnfIon of fho AnfI-InjuncfIon Acf, eupro, nf l2l3, If
doos nof doformIno whofhor fho µnymonf mny bo vIowod
ns nn oxorcIso of Congross`s fnxIng µowor. If Is uµ fo Con-
gross whofhor fo nµµIy fho AnfI-InjuncfIon Acf fo nny
µnrfIcuInr 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 µowor fo fnx.
Our µrocodonf rofIocfs fhIs: In l922, wo docIdod fwo


OµInIon of !OII!TS, C. J.
















34 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon 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 µnymonf undor fho AnfI-InjuncfIon
Acf; Congross cnIIod fho chIId Inbor fnx n fnx; Congross
fhoroforo Infondod fho AnfI-InjuncfIon Acf fo nµµIy. 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 µowor. 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 µowor fo fnx.
In fho Licenee Tox Coeee, for oxnmµIo, wo hoId fhnf fodornI
IIconsos fo soII IIquor nnd Ioffory fIckofsfor whIch fho
IIconsoo hnd fo µny n foocouId bo susfnInod ns oxorcIsos
of fho fnxIng µowor. 5 WnII., nf 4?l. And In Aeu Yor/ v.
Ini/eJ S/o/ee wo uµhoId ns n fnx n ¨surchnrgo¨ on ouf-of-
sfnfo nucIonr wnsfo shIµmonfs, n µorfIon of whIch wns
µnId fo fho IodornI Tronsury. 505 !. S., nf l?l. Wo fhus
nsk whofhor fho shnrod rosµonsIbIIIfy µnymonf fnIIs
wIfhIn Congross`s fnxIng µowor, ¨|d]IsrognrdIng fho dosIgnn-
fIon of fho oxncfIon, nnd vIowIng Ifs subsfnnco nnd nµµII-
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 µnssIng on fho consfIfufIonnIIfy of n fnx
Inw, wo nro concornod onIy wIfh Ifs µrncfIcnI oµornfIon,
nof Ifs dofInIfIon or fho µrocIso form of doscrIµfIvo words
whIch mny bo nµµIIod 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 'µonnIfy`


OµInIon of !OII!TS, C. J.

















35 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
. . . doos nof nIfor fhoIr ossonfInI chnrncfor ns fnxos¨).
?
Our cnsos confIrm fhIs funcfIonnI nµµronch. Ior ox-
nmµIo, In Drexel Iurni/ure, wo focusod on fhroo µrncfIcnI
chnrncforIsfIcs of fho so-cnIIod fnx on omµIoyIng chIId
Inborors fhnf convIncod us fho ¨fnx¨ wns ncfunIIy n µon-
nIfy. IIrsf, fho fnx Imµosod nn oxcoodIngIy honvy bur-
donl0 µorconf of n comµnny`s nof Incomoon fhoso who
omµIoyod chIIdron, no mnffor how smnII fhoIr InfrncfIon.
Socond, If Imµosod fhnf oxncfIon onIy on fhoso who know-
IngIy omµIoyod undorngo Inborors. Such scIonfor roquIro-
monfs nro fyµIcnI of µunIfIvo sfnfufos, bocnuso Congross
offon wIshos fo µunIsh onIy fhoso who InfonfIonnIIy bronk
fho Inw. ThIrd, fhIs ¨fnx¨ wns onforcod In µnrf by fho
Ðoµnrfmonf of !nbor, nn ngoncy rosµonsIbIo for µun-
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 Imµosod for vIoInfIon of n
soµnrnfo crImInnI Inw); Cone/on/ine, eupro, nf 295 (snmo).
Tho snmo nnnIysIs horo suggosfs fhnf fho shnrod ro-
sµonsIbIIIfy µnymonf mny for consfIfufIonnI µurµosos bo
consIdorod n fnx, nof n µonnIfy: IIrsf, for mosf AmorIcnns
fho nmounf duo wIII bo fnr Ioss fhnn fho µrIco of Insur-
nnco, nnd, by sfnfufo, If cnn novor bo moro.
8
If mny offon

?
So/elo, In µnrfIcuInr, 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 µonnIfy. Poe/, nf 20. Wo nro nof µorsundod by fho dIssonf`s
nffomµf fo dIsfInguIsh So/elo ns n sfnfufory consfrucfIon cnso from fho
bnnkruµfcy confoxf. Poe/, nf l?, n. 5. Tho dIssonf IfsoIf fronfs fho
quosfIon horo ns ono of sfnfufory InforµrofnfIon, nnd Indood nIso roIIos
on n sfnfufory InforµrofnfIon cnso from fho bnnkruµfcy 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 oxnmµIo, IndIvIdunIs mnkIng $35,000 n yonr nro ox-
µocfod 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 µrIco of n qunIIfyIng Insurnnco


OµInIon of !OII!TS, C. J.















36 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
bo n ronsonnbIo fInnncInI docIsIon fo mnko fho µnymonf
rnfhor fhnn µurchnso Insurnnco, unIIko fho ¨µrohIbIfory¨
fInnncInI µunIshmonf In Drexel Iurni/ure. 259 !. S., nf
3?. Socond, fho IndIvIdunI mnndnfo confnIns no scIonfor
roquIromonf. ThIrd, fho µnymonf Is coIIocfod soIoIy by fho
I!S fhrough fho normnI monns of fnxnfIonoxcoµf fhnf
fho SorvIco Is no/ nIIowod fo uso fhoso monns mosf suggos-
fIvo of n µunIfIvo snncfIon, such ns crImInnI µrosocufIon.
Soo §5000A(g)(2). Tho ronsons fho Courf In Drexel Iurni-
/ure hoId fhnf whnf wns cnIIod n ¨fnx¨ fhoro wns n µonnIfy
suµµorf fho concIusIon fhnf whnf Is cnIIod n ¨µonnIfy¨ horo
mny bo vIowod ns n fnx.
9
Þono of fhIs Is fo sny fhnf fho µnymonf Is nof Infondod
fo nffocf IndIvIdunI conducf. AIfhough fho µnymonf wIII
rnIso consIdornbIo rovonuo, If Is µInInIy dosIgnod fo ox-
µnnd honIfh Insurnnco covorngo. Iuf fnxos fhnf sook fo
InfIuonco conducf nro nofhIng now. Somo of our onrIIosf
fodornI fnxos soughf fo dofor fho µurchnso of Imµorfod
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, µ. 434 (l833)
(¨fho fnxIng µowor Is offon, vory offon, nµµIIod for ofhor
µurµosos, fhnn rovonuo¨). Todny, fodornI nnd sfnfo fnxos
cnn comµoso moro fhnn hnIf fho rofnII µrIco of cIgnroffos,

µoIIcy Is µrojocfod fo bo nround $400 µor monfh. Soo Ð. Þowmnn, C!S
!oµorf 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 µowor. Soo poe/, nf 2324
(joInf oµInIon of SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng).
Congross couId nof, for oxnmµIo, oxµnnd Ifs nufhorIfy fo Imµoso crImI-
nnI fInos by cronfIng sfrIcf IInbIIIfy offonsos onforcod by fho I!S rnfhor
fhnn fho III. Iuf fho fncf fho oxncfIon horo Is µnId IIko n fnx, fo fho
ngoncy fhnf coIIocfs fnxosrnfhor fhnn, for oxnmµIo, oxncfod by Ðo-
µnrfmonf of !nbor Insµocfors nffor forrofIng ouf wIIIfuI mnIfonsnnco
suggosfs fhnf fhIs oxncfIon mny bo vIowod ns n fnx.


OµInIon of !OII!TS, C. J.












3? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
nof jusf fo rnIso moro monoy, buf fo oncourngo µooµIo fo
quIf smokIng. And wo hnvo uµhoId 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 Inforµosos nn oconomIc ImµodImonf
fo fho ncfIvIfy fnxod ns comµnrod wIfh ofhors nof fnxod.¨
Soncine/,, eupro, nf 5l3. Thnf §5000A sooks fo shnµo
docIsIons nbouf whofhor fo buy honIfh Insurnnco doos nof
monn fhnf If cnnnof bo n vnIId oxorcIso of fho fnxIng
µowor.
In dIsfInguIshIng µonnIfIos from fnxos, fhIs Courf hns
oxµInInod fhnf ¨If fho concoµf of µonnIfy monns nnyfhIng,
If monns µunIshmonf 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] µonnIfy, ns fho
word Is horo usod, Is nn oxncfIon Imµosod by sfnfufo ns
µunIshmonf for nn unInwfuI ncf¨). WhIIo fho IndIvIdunI
mnndnfo cIonrIy nIms fo Induco fho µurchnso of honIfh
Insurnnco, If nood nof bo rond fo docInro fhnf fnIIIng fo do
so Is unInwfuI. ÞoIfhor fho Acf nor nny ofhor Inw nffnchos
nognfIvo IognI consoquoncos fo nof buyIng honIfh Insur-
nnco, boyond roquIrIng n µnymonf fo fho I!S. Tho Cov-
ornmonf ngroos wIfh fhnf rondIng, confIrmIng fhnf If
somoono choosos fo µny rnfhor fhnn obfnIn honIfh Insur-
nnco, fhoy hnvo fuIIy comµIIod wIfh fho Inw. IrIof for
!nIfod Sfnfos 606l; Tr. of OrnI Arg. 4950 (Mnr. 26,
20l2).
Indood, If Is osfImnfod fhnf four mIIIIon µooµIo onch yonr
wIII chooso fo µny fho I!S rnfhor fhnn buy Insurnnco. Soo
CongrossIonnI Iudgof OffIco, eupro, nf ?l. Wo wouId
oxµocf Congross fo bo froubIod by fhnf µrosµocf If such
conducf woro unInwfuI. Thnf Congross nµµnronfIy rognrds
such oxfonsIvo fnIIuro fo comµIy wIfh fho mnndnfo ns


OµInIon of !OII!TS, C. J.
















38 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
foIornbIo suggosfs fhnf Congross dId nof fhInk If wns
cronfIng four mIIIIon oufInws. If suggosfs Insfond fhnf fho
shnrod rosµonsIbIIIfy µnymonf moroIy Imµosos n fnx cIfI-
zons mny InwfuIIy chooso fo µny In IIou of buyIng honIfh
Insurnnco.
Tho µInInfIffs confond fhnf Congross`s choIco of Inn-
gungosfnfIng fhnf IndIvIdunIs ¨shnII¨ obfnIn Insurnnco
or µny n ¨µonnIfy¨roquIros rondIng §5000A ns µunIshIng
unInwfuI conducf, ovon If fhnf InforµrofnfIon 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 µrovIdIng fhnf ¨ '|o]nch Sfnfo shnII bo ro-
sµonsIbIo for µrovIdIng . . . for fho dIsµosnI of . . . Iow-IovoI
rndIoncfIvo wnsfo.` ¨ 505 !. S., nf l69 (quofIng 42 !. S. C.
§202lc(n)(l)(A)). A Sfnfo fhnf shIµµod Ifs wnsfo fo nnofhor
Sfnfo wns oxµosod fo surchnrgos by fho rocoIvIng Sfnfo,
n µorfIon of whIch wouId bo µnId ovor fo fho IodornI
Covornmonf. And n Sfnfo fhnf dId nof ndhoro fo fho
sfnfufory schomo fncod ¨|µ]onnIfIos for fnIIuro fo comµIy,¨
IncIudIng Incronsos In fho surchnrgo. §202lo(o)(2); Aeu
Yor/, 505 !. S., nf l52l53. Þow York urgod us fo rond
fho sfnfufo ns n fodornI commnnd fhnf fho sfnfo IogIsIn-
furo onncf IogIsInfIon fo dIsµoso of Ifs wnsfo, whIch wouId
hnvo vIoInfod fho ConsfIfufIon. To nvoId fhnf oufcomo, wo
Inforµrofod fho sfnfufo fo Imµoso onIy ¨n sorIos of Incon-
fIvos¨ for fho Sfnfo fo fnko rosµonsIbIIIfy for Ifs wnsfo. Wo
fhon susfnInod fho chnrgo µnId fo fho IodornI Covornmonf
ns nn oxorcIso of fho fnxIng µowor. 1J., nf l69l?4. Wo
soo no InsurmounfnbIo obsfncIo fo n sImIInr nµµronch
horo.
l0

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


OµInIon of !OII!TS, C. J.

















39 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
Tho joInf dIssonfors nrguo fhnf wo cnnnof uµhoId
§5000A ns n fnx bocnuso Congross dId nof ¨frnmo¨ If ns
such. Poe/, nf l?. In offocf, fhoy confond fhnf ovon If
fho ConsfIfufIon µormIfs Congross fo do oxncfIy whnf wo
Inforµrof fhIs sfnfufo fo do, fho Inw musf bo sfruck down
bocnuso Congross usod fho wrong InboIs. An oxnmµIo mny
hoIµ IIIusfrnfo why InboIs shouId nof confroI horo. Suµ-
µoso Congross onncfod n sfnfufo µrovIdIng fhnf ovory
fnxµnyor who owns n houso wIfhouf onorgy offIcIonf wIn-
dows musf µny $50 fo fho I!S. Tho nmounf duo Is ndjusfod
bnsod on fncfors such ns fnxnbIo Incomo nnd joInf fIIIng
sfnfus, nnd Is µnId nIong wIfh fho fnxµnyor`s Incomo fnx
rofurn. Thoso whoso Incomo Is boIow fho fIIIng fhroshoId
nood nof µny. Tho roquIrod µnymonf Is nof cnIIod n ¨fnx,¨
n ¨µonnIfy,¨ or nnyfhIng oIso. Þo ono wouId doubf fhnf
fhIs Inw Imµosod n fnx, nnd wns wIfhIn Congross`s µowor
fo fnx. Thnf concIusIon shouId nof chnngo sImµIy bocnuso
Congross usod fho word ¨µonnIfy¨ fo doscrIbo fho µny-
monf. InforµrofIng such n Inw fo bo n fnx wouId hnrdIy
¨|I]mµos|o] n fnx fhrough judIcInI IogIsInfIon.¨ Poe/, nf 25.
!nfhor, If wouId gIvo µrncfIcnI offocf fo fho !ogIsInfuro`s
onncfmonf.
Our µrocodonf domonsfrnfos fhnf Congross hnd fho
µowor fo Imµoso fho oxncfIon In §5000A undor fho fnxIng
µowor, nnd fhnf §5000A nood nof bo rond fo do moro fhnn
Imµoso n fnx. Thnf Is suffIcIonf fo susfnIn If. Tho ¨quos-
fIon of fho consfIfufIonnIIfy of ncfIon fnkon by Congross
doos nof doµond on rocIfnIs of fho µowor whIch If undor-
fnkos fo oxorcIso.¨ WooJe v. Clo,J W. Miller Co., 333 !. S.

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


OµInIon of !OII!TS, C. J.
















40 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of fho Courf
l38, l44 (l948).
Ivon If fho fnxIng µowor onnbIos Congross fo Imµoso
n fnx on nof obfnInIng honIfh Insurnnco, nny fnx musf
sfIII comµIy wIfh ofhor roquIromonfs In fho ConsfIfufIon.
IInInfIffs nrguo fhnf fho shnrod rosµonsIbIIIfy µnymonf
doos nof do so, cIfIng ArfIcIo I, §9, cInuso 4. Thnf cInuso
µrovIdos: ¨Þo CnµIfnfIon, or ofhor dIrocf, Tnx shnII bo InId,
unIoss In IroµorfIon fo fho Consus or InumornfIon horoIn
boforo dIrocfod fo bo fnkon.¨ ThIs roquIromonf monns fhnf
nny ¨dIrocf Tnx¨ musf bo nµµorfIonod so fhnf onch Sfnfo
µnys In µroµorfIon fo Ifs µoµuInfIon. AccordIng fo fho
µInInfIffs, If fho IndIvIdunI mnndnfo Imµosos n fnx, If Is n
dIrocf fnx, nnd If Is unconsfIfufIonnI bocnuso Congross
mndo no offorf fo nµµorfIon If nmong fho Sfnfos.
Ivon whon fho ÐIrocf Tnx CInuso wns wrIffon If wns
uncIonr whnf oIso, ofhor fhnn n cnµIfnfIon (nIso known ns
n ¨hond fnx¨ or n ¨µoII fnx¨), mIghf bo n dIrocf fnx. Soo
Springer v. Ini/eJ S/o/ee, l02 !. S. 586, 596598 (l88l).
Soon nffor fho frnmIng, Congross µnssod n fnx on ownor-
shIµ of cnrrIngos, ovor Jnmos MndIson`s objocfIon fhnf If
wns nn unnµµorfIonod dIrocf fnx. 1J., nf 59?. ThIs Courf
uµhoId fho fnx, In µnrf ronsonIng fhnf nµµorfIonIng such
n fnx wouId mnko IIffIo sonso, bocnuso If wouId hnvo ro-
quIrod fnxIng cnrrIngo ownors nf drnmnfIcnIIy dIfforonf
rnfos doµondIng on how mnny cnrrIngos woro In fhoIr
homo Sfnfo. Soo H,l/on v. Ini/eJ S/o/ee, 3 ÐnII. l?l, l?4
(l?96) (oµInIon of Chnso, J.). Tho Courf wns unnnImous,
nnd fhoso JusfIcos who wrofo oµInIons oIfhor dIrocfIy
nssorfod or sfrongIy suggosfod fhnf onIy fwo forms of
fnxnfIon woro dIrocf: cnµIfnfIons nnd Innd fnxos. Soo iJ.,
nf l?5; iJ., nf l?? (oµInIon of Inforson, J.); iJ., nf l83
(oµInIon of IrodoII, J.).
Thnf nnrrow vIow of whnf n dIrocf fnx mIghf bo µor-
sIsfod for n confury. In l880, for oxnmµIo, wo oxµInInod fhnf
¨Jirec/ /oxee, wIfhIn fho monnIng of fho ConsfIfufIon, nro
onIy cnµIfnfIon fnxos, ns oxµrossod In fhnf Insfrumonf,


OµInIon of !OII!TS, C. J.

















4l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
nnd fnxos on ronI osfnfo.¨ Springer, eupro, nf 602. In
l895, wo oxµnndod our InforµrofnfIon fo IncIudo fnxos on
µorsonnI µroµorfy nnd Incomo from µorsonnI µroµorfy, In
fho courso of sfrIkIng down nsµocfs 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
µorsonnI µroµorfy 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
cnµIfnfIon. CnµIfnfIons nro fnxos µnId by ovory µorson,
¨wIfhouf rognrd fo µroµorfy, µrofossIon, or on, o/ler cir-
cune/once.¨ H,l/on, eupro, nf l?5 (oµInIon of Chnso, J.)
(omµhnsIs nIforod). Tho whoIo µoInf of fho shnrod rosµon-
sIbIIIfy µnymonf Is fhnf If Is frIggorod by sµocIfIc cIr-
cumsfnncosonrnIng n corfnIn nmounf of Incomo buf nof
obfnInIng honIfh Insurnnco. Tho µnymonf Is nIso µInInIy
nof n fnx on fho ownorshIµ of Innd or µorsonnI µroµorfy.
Tho shnrod rosµonsIbIIIfy µnymonf Is fhus nof n dIrocf fnx
fhnf musf bo nµµorfIonod 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 µnymonf undor §5000A(b) romnIns n burdon
fhnf fho IodornI Covornmonf Imµosos for nn omIssIon, nof
nn ncf. If If Is froubIIng fo Inforµrof fho Commorco CInuso
ns nufhorIzIng Congross fo roguInfo fhoso who nbsfnIn
from commorco, µorhnµs If shouId bo sImIInrIy froubIIng fo
µormIf Congross fo Imµoso n fnx for nof doIng somofhIng.
Throo consIdornfIons nIIny fhIs concorn. IIrsf, nnd mosf
ImµorfnnfIy, If Is nbundnnfIy cIonr fho ConsfIfufIon doos
nof gunrnnfoo fhnf IndIvIdunIs mny nvoId fnxnfIon fhrough
InncfIvIfy. A cnµIfnfIon, nffor nII, Is n fnx fhnf ovory-
ono musf µny sImµIy for oxIsfIng, nnd cnµIfnfIons nro
oxµrossIy confomµInfod by fho ConsfIfufIon. Tho Courf
fodny hoIds fhnf our ConsfIfufIon µrofocfs us from fodornI


OµInIon of !OII!TS, C. J.












42 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon 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 µromIso wIfh rosµocf fo
fnxos. Soo !offor from IonjnmIn IrnnkIIn fo M. !o !oy
(Þov. l3, l?89) (¨Our now ConsfIfufIon Is now osfnbIIshod
. . . buf In fhIs worId nofhIng cnn bo snId fo bo corfnIn,
oxcoµf donfh nnd fnxos¨).
Whofhor fho mnndnfo cnn bo uµhoId undor fho Com-
morco CInuso Is n quosfIon nbouf fho scoµo of fodornI
nufhorIfy. Ifs nnswor doµonds on whofhor Congross cnn
oxorcIso whnf nII ncknowIodgo fo bo fho novoI courso of
dIrocfIng IndIvIdunIs fo µurchnso Insurnnco. Congross`s
uso of fho TnxIng CInuso fo oncourngo buyIng somofhIng
Is, by confrnsf, nof now. Tnx InconfIvos nIrondy µromofo,
for oxnmµIo, µurchnsIng homos nnd µrofossIonnI oducn-
fIons. Soo 26 !. S. C. §§l63(h), 25A. SusfnInIng fho
mnndnfo ns n fnx doµonds onIy on whofhor Congross loe
µroµorIy oxorcIsod Ifs fnxIng µowor fo oncourngo µurchns-
Ing honIfh Insurnnco, nof whofhor If con. !µhoIdIng fho
IndIvIdunI mnndnfo undor fho TnxIng CInuso fhus doos
nof rocognIzo nny now fodornI µowor. If doformInos fhnf
Congross hns usod nn oxIsfIng ono.
Socond, Congross`s nbIIIfy fo uso Ifs fnxIng µowor fo
InfIuonco conducf Is nof wIfhouf IImIfs. A fow of our cnsos
µoIIcod fhoso IImIfs nggrossIvoIy, InvnIIdnfIng µunIfIvo
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 µonnIIzIng fonfuros of fho so-cnIIod fnx whon If Iosos
Ifs chnrncfor ns such nnd bocomos n moro µonnIfy wIfh fho
chnrncforIsfIcs of roguInfIon nnd µunIshmonf.` ¨ Kur/l


OµInIon of !OII!TS, C. J.



















43 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of fho Courf
Ioncl, 5ll !. S., nf ??9 (quofIng Drexel Iurni/ure, eupro,
nf 38).
Wo hnvo nIrondy oxµInInod fhnf fho shnrod rosµonsIbII-
Ify µnymonf`s µrncfIcnI chnrncforIsfIcs µnss musfor ns n
fnx undor our nnrrowosf InforµrofnfIons of fho fnxIng
µowor. Supro, nf 3536. Iocnuso fho fnx nf hnnd Is
wIfhIn ovon fhoso sfrIcf IImIfs, wo nood nof horo docIdo fho
µrocIso µoInf nf whIch nn oxncfIon bocomos so µunIfIvo
fhnf fho fnxIng µowor doos nof nufhorIzo If. If romnIns
fruo, howovor, fhnf fho ¨ 'µowor fo fnx Is nof fho µowor 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 µowor fo fnx
Is gronfor fhnn Ifs µowor fo roguInfo commorco, fho fnxIng
µowor doos nof gIvo Congross fho snmo dogroo of confroI
ovor IndIvIdunI bohnvIor. Onco wo rocognIzo fhnf Con-
gross mny roguInfo n µnrfIcuInr docIsIon undor fho Com-
morco CInuso, fho IodornI Covornmonf cnn brIng Ifs fuII
woIghf fo bonr. Congross mny sImµIy 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 ImµrIsonmonf, buf nII fho nf-
fondnnf consoquoncos of boIng brnndod n crImInnI: doµrI-
vnfIon of ofhorwIso µrofocfod cIvII rIghfs, such ns fho rIghf
fo bonr nrms or vofo In oIocfIons; Ioss of omµIoymonf oµ-
µorfunIfIos; socInI sfIgmn; nnd sovoro dIsnbIIIfIos In ofhor
confrovorsIos, such ns cusfody or ImmIgrnfIon dIsµufos.
Iy confrnsf, Congross`s nufhorIfy undor fho fnxIng
µowor Is IImIfod fo roquIrIng nn IndIvIdunI fo µny monoy
Info fho IodornI Tronsury, no moro. If n fnx Is µroµorIy
µnId, fho Covornmonf hns no µowor fo comµoI or µunIsh
IndIvIdunIs subjocf fo If. Wo do nof mnko IIghf of fho so-
voro burdon fhnf fnxnfIonosµocInIIy fnxnfIon mofIvnfod
by n roguInfory µurµosocnn Imµoso. Iuf ImµosIfIon

















44 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
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 µny n fnx IovIod on fhnf choIco.
ll
Tho AffordnbIo Cnro Acf`s roquIromonf fhnf corfnIn In-
dIvIdunIs µny n fInnncInI µonnIfy for nof obfnInIng honIfh
Insurnnco mny ronsonnbIy bo chnrncforIzod ns n fnx. Io-
cnuso fho ConsfIfufIon µormIfs such n fnx, If Is nof our roIo
fo forbId If, or fo µnss uµon Ifs wIsdom or fnIrnoss.
Ð
J!STICI CIÞSI!!C quosfIons fho nocossIfy of rojocfIng
fho Covornmonf`s commorco µowor nrgumonf, gIvon fhnf
§5000A cnn bo uµhoId undor fho fnxIng µowor. Poe/, nf 3?.
Iuf fho sfnfufo ronds moro nnfurnIIy ns n commnnd fo buy
Insurnnco fhnn ns n fnx, nnd I wouId uµhoId 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 µowor quosfIon.
And If Is onIy bocnuso wo hnvo n dufy fo consfruo n sfnf-
ufo fo snvo If, If fnIrIy µossIbIo, fhnf §5000A cnn bo Infor-
µrofod ns n fnx. WIfhouf docIdIng fho Commorco CInuso
quosfIon, I wouId fInd no bnsIs fo ndoµf such n snvIng
consfrucfIon.
Tho IodornI Covornmonf doos nof hnvo fho µowor fo
ordor µooµIo fo buy honIfh Insurnnco. SocfIon 5000A
wouId fhoroforo bo unconsfIfufIonnI If rond ns n commnnd.
Tho IodornI Covornmonf doos hnvo fho µowor fo Imµoso n
fnx on fhoso wIfhouf honIfh Insurnnco. SocfIon 5000A Is

ll
Of courso, IndIvIdunIs do nof hnvo n InwfuI choIco nof fo µny n fnx
duo, nnd mny somofImos fnco µrosocufIon for fnIIIng fo do so (nIfhough
nof for docIInIng fo mnko fho shnrod rosµonsIbIIIfy µnymonf, 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 µrodIcnfod. Thoso subjocf fo fho IndIvIdunI mnndnfo mny InwfuIIy
forgo honIfh Insurnnco nnd µny hIghor fnxos, or buy honIfh Insurnnco
nnd µny Iowor fnxos. Tho onIy fhIng fhoy mny nof InwfuIIy do Is nof
buy honIfh Insurnnco nnd nof µny fho rosuIfIng fnx.
















45 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
fhoroforo consfIfufIonnI, bocnuso If cnn ronsonnbIy bo rond
ns n fnx.
IV
A
Tho Sfnfos nIso confond fhnf fho ModIcnId oxµnnsIon
oxcoods Congross`s nufhorIfy undor fho SµondIng CInuso.
Thoy cInIm fhnf Congross Is coorcIng fho Sfnfos fo ndoµf
fho chnngos If wnnfs by fhronfonIng fo wIfhhoId nII of n
Sfnfo`s ModIcnId grnnfs, unIoss fho Sfnfo nccoµfs fho now
oxµnndod fundIng nnd comµIIos wIfh fho condIfIons fhnf
como wIfh If. ThIs, fhoy nrguo, vIoInfos fho bnsIc µrIncIµIo
fhnf fho ¨IodornI Covornmonf mny nof comµoI fho Sfnfos
fo onncf or ndmInIsfor n fodornI roguInfory µrogrnm.¨ Aeu
Yor/, 505 !. S., nf l88.
Thoro Is no doubf fhnf fho Acf drnmnfIcnIIy Incronsos
sfnfo obIIgnfIons undor ModIcnId. Tho curronf ModIcnId
µrogrnm roquIros Sfnfos fo covor onIy corfnIn dIscrofo
cnfogorIos of noody IndIvIdunIsµrognnnf 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 fyµIcnIIy
do nof offor nny such covorngo. Tho Sfnfos nIso onjoy
consIdornbIo fIoxIbIIIfy wIfh rosµocf fo fho covorngo IovoIs
for µnronfs of noody fnmIIIos. §l396n(n)(l0)(A)(II). On
nvorngo Sfnfos covor onIy fhoso unomµIoyod µnronfs who
mnko Ioss fhnn 3? µorconf of fho fodornI µovorfy IovoI, nnd
onIy fhoso omµIoyod µnronfs who mnko Ioss fhnn 63 µor-
conf of fho µovorfy IIno. KnIsor Comm`n on ModIcnId nnd
fho !nInsurod, IorformIng !ndor Irossuro ll, nnd fIg. ll
(20l2).
Tho ModIcnId µrovIsIons of fho AffordnbIo Cnro Acf, In
confrnsf, roquIro Sfnfos fo oxµnnd fhoIr ModIcnId µro-
grnms by 20l4 fo covor oll IndIvIdunIs undor fho ngo of 65
wIfh Incomos boIow l33 µorconf of fho fodornI µovorfy IIno.
§l396n(n)(l0)(A)(I)(VIII). Tho Acf nIso osfnbIIshos n now

















46 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
¨|o]ssonfInI honIfh bonofIfs¨ µnckngo, whIch Sfnfos musf
µrovIdo fo nII now ModIcnId rocIµIonfsn IovoI suffIcIonf
fo snfIsfy n rocIµIonf`s obIIgnfIons undor fho IndIvIdunI mnn-
dnfo. §§l396n(k)(l), l396u?(b)(5), l8022(b). Tho Af-
fordnbIo Cnro Acf µrovIdos fhnf fho IodornI Covornmonf
wIII µny l00 µorconf of fho cosfs of covorIng fhoso nowIy
oIIgIbIo IndIvIdunIs fhrough 20l6. §l396d(y)(l). In fho
foIIowIng yonrs, fho fodornI µnymonf IovoI grndunIIy do-
cronsos, fo n mInImum of 90 µorconf. 1IiJ. In IIghf of
fho oxµnnsIon In covorngo mnndnfod by fho Acf, fho IodornI
Covornmonf osfImnfos fhnf Ifs ModIcnId sµondIng wIII In-
cronso by nµµroxImnfoIy $l00 bIIIIon µor yonr, nonrIy 40
µorconf nbovo curronf IovoIs. Sfnfomonf of ÐougIns W.
IImondorf, CIO`s AnnIysIs of fho Mnjor HonIfh Cnro
!ogIsInfIon Inncfod In Mnrch 20l0, µ. l4, TnbIo 2 (Mnr.
30, 20ll).
Tho SµondIng CInuso grnnfs Congross fho µowor ¨fo µny
fho Ðobfs nnd µrovIdo for fho . . . gonornI WoIfnro of fho
!nIfod Sfnfos.¨ !. S. Consf., Arf. I, §8, cI. l. Wo hnvo
Iong rocognIzod fhnf Congross mny uso fhIs µowor fo grnnf
fodornI funds fo fho Sfnfos, nnd mny condIfIon such n
grnnf uµon 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 µnrfIcuInr wny, |nnd] InfIuonc|o] n Sfnfo`s
µoIIcy choIcos.¨ Aeu Yor/, eupro, nf l66. Tho con-
dIfIons Imµosod by Congross onsuro fhnf fho funds nro
usod by fho Sfnfos fo ¨µrovIdo for fho . . . gonornI WoIfnro¨
In fho mnnnor Congross Infondod.
Af fho snmo fImo, our cnsos hnvo rocognIzod IImIfs on
Congross`s µowor undor fho SµondIng CInuso fo socuro
sfnfo comµIInnco wIfh fodornI objocfIvos. ¨Wo hnvo ro-
µonfodIy chnrncforIzod . . . SµondIng 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)
OµInIon of !OII!TS, C. J.
IogIfImncy of Congross`s oxorcIso of fho sµondIng µowor
¨fhus rosfs on whofhor fho Sfnfo voIunfnrIIy nnd knowIngIy
nccoµfs fho forms of fho 'confrncf.` ¨ Pennlure/, eupro,
nf l?. !osµocfIng fhIs IImIfnfIon Is crIfIcnI fo onsurIng
fhnf SµondIng CInuso IogIsInfIon doos nof undormIno fho
sfnfus of fho Sfnfos ns Indoµondonf 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 ___ (sIIµ oµ., nf 8) (quofIng AlJen v. Moine, 52?
!. S. ?06, ?58 (l999)). Ior fhIs ronson, ¨fho ConsfIfufIon
hns novor boon undorsfood fo confor uµon 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 µowor 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 nµµnrnfus for fodornI µurµosos. Soo, e.g.,
Prin/c, 52l !. S., nf 933 (sfrIkIng down fodornI IogIsIn-
fIon comµoIIIng sfnfo Inw onforcomonf offIcors fo µorform
fodornIIy mnndnfod bnckground chocks on hnndgun µur-
chnsors); Aeu Yor/, eupro, nf l?4l?5 (InvnIIdnfIng µrovI-
sIons of nn Acf fhnf wouId comµoI n Sfnfo fo oIfhor fnko
fIfIo fo nucIonr wnsfo or onncf µnrfIcuInr sfnfo wnsfo
roguInfIons). If hns nIso Iod us fo scrufInIzo SµondIng
CInuso IogIsInfIon fo onsuro fhnf Congross Is nof usIng
fInnncInI Inducomonfs fo oxorf n ¨µowor nkIn fo unduo
InfIuonco.¨ S/euorJ Mocline Co. v. Dotie, 30l !. S. 548,
590 (l93?). Congross mny uso Ifs sµondIng µowor fo cro-
nfo InconfIvos for Sfnfos fo ncf In nccordnnco wIfh fodornI
µoIIcIos. Iuf whon ¨µrossuro furns Info comµuIsIon,¨ iIiJ.,
fho IogIsInfIon runs confrnry fo our sysfom of fodornIIsm.
¨|T]ho ConsfIfufIon sImµIy doos nof gIvo Congross fho
nufhorIfy fo roquIro fho Sfnfos fo roguInfo.¨ Aeu Yor/,















48 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
505 !. S., nf l?8. Thnf Is fruo whofhor Congross dIrocfIy
commnnds n Sfnfo fo roguInfo or IndIrocfIy coorcos n Sfnfo
fo ndoµf n fodornI roguInfory sysfom ns Ifs own.
IormIffIng fho IodornI Covornmonf fo forco fho Sfnfos
fo ImµIomonf n fodornI µrogrnm wouId fhronfon fho µoIIfI-
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 µubIIc dIsnµ-
µrovnI, whIIo fho fodornI offIcInIs who dovIsod fho rogu-
Infory µrogrnm mny romnIn InsuInfod from fho oIocfornI
rnmIfIcnfIons of fhoIr docIsIon.¨ 1J., nf l69. SµondIng
CInuso µrogrnms do nof µoso fhIs dnngor whon n Sfnfo hns
n IogIfImnfo choIco whofhor fo nccoµf fho fodornI condI-
fIons In oxchnngo for fodornI funds. In such n sIfunfIon,
sfnfo offIcInIs cnn fnIrIy bo hoId µoIIfIcnIIy nccounfnbIo for
choosIng fo nccoµf 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 SµondIng CInuso, bocnuso
Congross cnn uso fhnf µowor fo ImµIomonf fodornI µoIIcy If
couId nof Imµoso dIrocfIy undor Ifs onumornfod µowors.
Wo nddrossod such concorns In S/euorJ Mocline. Thnf
cnso InvoIvod n fodornI fnx on omµIoyors fhnf wns nbnfod
If fho busInossos µnId Info n sfnfo unomµIoymonf µInn fhnf
mof corfnIn fodornIIy sµocIfIod condIfIons. An omµIoyor
suod, nIIogIng fhnf fho fnx wns ImµormIssIbIy ¨drIv|Ing]
fho sfnfo IogIsInfuros undor fho whIµ of oconomIc µrossuro
Info fho onncfmonf of unomµIoymonf comµonsnfIon Inws
nf fho bIddIng of fho confrnI govornmonf.¨ 30l !. S., nf
58?. Wo ncknowIodgod fho dnngor fhnf fho IodornI Cov-
ornmonf mIghf omµIoy Ifs fnxIng µowor fo oxorf n ¨µowor
nkIn fo unduo InfIuonco¨ uµon fho Sfnfos. 1J., nf 590. Iuf
wo obsorvod fhnf Congross ndoµfod fho chnIIongod fnx nnd
nbnfomonf µrogrnm fo chnnnoI monoy fo fho Sfnfos fhnf
wouId ofhorwIso hnvo gono Info fho IodornI Tronsury for
















49 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
uso In µrovIdIng nnfIonnI unomµIoymonf sorvIcos. Con-
gross wns wIIIIng fo dIrocf busInossos fo Insfond µny fho
monoy Info sfnfo µrogrnms onIy on fho condIfIon fhnf fho
monoy bo usod for fho snmo µurµosos. IrodIcnfIng fnx
nbnfomonf on n Sfnfo`s ndoµfIon of n µnrfIcuInr fyµo of un-
omµIoymonf 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 µorsunsIon doos nof go boyond fho
bounds of µowor.¨ 1IiJ.
In rojocfIng fho nrgumonf fhnf fho fodornI Inw wns n
¨wonµon| ] of coorcIon, dosfroyIng or ImµnIrIng fho nufon-
omy of fho sfnfos,¨ fho Courf nofod fhnf fhoro wns no
ronson fo suµµoso 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
µnssIng fho unomµIoymonf Inw sho wns nffocfod by du-
ross.¨ 1J., nf 589.
As our docIsIon In S/euorJ Mocline confIrms, Congross
mny nffnch nµµroµrInfo condIfIons fo fodornI fnxIng nnd
sµondIng µrogrnms fo µrosorvo Ifs confroI ovor fho uso of
fodornI funds. In fho fyµIcnI cnso wo Iook fo fho Sfnfos fo
dofond fhoIr µrorognfIvos by ndoµfIng ¨fho sImµIo oxµodI-
onf of nof yIoIdIng¨ fo fodornI bInndIshmonfs whon fhoy
do nof wnnf fo ombrnco fho fodornI µoIIcIos ns fhoIr own.
Moeeocluee//e v. Mellon, 262 !. S. 44?, 482 (l923). Tho
Sfnfos nro soµnrnfo nnd Indoµondonf sovoroIgns. Somo-
fImos fhoy hnvo fo ncf IIko If.
Tho Sfnfos, howovor, nrguo fhnf fho ModIcnId oxµnnsIon
Is fnr from fho fyµIcnI 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 sImµIy rofusIng fo grnnf fho
now funds fo Sfnfos fhnf wIII nof nccoµf fho now condI-
fIons, Congross hns nIso fhronfonod fo wIfhhoId fhoso
Sfnfos` oxIsfIng ModIcnId funds. Tho Sfnfos cInIm fhnf




















50 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
fhIs fhronf sorvos no µurµoso ofhor fhnn fo forco unwIIIIng
Sfnfos fo sIgn uµ for fho drnmnfIc oxµnnsIon In honIfh cnro
covorngo offocfod by fho Acf.
CIvon fho nnfuro of fho fhronf nnd fho µrogrnms nf
Issuo horo, wo musf ngroo. Wo hnvo uµhoId Congross`s
nufhorIfy fo condIfIon fho rocoIµf of funds on fho Sfnfos`
comµIyIng wIfh rosfrIcfIons on fho uso of fhoso funds,
bocnuso fhnf Is fho monns by whIch Congross onsuros fhnf
fho funds nro sµonf 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 oxnmµIo, such condIfIons fnko fho form of
fhronfs fo formInnfo ofhor sIgnIfIcnnf Indoµondonf grnnfs,
fho condIfIons nro µroµorIy vIowod ns n monns of µrossur-
Ing fho Sfnfos fo nccoµf µoIIcy chnngos.
In Sou/l Do/o/o v. Dole, wo consIdorod n chnIIongo fo n
fodornI Inw fhnf fhronfonod fo wIfhhoId fIvo µorconf 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 µurµosos for whIch
hIghwny funds nro oxµondodsnfo Inforsfnfo frnvoI.¨ 483
!. S., nf 208. Af fho snmo fImo, fho condIfIon wns nof n
rosfrIcfIon on how fho hIghwny fundssof nsIdo for sµoc-
IfIc hIghwny Imµrovomonf nnd mnInfonnnco offorfsworo
fo bo usod.
Wo nccordIngIy nskod whofhor ¨fho fInnncInI Induco-
monf offorod by Congross¨ wns ¨so coorcIvo ns fo µnss fho
µoInf nf whIch 'µrossuro furns Info comµuIsIon.` ¨ 1J., nf
2ll (quofIng S/euorJ Mocline, eupro, nf 590). Iy ¨fInnn-
cInI Inducomonf¨ fho Courf monnf fho fhronf of IosIng fIvo
µorconf of hIghwny funds; no now monoy wns offorod fo
fho Sfnfos fo rnIso fhoIr drInkIng ngos. Wo found fhnf fho
Inducomonf wns nof ImµormIssIbIy coorcIvo, bocnuso
Congross wns offorIng onIy ¨roInfIvoIy mIId oncourngomonf
fo fho Sfnfos.¨ Dole, 483 !. S., nf 2ll. Wo obsorvod fhnf
¨nII Soufh Ðnkofn wouId Ioso If sho ndhoros fo hor choson

























5l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
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 µorconf of Soufh
Ðnkofn`s budgof nf fho fImo. Soo Þnf. Assn. of Sfnfo
Iudgof OffIcors, Tho Sfnfo IxµondIfuro !oµorf 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 sµondIng µowor.¨
Dole, 483 !. S., nf 2l2. Whofhor fo nccoµf fho drInkIng
ngo chnngo ¨romnIn|od] fho µrorognfIvo 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-
monf¨If Is n gun fo fho hond. SocfIon l396c of fho ModI-
cnId Acf µrovIdos fhnf If n Sfnfo`s ModIcnId µInn doos
nof comµIy wIfh fho Acf`s roquIromonfs, fho Socrofnry of
HonIfh nnd Humnn SorvIcos mny docInro fhnf ¨furfhor
µnymonfs wIII nof bo mndo fo fho Sfnfo.¨ 42 !. S. C.
§l396c. A Sfnfo fhnf oµfs ouf of fho AffordnbIo Cnro Acf`s
oxµnnsIon In honIfh cnro covorngo fhus sfnnds fo Ioso nof
moroIy ¨n roInfIvoIy smnII µorconfngo¨ of Ifs oxIsfIng ModI-
cnId fundIng, buf oll of If. Dole, eupro, nf 2ll. ModIcnId
sµondIng nccounfs for ovor 20 µorconf of fho nvorngo
Sfnfo`s fofnI budgof, wIfh fodornI funds covorIng 50 fo 83
µorconf of fhoso cosfs. Soo Þnf. Assn. of Sfnfo Iudgof
OffIcors, IIscnI Yonr 20l0 Sfnfo IxµondIfuro !oµorf, µ. ll,
TnbIo 5 (20ll); 42 !. S. C. §l396d(b). Tho IodornI Cov-
ornmonf osfImnfos fhnf If wIII µny ouf nµµroxImnfoIy $3.3
frIIIIon bofwoon 20l0 nnd 20l9 In ordor fo covor fho cosfs
of pre-oxµnnsIon ModIcnId. IrIof for !nIfod Sfnfos l0,
n. 6. In nddIfIon, fho Sfnfos hnvo dovoIoµod InfrIcnfo
sfnfufory nnd ndmInIsfrnfIvo rogImos ovor fho courso of
mnny docndos fo ImµIomonf 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
µorconf of Soufh Ðnkofn`s budgof Ioff fhnf Sfnfo wIfh n





























52 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
¨µrorognfIvo¨ fo rojocf Congross`s dosIrod µoIIcy, ¨nof
moroIy In fhoory buf In fncf.¨ 483 !. S., nf 2ll2l2. Tho
fhronfonod Ioss of ovor l0 µorconf of n Sfnfo`s ovornII
budgof, In confrnsf, Is oconomIc drngoonIng fhnf Ionvos fho
Sfnfos wIfh no ronI oµfIon buf fo ncquIosco In fho ModIcnId
oxµnnsIon.
l2
J!STICI CIÞSI!!C cInIms fhnf Dole Is dIsfInguIshnbIo
bocnuso horo ¨Congross hns nof fhronfonod fo wIfhhoId
funds onrmnrkod for nny ofhor µrogrnm.¨ Poe/, nf 4?. Iuf
fhnf bogs fho quosfIon: Tho Sfnfos confond fhnf fho ox-
µnnsIon Is In ronIIfy n now µrogrnm nnd fhnf Congross Is
forcIng fhom fo nccoµf If by fhronfonIng fho funds for fho
oxIsfIng ModIcnId µrogrnm. Wo cnnnof ngroo fhnf oxIsfIng
ModIcnId nnd fho oxµnnsIon dIcfnfod by fho AffordnbIo
Cnro Acf nro nII ono µrogrnm sImµIy bocnuso ¨Congross
sfyIod¨ fhom ns such. Poe/, nf 49. If fho oxµnnsIon Is nof
µroµorIy vIowod ns n modIfIcnfIon of fho oxIsfIng ModIcnId
µrogrnm, Congross`s docIsIon fo so fIfIo If Is IrroIovnnf.
l3

l2
J!STICI CIÞSI!!C obsorvos fhnf sfnfo ModIcnId sµondIng wIII In-
cronso by onIy 0.8 µorconf nffor fho oxµnnsIon. Poe/, nf 43. Thnf nof
onIy Ignoros Incronsod sfnfo ndmInIsfrnfIvo oxµonsos, buf nIso nssumos
fhnf fho IodornI Covornmonf wIII confInuo fo fund fho oxµnnsIon nf fho
curronf sfnfuforIIy sµocIfIod IovoIs. If Is nof unhonrd of, howovor, for
fho IodornI Covornmonf fo Incronso roquIromonfs In such n mnnnor ns
fo Imµoso unfundod mnndnfos on fho Sfnfos. Moro ImµorfnnfIy, fho
sIzo of fho now fInnncInI burdon Imµosod on n Sfnfo Is IrroIovnnf In
nnnIyzIng whofhor fho Sfnfo hns boon coorcod Info nccoµfIng fhnf
burdon. ¨Your monoy or your IIfo¨ Is n coorcIvo µroµosIfIon, whofhor
you hnvo n sIngIo doIInr In your µockof or $500.
l3
Þor, of courso, cnn fho numbor of µngos fho nmondmonf occu-
µIos, or fho oxfonf fo whIch fho chnngo µrosorvos nnd works wIfhIn
fho oxIsfIng µrogrnm, bo dIsµosIfIvo. Cf. poe/, nf 4950 (oµInIon of
CIÞSI!!C, J.). Tnko, for oxnmµIo, fho foIIowIng hyµofhofIcnI nmond-
monf: ¨AII of n Sfnfo`s cIfIzons nro now oIIgIbIo for ModIcnId.¨ Thnf
chnngo wouId fnko uµ n sIngIo IIno nnd wouId nof nIfor nny ¨oµornfIonnI
nsµocf| ] of fho µrogrnm¨ boyond fho oIIgIbIIIfy roquIromonfs. Poe/, nf
49. Yof If couId hnrdIy bo nrguod fhnf such nn nmondmonf wns n
µormIssIbIo modIfIcnfIon of ModIcnId, rnfhor fhnn nn nffomµf fo foIsf nn
onfIroIy now honIfh cnro sysfom uµon fho Sfnfos.

















53 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
Horo, fho Covornmonf cInIms fhnf fho ModIcnId oxµnn-
sIon Is µroµorIy vIowod moroIy ns n modIfIcnfIon of fho ox-
IsfIng µrogrnm bocnuso fho Sfnfos ngrood fhnf Congross
couId chnngo fho forms of ModIcnId whon fhoy sIgnod on
In fho fIrsf µInco. Tho Covornmonf obsorvos fhnf fho
SocInI SocurIfy Acf, whIch IncIudos fho orIgInnI ModIcnId
µrovIsIons, confnIns n cInuso oxµrossIy rosorvIng ¨|f]ho
rIghf fo nIfor, nmond, or roµonI nny µrovIsIon¨ of fhnf
sfnfufo. 42 !. S. C. §l304. So If doos. Iuf ¨If Congross
Infonds fo Imµoso 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 µorfInonf µrovIsIons
of fho SocInI SocurIfy Acf mIghf ronsonnbIy nssumo fhnf
Congross wns onfIfIod fo mnko ndjusfmonfs fo fho ModI-
cnId µrogrnm ns If dovoIoµod. 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 µnrfIy 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 oxµnnsIon, howovor, nccomµIIshos n shIff
In kInd, nof moroIy dogroo. Tho orIgInnI µrogrnm wns do-
sIgnod fo covor modIcnI sorvIcos for four µnrfIcuInr cnf-
ogorIos of fho noody: fho dIsnbIod, fho bIInd, fho oIdorIy,
nnd noody fnmIIIos wIfh doµondonf chIIdron. Soo 42
!. S. C. §l396n(n)(l0). IrovIous nmondmonfs fo ModIcnId
oIIgIbIIIfy moroIy nIforod nnd oxµnndod fho boundnrIos of
fhoso cnfogorIos. !ndor fho AffordnbIo Cnro Acf, ModIcnId
Is frnnsformod Info n µrogrnm fo moof fho honIfh cnro
noods of fho onfIro nonoIdorIy µoµuInfIon wIfh Incomo
boIow l33 µorconf of fho µovorfy IovoI. If Is no Iongor n
µrogrnm fo cnro for fho noodIosf nmong us, buf rnfhor nn
oIomonf of n comµrohonsIvo nnfIonnI µInn fo µrovIdo unI-





















54 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
vorsnI honIfh Insurnnco covorngo.
l4
Indood, fho mnnnor In whIch fho oxµnnsIon Is sfruc-
furod IndIcnfos fhnf whIIo Congross mny hnvo sfyIod fho
oxµnnsIon n moro nIfornfIon of oxIsfIng ModIcnId, If rocog-
nIzod If wns onIIsfIng fho Sfnfos In n now honIfh cnro
µrogrnm. Congross cronfod n soµnrnfo fundIng µrovIsIon
fo covor fho cosfs of µrovIdIng sorvIcos fo nny µorson
mndo nowIy oIIgIbIo by fho oxµnnsIon. WhIIo Congross µnys
50 fo 83 µorconf of fho cosfs of covorIng IndIvIdunIs cur-
ronfIy onroIIod In ModIcnId, §l396d(b), onco fho oxµnnsIon Is
fuIIy ImµIomonfod Congross wIII µny 90 µorconf of fho
cosfs for nowIy oIIgIbIo µorsons, §l396d(y)(l). Tho condI-
fIons on uso of fho dIfforonf funds nro nIso dIsfIncf. Con-
gross mnndnfod fhnf nowIy oIIgIbIo µorsons rocoIvo n IovoI
of covorngo fhnf Is Ioss comµrohonsIvo fhnn fho frndIfIonnI
ModIcnId bonofIf µnckngo. §l396n(k)(l); soo IrIof for
!nIfod Sfnfos 9.
As wo hnvo oxµInInod, ¨|f]hough Congross` µowor fo
IogIsInfo undor fho sµondIng µowor Is brond, If doos nof
IncIudo surµrIsIng µnrfIcIµnfIng Sfnfos wIfh µosfnc-
coµfnnco or 'rofroncfIvo` condIfIons.¨ Pennlure/, eupro, nf
25. A Sfnfo couId hnrdIy nnfIcIµnfo fhnf Congross`s rosor-
vnfIon of fho rIghf fo ¨nIfor¨ or ¨nmond¨ fho ModIcnId
µrogrnm IncIudod fho µowor fo frnnsform If so drnmnfIcnIIy.
J!STICI CIÞSI!!C cInIms fhnf In fncf fhIs oxµnnsIon Is

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

















55 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
no dIfforonf from fho µrovIous chnngos fo ModIcnId, such
fhnf ¨n Sfnfo wouId bo hnrd µuf fo comµInIn fhnf If Inckod
fnIr nofIco.¨ Poe/, nf 56. Iuf fho µrIor chnngo sho dIs-
cussosµrosumnbIy fho mosf drnmnfIc nIfornfIon sho couId
fInddoos nof como cIoso fo workIng fho frnnsformnfIon
fho oxµnnsIon nccomµIIshos. Sho hIghIIghfs nn nmond-
monf roquIrIng Sfnfos fo covor µrognnnf womon nnd In-
cronsIng fho numbor of oIIgIbIo chIIdron. 1IiJ. Iuf fhIs
modIfIcnfIon cnn hnrdIy bo doscrIbod ns n mnjor chnngo In
n µrogrnm fhnffrom Ifs IncoµfIonµrovIdod honIfh cnro
for ¨fnmIIIos wIfh doµondonf chIIdron.¨ IrovIous ModIcnId
nmondmonfs sImµIy do nof fnII Info fho snmo cnfogory ns
fho ono nf sfnko horo.
Tho Courf In S/euorJ Mocline dId nof nffomµf fo ¨fIx
fho ouformosf IIno¨ whoro µorsunsIon gIvos wny fo coor-
cIon. 30l !. S., nf 59l. Tho Courf found If ¨|o]nough for
µrosonf µurµosos 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
sImµIy ¨conscrIµf sfnfo |ngoncIos] Info fho nnfIonnI bu-
ronucrnfIc nrmy,¨ I1IC v. Mieeieeippi, 456 !. S. ?42, ??5
(l982) (O`Connor, J., concurrIng In judgmonf In µnrf nnd
dIssonfIng In µnrf), nnd fhnf Is whnf If Is nffomµfIng fo do
wIfh fho ModIcnId oxµnnsIon.
I
ÞofhIng In our oµInIon µrocIudos Congross from offorIng
funds undor fho AffordnbIo Cnro Acf fo oxµnnd fho nvnIIn-
bIIIfy of honIfh cnro, nnd roquIrIng fhnf Sfnfos nccoµfIng
such funds comµIy wIfh fho condIfIons on fhoIr uso. Whnf
Congross Is nof froo fo do Is fo µonnIIzo Sfnfos fhnf chooso
nof fo µnrfIcIµnfo In fhnf now µrogrnm by fnkIng nwny
fhoIr oxIsfIng ModIcnId fundIng. SocfIon l396c gIvos fho
Socrofnry of HonIfh nnd Humnn SorvIcos fho nufhorIfy fo


















56 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
do jusf fhnf. If nIIows hor fo wIfhhoId oll ¨furfhor |ModI-
cnId] µnymonfs . . . fo fho Sfnfo¨ If sho doformInos fhnf fho
Sfnfo Is ouf of comµIInnco wIfh nny ModIcnId roquIromonf,
IncIudIng fhoso confnInod In fho oxµnnsIon. 42 !. S. C.
§l396c. In IIghf of fho Courf`s hoIdIng, fho Socrofnry
cnnnof nµµIy §l396c fo wIfhdrnw oxIsfIng ModIcnId funds
for fnIIuro fo comµIy wIfh fho roquIromonfs sof ouf In fho
oxµnnsIon.
Thnf fuIIy romodIos fho consfIfufIonnI vIoInfIon wo hnvo
IdonfIfIod. Tho chnµfor of fho !nIfod Sfnfos Codo fhnf
confnIns §l396c IncIudos n sovornbIIIfy cInuso confIrmIng
fhnf wo nood go no furfhor. Thnf cInuso sµocIfIos fhnf ¨|I]f
nny µrovIsIon of fhIs chnµfor, or fho nµµIIcnfIon fhoroof fo
nny µorson or cIrcumsfnnco, Is hoId InvnIId, fho romnIndor
of fho chnµfor, nnd fho nµµIIcnfIon of such µrovIsIon fo
ofhor µorsons or cIrcumsfnncos shnII nof bo nffocfod fhoroby.¨
§l303. Todny`s hoIdIng doos nof nffocf fho confInuod nµ-
µIIcnfIon of §l396c fo fho oxIsfIng ModIcnId µrogrnm. Þor
doos If nffocf fho Socrofnry`s nbIIIfy fo wIfhdrnw funds µro-
vIdod undor fho AffordnbIo Cnro Acf If n Sfnfo fhnf hns
choson fo µnrfIcIµnfo In fho oxµnnsIon fnIIs fo comµIy wIfh
fho roquIromonfs of fhnf Acf.
ThIs Is nof fo sny, ns fho joInf dIssonf suggosfs, fhnf wo
nro ¨rowrIfIng fho ModIcnId IxµnnsIon.¨ Poe/, nf 48.
Insfond, wo doformIno, fIrsf, fhnf §l396c Is unconsfIfu-
fIonnI whon nµµIIod fo wIfhdrnw oxIsfIng ModIcnId funds
from Sfnfos fhnf docIIno fo comµIy wIfh fho oxµnnsIon.
Wo fhon foIIow Congross`s oxµIIcIf foxfunI InsfrucfIon fo
Ionvo unnffocfod ¨fho romnIndor of fho chnµfor, nnd fho
nµµIIcnfIon of |fho chnIIongod] µrovIsIon fo ofhor µorsons
or cIrcumsfnncos.¨ §l303. Whon wo InvnIIdnfo nn nµµIIcn-
fIon of n sfnfufo bocnuso fhnf nµµIIcnfIon Is unconsfIfu-
fIonnI, wo nro nof ¨rowrIfIng¨ fho sfnfufo; wo nro moroIy
onforcIng fho ConsfIfufIon.
Tho quosfIon romnIns whofhor fodny`s hoIdIng nffocfs
ofhor µrovIsIons of fho AffordnbIo Cnro Acf. In consIdorIng

















5? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
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 µowors 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 µnrfIcIµnfo In fho now ModIcnId
oxµnnsIon. !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
µrosorvo fho rosf of fho Acf. If Is fnIr fo sny fhnf Congross
nssumod fhnf ovory Sfnfo wouId µnrfIcIµnfo In fho ModI-
cnId oxµnnsIon, 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 µnrfIcIµnfIon In mInd; fhoy µoInf
ouf fhnf Congross mndo ModIcnId n monns for snfIsfyIng
fho mnndnfo, 26 !. S. C. §5000A(f)(l)(A)(II), nnd onncfod
no ofhor µInn for µrovIdIng 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 µros-
suro fho Socrofnry mny nµµIy fo Induco Sfnfos fo nccoµf
fho forms of fho ModIcnId oxµnnsIon. As n µrncfIcnI mnf-
for, fhnf monns Sfnfos mny now chooso fo rojocf fho ox-
µnnsIon; fhnf Is fho whoIo µoInf. Iuf fhnf doos nof monn
nII or ovon nny wIII. Somo Sfnfos mny Indood docIIno fo
µnrfIcIµnfo, 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-















58 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of !OII!TS, C. J.
fIvo rosourcos nocossnry fo suµµorf fho oxµnnsIon. Ofhor
Sfnfos, howovor, mny voIunfnrIIy sIgn uµ, fIndIng fho Idon
of oxµnndIng ModIcnId covorngo nffrncfIvo, µnrfIcuInrIy
gIvon fho IovoI of fodornI fundIng fho Acf offors nf fho
oufsof.
Wo hnvo no wny of knowIng how mnny Sfnfos wIII nc-
coµf fho forms of fho oxµnnsIon, buf wo do nof boIIovo
Congross wouId hnvo wnnfod fho whoIo Acf fo fnII, sImµIy
bocnuso somo mny chooso nof fo µnrfIcIµnfo. Tho ofhor
roforms Congross onncfod, nffor nII, wIII romnIn ¨fuIIy
oµornfIvo 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 µnrf nnd
unconsfIfufIonnI In µnrf. Tho IndIvIdunI mnndnfo cnnnof
bo uµhoId ns nn oxorcIso of Congross`s µowor 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 µowor fo fnx.
As for fho ModIcnId oxµnnsIon, fhnf µorfIon 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 comµIy wIfh nccomµnnyIng condIfIons, buf fho
Sfnfos musf hnvo n gonuIno choIco whofhor fo nccoµf fho
offor. Tho Sfnfos nro gIvon no such choIco In fhIs cnso:











59 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of !OII!TS, C. J.
Thoy musf oIfhor nccoµf n bnsIc chnngo In fho nnfuro of
ModIcnId, or rIsk IosIng nII ModIcnId fundIng. Tho romody
for fhnf consfIfufIonnI vIoInfIon Is fo µrocIudo fho IodornI
Covornmonf from ImµosIng such n snncfIon. Thnf romody
doos nof roquIro sfrIkIng down ofhor µorfIons of fho Af-
fordnbIo Cnro Acf.
Tho Irnmors cronfod n IodornI Covornmonf of IImIfod
µowors, nnd nssIgnod fo fhIs Courf fho dufy of onforcIng
fhoso IImIfs. Tho Courf doos so fodny. Iuf fho Courf doos
nof oxµross nny oµInIon on fho wIsdom of fho AffordnbIo
Cnro Acf. !ndor fho ConsfIfufIon, fhnf judgmonf Is ro-
sorvod fo fho µooµIo.
Tho judgmonf of fho Courf of AµµonIs for fho IIovonfh
CIrcuIf Is nffIrmod In µnrf nnd rovorsod In µnrf.
1/ ie eo orJereJ.



_________________

_________________























l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
SUPREME COURT OF THE UNITED STATES
Þos. ll393, ll398 nnd ll400
ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS, IT A!., IITITIOÞI!S
ll393 t.
KATH!IIÞ SIII!I!S, SIC!ITA!Y OI HIA!TH
AÞÐ H!MAÞ SI!VICIS, IT A!.
ÐIIA!TMIÞT OI HIA!TH AÞÐ H!MAÞ
SI!VICIS, IT A!., IITITIOÞI!S
ll398 t.
I!O!IÐA IT A!.
ll400
I!O!IÐA, IT A!., IITITIOÞI!S
t.
ÐIIA!TMIÞT OI HIA!TH AÞÐ
H!MAÞ SI!VICIS IT A!.
OÞ W!ITS OI CI!TIO!A!I TO THI !ÞITIÐ STATIS CO!!T OI
AIIIA!S IO! THI I!IVIÞTH CI!C!IT
|Juno 28, 20l2]
J!STICI CIÞSI!!C, wIfh whom J!STICI SOTOMAYO!
joIns, nnd wIfh whom J!STICI I!IYI! nnd J!STICI
KACAÞ joIn ns fo Inrfs I, II, III, nnd IV, concurrIng In
µnrf, concurrIng In fho judgmonf In µnrf, nnd dIssonfIng In
µnrf.
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 µrovIsIon Is n µroµor
oxorcIso of Congross` fnxIng µowor. I fhoroforo joIn Inrfs
I, II, nnd IIIC of THI CHIII J!STICI`s oµInIon.
!nIIko THI CHIII J!STICI, howovor, I wouId hoId, nIfornn-



















2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fIvoIy, fhnf fho Commorco CInuso nufhorIzos Congross fo
onncf fho mInImum covorngo µrovIsIon. I wouId nIso hoId
fhnf fho SµondIng CInuso µormIfs fho ModIcnId oxµnnsIon
oxncfIy ns Congross onncfod If.
I
Tho µrovIsIon of honIfh cnro Is fodny n concorn of nn-
fIonnI dImonsIon, jusf ns fho µrovIsIon of oId-ngo nnd
survIvors` bonofIfs wns In fho l930`s. In fho SocInI Socu-
rIfy Acf, Congross InsfnIIod n fodornI sysfom fo µrovIdo
monfhIy bonofIfs fo rofIrod wngo onrnors nnd, ovonfunIIy,
fo fhoIr survIvors. Ioyond quosfIon, Congross couId hnvo
ndoµfod n sImIInr schomo for honIfh cnro. Congross choso,
Insfond, fo µrosorvo n confrnI roIo for µrIvnfo Insurors nnd
sfnfo govornmonfs. AccordIng fo THI CHIII J!STICI, fho
Commorco CInuso doos nof µormIf fhnf µrosorvnfIon. ThIs
rIgId rondIng of fho CInuso mnkos scnnf sonso nnd Is
sfunnIngIy rofrogrossIvo.
SInco l93?, our µrocodonf hns rocognIzod Congross`
Inrgo nufhorIfy fo sof fho ÞnfIon`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 µrohIbI-
fIon nro wIfhIn fho µIonnry µowor conforrod on Congross
by fho Commorco CInuso¨); ALIB v. Jonee & Lougllin
S/eel Corp., 30l !. S. l, 3? (l93?) (¨|Tho commorco]
µowor Is µIonnry nnd mny bo oxorfod fo µrofocf 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 comµuIsory rofIromonf nnd


















3 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
µonsIon µInn for omµIoyoos 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 µowor.
A
In onncfIng fho InfIonf IrofocfIon nnd AffordnbIo Cnro
Acf (ACA), Congross comµrohonsIvoIy roformod fho
nnfIonnI mnrkof for honIfh-cnro µroducfs nnd sorvIcos.
Iy nny monsuro, fhnf mnrkof Is Immonso. CoIIocfIvoIy,
AmorIcnns sµonf $2.5 frIIIIon on honIfh cnro In 2009,
nccounfIng for l?.6° of our ÞnfIon`s oconomy. 42 !. S. C.
§l809l(2)(I) (2006 od., Suµµ. IV). WIfhIn fho noxf docndo,
If Is nnfIcIµnfod, sµondIng 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 µroducf
or sorvIco, fho mnrkof for modIcnI cnro Is ono In whIch nII
IndIvIdunIs InovIfnbIy µnrfIcIµnfo. VIrfunIIy ovory µorson
rosIdIng In fho !nIfod Sfnfos, soonor or Infor, wIII vIsIf
n docfor or ofhor honIfh-cnro µrofossIonnI. Soo Ðoµf. of
HonIfh nnd Humnn SorvIcos, ÞnfIonnI Confor for HonIfh
SfnfIsfIcs, Summnry HonIfh SfnfIsfIcs for !. S. AduIfs:
ÞnfIonnI HonIfh InforvIow Survoy 2009, Sor. l0, Þo. 249,
µ. l24, TnbIo 3? (Ðoc. 20l0) (Ovor 99.5° of nduIfs nbovo
65 hnvo vIsIfod n honIfh-cnro µrofossIonnI.). Mosf µooµIo
wIII do so roµonfodIy. 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 oxµonsos.
Ðoµf. of HonIfh nnd Humnn SorvIcos, Confors for ModI-
cnro nnd ModIcnId SorvIcos, HIsforIc ÞnfIonnI HonIfh














4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
IxµondIfuro Ðnfn, ÞnfIonnI HonIfh IxµondIfuros: So-
Iocfod CnIondnr Yonrs l96020l0 (TnbIo l). Ovor n IIfo-
fImo, cosfs mounf fo hundrods of fhousnnds of doIInrs. Soo
AIomnynhu & Wnrnor, Tho !IfofImo ÐIsfrIbufIon of
HonIfh Cnro Cosfs, In 39 HonIfh SorvIco !osonrch 62?, 635
(Juno 2004). Whon n µorson roquIros nonroufIno cnro, fho
cosf wIII gonornIIy oxcood whnf ho or sho cnn nfford fo µny.
A sIngIo hosµIfnI sfny, for Insfnnco, fyµIcnIIy cosfs uµ-
wnrds of $l0,000. Soo Ðoµf. 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 Þo. ll398, µ. 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 oxµonsos durIng hIs or hor IIfofImo, fho fImo whon
cnro wIII bo noodod Is offon unµrodIcfnbIo. An nccIdonf, n
honrf nffnck, or n cnncor dIngnosIs commonIy occurs wIfh-
ouf wnrnIng. InoscnµnbIy, wo nro nII nf µorII of noodIng
modIcnI cnro wIfhouf n momonf`s nofIco. Soo, e.g., Cnmµ-
boII, Ðown fho Insurnnco !nbbIf HoIo, Þ. Y. TImos, Aµr. 5,
20l2, µ. A23 (foIIIng of nn unInsurod 32-yonr-oId womnn
who, honIfhy ono dny, bocnmo n qundrIµIogIc fho noxf duo
fo nn nufo nccIdonf).
To mnnngo fho rIsks nssocInfod wIfh modIcnI cnro
Ifs hIgh cosf, Ifs unµrodIcfnbIIIfy, nnd Ifs InovIfnbIIIfy
mosf µooµIo In fho !nIfod Sfnfos obfnIn honIfh Insurnnco.
Mnny (nµµroxImnfoIy l?0 mIIIIon In 2009) nro Insurod by
µrIvnfo Insurnnco comµnnIos. Ofhors, IncIudIng fhoso
ovor 65 nnd corfnIn µoor nnd dIsnbIod µorsons, roIy on
govornmonf-fundod Insurnnco µrogrnms, nofnbIy ModIcnro
nnd ModIcnId. CombInod, µrIvnfo honIfh Insurors nnd
Sfnfo nnd IodornI Covornmonfs fInnnco nImosf 85° of fho
















5 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
modIcnI cnro ndmInIsforod fo !. S. rosIdonfs. Soo Con-
grossIonnI Iudgof OffIco, CIO`s 20ll !ong-Torm Iudgof
OufIook 3? (Juno 20ll).
Þof nII !. S. rosIdonfs, howovor, hnvo honIfh Insurnnco.
In 2009, nµµroxImnfoIy 50 mIIIIon µooµIo woro unInsurod,
oIfhor by choIco or, moro IIkoIy, bocnuso fhoy couId nof
nfford µrIvnfo Insurnnco nnd dId nof qunIIfy for govorn-
monf nId. Soo Ðoµf. of Commorco, Consus Iuronu, C.
ÐoÞnvns-WnIf, I. Irocfor, & J. SmIfh, Incomo, Iovorfy,
nnd HonIfh Insurnnco Covorngo In fho !nIfod Sfnfos: 2009,
µ. 23, TnbIo 8 (Soµf. 20l0). As n grouµ, unInsurod IndIvId-
unIs nnnunIIy consumo moro fhnn $l00 bIIIIon In honIfh-
cnro sorvIcos, nonrIy 5° of fho ÞnfIon`s fofnI. HIddon
HonIfh Tnx: AmorIcnns Iny n IromIum 2 (2009), nvnII-
nbIo nf hffµ://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 Ðoµf. of HonIfh nnd Humnn SorvIcos, ÞnfIonnI Con-
for for HonIfh SfnfIsfIcs, HonIfh!nIfod Sfnfos20l0,
µ. 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 µny on hor own. !nIIko mnrkofs for mosf µroducfs,
howovor, fho InnbIIIfy fo µny for cnro doos nof monn fhnf
nn unInsurod IndIvIdunI wIII rocoIvo no cnro. IodornI nnd
sfnfo Inw, ns woII ns µrofossIonnI obIIgnfIons nnd ombod-
dod socInI norms, roquIro hosµIfnIs nnd µhysIcInns fo
µrovIdo cnro whon If Is mosf noodod, rognrdIoss of fho
µnfIonf`s nbIIIfy fo µny. Soo, e.g., 42 !. S. C. §l395dd; IIn.
Sfnf. §395.l04l(3)(f) (20l0); Tox. HonIfh & Snfofy Codo













6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
Ann. §§3ll.022(n) nnd (b) (Wosf 20l0); AmorIcnn ModIcnI
AssocInfIon, CouncII on IfhIcnI nnd JudIcInI AffnIrs,
Codo of ModIcnI IfhIcs, Curronf OµInIons: OµInIon 8.ll
ÞogIocf of InfIonf, µ. ?0 (l998l999 od.).
As n consoquonco, modIcnI-cnro µrovIdors doIIvor sIg-
nIfIcnnf nmounfs of cnro fo fho unInsurod for whIch fho
µrovIdors rocoIvo no µnymonf. In 2008, for oxnmµIo, hosµI-
fnIs, µhysIcInns, nnd ofhor honIfh-cnro µrofossIonnIs
rocoIvod no comµonsnfIon 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., Suµµ. IV).
HonIfh-cnro µrovIdors do nof nbsorb fhoso bnd dobfs.
Insfond, fhoy rnIso fhoIr µrIcos, µnssIng nIong fho cosf
of uncomµonsnfod cnro fo fhoso who do µny roIInbIy: fho
govornmonf nnd µrIvnfo Insurnnco comµnnIos. In rosµonso,
µrIvnfo Insurors Incronso fhoIr µromIums, shIffIng fho
cosf of fho oIovnfod bIIIs from µrovIdors 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 hnµµons, fho unInsurod
¨froo rIdo¨ on fhoso who µny for honIfh Insurnnco.
Tho sIzo of fhIs subsIdy Is consIdornbIo. Congross found
fhnf fho cosf-shIffIng jusf doscrIbod ¨Incronsos fnmIIy
|Insurnnco] µromIums by on nvorngo ovor $l,000 n yonr.¨
1IiJ. HIghor µromIums, In furn, rondor honIfh Insurnnco
Ioss nffordnbIo, forcIng moro µooµIo 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 µromµf oIovnfIon of fho µrIco of honIfh
cnro nnd honIfh Insurnnco. Insurnnco comµnnIos nnd
honIfh-cnro µrovIdors know fhnf somo µorconfngo of
honIfhy, unInsurod µooµIo wIII suffor sIcknoss or Injury
onch yonr nnd wIII rocoIvo modIcnI cnro dosµIfo fhoIr Inn-
bIIIfy fo µny. In nnfIcIµnfIon of fhIs uncomµonsnfod cnro,
honIfh-cnro comµnnIos rnIso fhoIr µrIcos, nnd Insurors
fhoIr µromIums. In ofhor words, bocnuso nny unInsurod
















? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
µorson mny nood modIcnI cnro nf nny momonf nnd bocnuso
honIfh-cnro comµnnIos musf nccounf for fhnf rIsk, ovory
unInsurod µorson Imµncfs fho mnrkof µrIco 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 µrovonfn-
fIvo cnro, fhoy do nof rocoIvo fronfmonf for condIfIons
IIko hyµorfonsIon nnd dInbofosfhnf cnn bo succossfuIIy
nnd nffordnbIy fronfod If dIngnosod onrIy on. Soo InsfIfufo
of ModIcIno, ÞnfIonnI AcndomIos, InsurIng AmorIcn`s
HonIfh: IrIncIµIos nnd !ocommondnfIons 43 (2004). Whon
sIcknoss fInnIIy drIvos fho unInsurod fo sook cnro, onco
fronfnbIo condIfIons hnvo oscnInfod Info grnvo honIfh
µrobIoms, roquIrIng moro cosfIy nnd oxfonsIvo Inforvon-
fIon. 1J., nf 4344. Tho oxfrn fImo nnd rosourcos µrovId-
ors sµond sorvIng fho unInsurod Iossons fho µrovIdors`
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 hosµIfnIs dIvorf fImo nnd rosourcos fo µrovIdo
uncomµonsnfod cnro, fho qunIIfy of cnro fho hosµIfnIs
doIIvor fo fhoso wIfh Insurnnco droµs sIgnIfIcnnfIy), nvnIIn-
bIo nf hffµ://www.wnshIngfonµosf.com/bIogs/ozrn-kIoIn/µosf/
hIgh-unInsurod-rnfos-cnn-kIII-you-ovon-If-you-hnvo-covorngo/20l2/
05/0?/gIQA!ÞHÞ8T_µrInf.hfmI.
C
Sfnfos cnnnof rosoIvo fho µrobIom of fho unInsurod on
fhoIr own. !Iko SocInI SocurIfy bonofIfs, n unIvorsnI
honIfh-cnro sysfom, If ndoµfod by nn IndIvIdunI Sfnfo,
wouId bo ¨bnIf fo fho noody nnd doµondonf oIsowhoro,
oncourngIng fhom fo mIgrnfo nnd sook n hnvon of roµoso.¨
Heltering v. Dotie, 30l !. S. 6l9, 644 (l93?). Soo nIso
IrIof for CommonwonIfh of Mnssnchusoffs ns Anicue















8 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
Curioe In Þo. ll398, µ. 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 sµondIng on modIcnI sorvIcos. To covor fho
Incronsod cosfs, n Sfnfo wouId hnvo fo rnIso fnxos, nnd
µrIvnfo honIfh-Insurnnco comµnnIos wouId hnvo fo In-
cronso µromIums. 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 ¨µIncIng fhomsoIvos In n µosIfIon of oconomIc
dIsndvnnfngo ns comµnrod wIfh noIghbors or comµofIfors.¨
Dotie, 30l !. S., nf 644. Soo nIso IrIof for HonIfh Cnro for
AII, Inc., of nI. ns Anici Curioe In Þo. ll398, µ. 4 (¨|O]uf-
of-sfnfo rosIdonfs confInuo fo sook nnd rocoIvo mIIIIons of
doIInrs In uncomµonsnfod cnro In Mnssnchusoffs hosµIfnIs,
IImIfIng fho Sfnfo`s offorfs fo Imµrovo Ifs honIfh cnro
sysfom fhrough fho oIImInnfIon of uncomµonsnfod cnro.¨).
IncIng fhnf rIsk, IndIvIdunI Sfnfos nro unIIkoIy fo fnko fho
InIfInfIvo In nddrossIng fho µrobIom of fho unInsurod, ovon
fhough soIvIng fhnf µrobIom Is In nII Sfnfos` bosf Inforosfs.
Congross` InforvonfIon wns noodod fo ovorcomo fhIs coIIocfIvo-
ncfIon Imµnsso.
Ð
Awnro fhnf n nnfIonnI soIufIon wns roquIrod, Congross
couId hnvo fnkon ovor fho honIfh-Insurnnco mnrkof by
osfnbIIshIng n fnx-nnd-sµond fodornI µrogrnm IIko SocInI
SocurIfy. Such n µrogrnm, commonIy roforrod fo ns n
sIngIo-µnyor sysfom (whoro fho soIo µnyor Is fho IodornI
Covornmonf), wouId hnvo Ioff IIffIo, If nny, room for µrI-
vnfo onforµrIso or fho Sfnfos. Insfond of goIng fhIs roufo,
Congross onncfod fho ACA, n soIufIon fhnf rofnIns n ro-
busf roIo for µrIvnfo Insurors nnd sfnfo govornmonfs. To
mnko Ifs choson nµµronch work, howovor, Congross hnd fo


















9 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
uso somo now fooIs, IncIudIng n roquIromonf fhnf mosf
IndIvIdunIs obfnIn µrIvnfo honIfh Insurnnco covorngo. Soo
26 !. S. C. §5000A (2006 od., Suµµ. IV) (fho mInImum
covorngo µrovIsIon). As oxµInInod boIow, by omµIoyIng
fhoso fooIs, Congross wns nbIo fo nchIovo n µrncfIcnI, 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., Suµµ. IV). Tho mInImum covorngo
µrovIsIon ndvnncos fhIs objocfIvo by gIvIng µofonfInI rocIµ-
Ionfs of honIfh cnro n fInnncInI InconfIvo fo ncquIro Insur-
nnco. Ior fho mInImum covorngo µrovIsIon, nn IndIvIdunI
musf oIfhor obfnIn Insurnnco or µny n foII consfrucfod ns n
fnx µonnIfy. Soo 26 !. S. C. §5000A.
Tho mInImum covorngo µrovIsIon sorvos n furfhor µur-
µoso vIfnI fo Congross` µInn fo roduco fho numbor of unIn-
surod. Congross know fhnf oncourngIng IndIvIdunIs fo
µurchnso Insurnnco wouId nof suffIco fo soIvo fho µrobIom,
bocnuso mosf of fho unInsurod nro nof unInsurod by
choIco.
l
Of µnrfIcuInr concorn fo Congross woro µooµIo
who, fhough dosµornfoIy In nood of Insurnnco, offon cnnnof
ncquIro If: µorsons who suffor from µrooxIsfIng modIcnI
condIfIons.
Ioforo fho ACA`s onncfmonf, µrIvnfo Insurnnco comµn-
nIos fook nn nµµIIcnnf`s modIcnI hIsfory Info nccounf whon
soffIng Insurnnco rnfos or docIdIng whofhor fo Insuro nn
IndIvIdunI. Iocnuso IndIvIdunIs wIfh µrooxIsfIng mod-

l
AccordIng fo ono sfudy conducfod by fho ÞnfIonnI 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 omµIoyor`s
unwIIIIngnoss fo offor Insurnnco or nn Insurors` unwIIIIngnoss fo covor
fhoso wIfh µrooxIsfIng modIcnI condIfIons, nnd Ioss of ModIcnId covor-
ngo. Soo Ðoµf. of HonIfh nnd Humnn SorvIcos, ÞnfIonnI Confor for
HonIfh SfnfIsfIcs, Summnry HonIfh SfnfIsfIcs for fho !. S. IoµuInfIon:
ÞnfIonnI HonIfh InforvIow Survoy2009, Sor. l0, Þo. 248, µ. ?l, TnbIo
25 (Ðoc. 20l0). ¨|Ð]Id nof wnnf or nood covorngo¨ rocoIvod foo fow ro-
sµonsos fo wnrrnnf Ifs own cnfogory. Soo iIiJ., n. 2.















l0 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
IcnI condIfIons cosf Insurnnco comµnnIos sIgnIfIcnnfIy moro
fhnn fhoso wIfhouf such condIfIons, Insurors roufInoIy ro-
fusod fo Insuro fhoso IndIvIdunIs, chnrgod fhom subsfnn-
fInIIy hIghor µromIums, or offorod onIy IImIfod covorngo
fhnf dId nof IncIudo fho µrooxIsfIng IIInoss. Soo Ðoµf. of
HonIfh nnd Humnn SorvIcos, Covorngo ÐonIod: How fho
Curronf HonIfh Insurnnco Sysfom !onvos MIIIIons IohInd
l (2009) (Ovor fho µnsf fhroo yonrs, l2.6 mIIIIon non-
oIdorIy nduIfs woro donIod Insurnnco covorngo or chnrgod
hIghor µromIums duo fo n µrooxIsfIng condIfIon.).
To onsuro fhnf IndIvIdunIs wIfh modIcnI hIsforIos hnvo
nccoss fo nffordnbIo Insurnnco, Congross dovIsod n fhroo-
µnrf soIufIon. IIrsf, Congross Imµosod n ¨gunrnnfood Is-
suo¨ roquIromonf, whIch bnrs Insurors from donyIng
covorngo fo nny µorson on nccounf of fhnf µorson`s modIcnI
condIfIon or hIsfory. Soo 42 !. S. C. §§300ggl, 300gg3,
300gg4(n) (2006 od., Suµµ. IV). Socond, Congross roquIrod
Insurors fo uso ¨communIfy rnfIng¨ fo µrIco fhoIr Insurnnco
µoIIcIos. Soo §300gg. CommunIfy rnfIng, In offocf, bnrs
Insurnnco comµnnIos from chnrgIng hIghor µromIums
fo fhoso wIfh µrooxIsfIng condIfIons.
Iuf fhoso fwo µrovIsIons, Congross comµrohondod, couId
nof work offocfIvoIy unIoss IndIvIdunIs woro gIvon n µow-
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-
µosIfIon of connuni/,-ro/eJ preniune nnd guoron/eeJ
Issuo on n mnrkof of comµofIng µrIvnfo honIfh Insurors
wIII InoxornbIy drIvo fhnf mnrkof Info oxfIncfIon, unIoss
fhoso fwo fonfuros nro couµIod wIfh . . . o nonJo/e on
inJitiJuol[e] /o Ie ineureJ.¨ (omµhnsIs In orIgInnI)).
In fho l990`s, sovornI SfnfosIncIudIng Þow York, Þow
Jorsoy, WnshIngfon, Konfucky, MnIno, Þow HnmµshIro,
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)
OµInIon of CIÞSI!!C, J.
sovon sfnfos sufforod from skyrockofIng Insurnnco µro-
mIum cosfs, roducfIons In IndIvIdunIs wIfh covorngo, nnd
roducfIons In Insurnnco µroducfs nnd µrovIdors.¨ IrIof for
AmorIcnn AssocInfIon of IooµIo wIfh ÐIsnbIIIfIos of nI. ns
Anici Curioe In Þo. ll398, µ. 9 (horoInnffor AAIÐ IrIof).
Soo nIso IrIof for Covornor of WnshIngfon ChrIsfIno
CrogoIro ns Anicue Curioe In Þo. ll398, µµ. lll4 (do-
scrIbIng fho ¨donfh sµIrnI¨ In fho Insurnnco mnrkof Wnsh-
Ingfon oxµorIoncod whon fho Sfnfo µnssod n Inw roquIrIng
covorngo for µrooxIsfIng condIfIons).
Congross comµrohondod fhnf gunrnnfood-Issuo nnd
communIfy-rnfIng Inws nIono wIII nof work. Whon Insur-
nnco comµnnIos nro roquIrod fo Insuro fho sIck nf nffordn-
bIo µrIcos, 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 comµnnIos` mnIn cusfomors. ThIs ¨ndvorso
soIocfIon¨ µrobIom Ionvos Insurors wIfh fwo choIcos: Thoy
cnn oIfhor rnIso µromIums 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 µrovI-
sIon, fhnf Is µrocIsoIy whnf Insurnnco comµnnIos dId. Soo,
e.g., AAIÐ IrIof l0 (¨|In MnIno,] |m]nny Insurnnco µrovId-
ors doubIod fhoIr µromIums In jusf fhroo yonrs or Ioss.¨);
iJ., nf l2 (¨!Iko Þow York, Vormonf snw subsfnnfInI
Incronsos In µromIums nffor Ifs . . . Insurnnco roform
monsuros fook offocf In l993.¨); HnII, An IvnIunfIon of
Þow 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 Þow York`s IndIvIdunI |Insurnnco] mnrkof.¨); IrIof
for Inrry IrIodmnn of nI. ns Anici Curioe In Þo. ll398,
µ. l? (¨In Konfucky, nII buf fwo Insurors (ono Sfnfo-run)
nbnndonod fho Sfnfo.¨).
Mnssnchusoffs, Congross wns foId, crnckod fho ndvorso
















l2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
soIocfIon µrobIom. 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 Þo. ll398, µ. 3 (nof-
Ing fhnf fho CommonwonIfh`s roforms roducod fho numbor
of unInsurod rosIdonfs fo Ioss fhnn 2°, fho Iowosf rnfo In
fho ÞnfIon, nnd cuf fho nmounf of uncomµonsnfod cnro
by n fhIrd); 42 !. S. C. §l809l(2)(Ð) (2006 od., Suµµ. IV)
(nofIng fho succoss of Mnssnchusoffs` roforms).
2
In cou-
µIIng fho mInImum covorngo µrovIsIon wIfh gunrnnfood-
Issuo nnd communIfy-rnfIng µroscrIµfIons, Congross
foIIowod Mnssnchusoffs` Iond.
* * *
In sum, Congross µnssod fho mInImum covorngo µrovI-
sIon ns n koy comµononf of fho ACA fo nddross nn oconom-
Ic nnd socInI µrobIom fhnf hns µInguod fho ÞnfIon for
docndos: fho Inrgo numbor of !. S. rosIdonfs who nro
unnbIo or unwIIIIng fo obfnIn honIfh Insurnnco. Whnfovor
ono fhInks of fho µoIIcy docIsIon Congross mndo, If wns
Congross` µrorognfIvo fo mnko If. !ovIowod wIfh nµµro-
µrInfo doforonco, fho mInImum covorngo µrovIsIon, nIIIod
fo fho gunrnnfood-Issuo nnd communIfy-rnfIng µroscrIµ-
fIons, shouId survIvo monsuromonf undor fho Commorco
nnd Þocossnry nnd Iroµor CInusos.
II
A
Tho Commorco CInuso, If Is wIdoIy ncknowIodgod, ¨wns
fho Irnmors` rosµonso fo fho confrnI µrobIom fhnf gnvo

2
ÐosµIfo Ifs succoss, Mnssnchusoffs` modIcnI-cnro µrovIdors sfIII nd-
mInIsfor subsfnnfInI nmounfs of uncomµonsnfod cnro, much of fhnf fo
unInsurod µnfIonfs from ouf-of-sfnfo. Soo eupro, nf ?8.













l3 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
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 µrocursor, fho roguInfIon of commorco wns
Ioff fo fho Sfnfos. ThIs schomo µrovod unworknbIo, bo-
cnuso fho IndIvIdunI Sfnfos, undorsfnndnbIy focusod on
fhoIr own oconomIc Inforosfs, offon fnIIod fo fnko ncfIons
crIfIcnI fo fho succoss of fho ÞnfIon 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 µosIfIvo & comµIonf nufhorIfy In nII cnsos
whoro unIform monsuros nro nocossnry.¨ Soo !offor from
Jnmos MndIson fo Idmund !nndoIµh (Aµr. 8, l?8?), In 9
Inµors of Jnmos MndIson 368, 3?0 (!. !ufInnd od. l9?5).
Soo nIso !offor from Coorgo WnshIngfon fo Jnmos MndI-
son (Þov. 30, l?85), In 8 iJ., nf 428, 429 (¨Wo nro oIfhor n
!nIfod µooµIo, 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 µromofo, nnd n nnfIonnI chnrncfor
fo suµµorf.¨). Tho Irnmors` soIufIon wns fho Commorco
CInuso, whIch, ns fhoy µorcoIvod 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 soµnrnfoIy Incomµofonf.¨ 2 !oc-
ords of fho IodornI ConvonfIon of l?8?, µµ. l3ll32, ¶8

3
AIoxnndor HnmIIfon doscrIbod fho µrobIom fhIs wny: ¨|Offon] If
wouId bo bonofIcInI fo nII fho sfnfos fo oncourngo, or suµµross|,] n
µnrfIcuInr brnnch of frndo, whIIo If wouId bo dofrImonfnI . . . fo nffomµf
If wIfhouf fho concurronco of fho rosf.¨ Tho ConfInonfnIIsf Þo. V, In 3
Inµors of AIoxnndor HnmIIfon ?5, ?8 (H. Syroff od. l962). Iocnuso fho
concurronco of nII Sfnfos wns oxcoodIngIy dIffIcuIf fo obfnIn, HnmIIfon
obsorvod, ¨fho oxµorImonf wouId µrobnbIy bo Ioff unfrIod.¨ 1IiJ.



















l4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
(M. Inrrnnd rov. l966). Soo nIso Aor/l Anericon Co. v.
S1C, 32? !. S. 686, ?05 (l946) (¨|Tho commorco µowor]
Is nn nffIrmnfIvo µowor commonsurnfo wIfh fho nnfIonnI
noods.¨).
Tho Irnmors undorsfood fhnf fho ¨gonornI Inforosfs of
fho !nIon¨ wouId chnngo ovor fImo, In wnys fhoy couId nof
nnfIcIµnfo. AccordIngIy, fhoy rocognIzod fhnf fho ConsfI-
fufIon wns of nocossIfy n ¨gronf oufIIn|o],¨ nof n dofnIIod
bIuoµrInf, soo McCullocl v. Mor,lonJ, 4 Whonf. 3l6, 40?
(l8l9), nnd fhnf Ifs µrovIsIons IncIudod brond concoµfs, fo
bo ¨oxµInInod by fho confoxf or by fho fncfs of fho cnso,¨
!offor from Jnmos MndIson fo Þ. I. TrIsf (Ðoc. l83l), In 9
WrIfIngs of Jnmos MndIson 4?l, 4?5 (C. Hunf od. l9l0).
¨ÞofhIng . . . cnn bo moro fnIIncIous,¨ AIoxnndor HnmIIfon
omµhnsIzod, ¨fhnn fo Infor fho oxfonf of nny µowor, µroµor
fo bo Iodgod In fho nnfIonnI govornmonf, from . . . Ifs
ImmodInfo nocossIfIos. Thoro oughf fo bo n CAIACITY fo
µrovIdo for fufuro confIngoncIos|,] ns fhoy mny hnµµon;
nnd ns fhoso nro IIIImIfnbIo In fhoIr nnfuro, If Is ImµossIbIo
snfoIy fo IImIf fhnf cnµncIfy.¨ Tho IodornIIsf Þo. 34,
µµ. 205, 206 (John Hnrvnrd !Ibrnry od. 2009). Soo nIso
McCullocl, 4 Whonf., nf 4l5 (Tho Þocossnry nnd Iroµor
CInuso Is Iodgod ¨In n consfIfufIon|,] Infondod fo onduro
for ngos fo como, nnd consoquonfIy, fo bo ndnµfod fo fho
vnrIous crieee of humnn nffnIrs.¨).
I
ConsIsfonf wIfh fho Irnmors` Infonf, wo hnvo roµonfodIy
omµhnsIzod fhnf Congross` nufhorIfy undor fho Commorco
CInuso Is doµondonf uµon ¨µrncfIcnI¨ consIdornfIons,
IncIudIng ¨ncfunI oxµorIonco.¨ 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) (KIÞÞIÐY, J., concurrIng) (omµhnsIzIng
¨fho Courf`s dofInIfIvo commIfmonf fo fho µrncfIcnI con-
coµfIon of fho commorco µowor¨). Soo nIso Aor/l Anericon

















l5 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
Co., 32? !. S., nf ?05 (¨Commorco IfsoIf Is nn InfonsoIy
µrncfIcnI 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 µrobIoms dIrocfIy
nnd ronIIsfIcnIIy.¨ Anericon Pouer & Ligl/ Co. v. S1C,
329 !. S. 90, l03 (l946).
!nfII fodny, fhIs Courf`s µrngmnfIc nµµronch fo judgIng
whofhor Congross vnIIdIy oxorcIsod Ifs commorco µowor
wns guIdod by fwo fnmIIInr µrIncIµIos. IIrsf, Congross hns
fho µowor fo roguInfo oconomIc ncfIvIfIos ¨fhnf subsfnn-
fInIIy nffocf Inforsfnfo commorco.¨ Goncolee v. Ioicl, 545
!. S. l, l? (2005). ThIs cnµncIous µowor oxfonds ovon fo
IocnI ncfIvIfIos fhnf, vIowod In fho nggrognfo, hnvo n sub-
sfnnfInI Imµncf on Inforsfnfo commorco. Soo iIiJ. Soo
nIso Wic/orJ, 3l? !. S., nf l25 (¨|I]von If nµµoIIoo`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.¨ (omµhnsIs nddod)); Jonee & Lougl-
lin S/eel Corp., 30l !. S., nf 3?.
Socond, wo owo n Inrgo monsuro of rosµocf 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 µoIIcy.¨); 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 uµon If nro cIonrIy non-oxIsfonf.¨ (InfornnI quofnfIon
mnrks omIffod)). Whon nµµrnIsIng 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




















l6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
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 µrosumo fho sfnfufo undor rovIow Is consfI-
fufIonnI nnd mny sfrIko If down onIy on n ¨µInIn showIng¨
fhnf Congross ncfod IrrnfIonnIIy. Ini/eJ S/o/ee v. Morri-
eon, 529 !. S. 598, 60? (2000).
C
SfrnIghfforwnrd nµµIIcnfIon of fhoso µrIncIµIos wouId
roquIro fho Courf fo hoId fhnf fho mInImum covorngo
µrovIsIon Is µroµor Commorco CInuso IogIsInfIon. Ioyond
dIsµufo, 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 µroducfs nnd sorvIcos onch yonr. Soo
eupro, nf 5. Thoso goods nro µroducod, soId, nnd doIIvorod
InrgoIy by nnfIonnI nnd rogIonnI comµnnIos 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 µrovIdos boffor cnro for fhoso who
hnvo nof µroµnId for cnro. Soo eupro, nf ?8.
Þof onIy do fhoso wIfhouf Insurnnco consumo n Inrgo
nmounf of honIfh cnro onch yonr; crIfIcnIIy, ns onrIIor
oxµInInod, fhoIr InnbIIIfy fo µny for n sIgnIfIcnnf µorfIon of
fhnf consumµfIon drIvos uµ mnrkof µrIcos, 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)
OµInIon of CIÞSI!!C, J.
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 µowor fo roguInfo commorco IncIudos fho µowor fo rogu-
Info fho µrIcos nf whIch commodIfIos In fhnf commorco nro
donIf In nnd proc/icee offec/ing eucl pricee.¨ (omµhnsIs
nddod)).
Tho mInImum covorngo µrovIsIon, furfhormoro, bonrs n
¨ronsonnbIo connocfIon¨ fo Congross` gonI of µrofocfIng fho
honIfh-cnro mnrkof from fho dIsruµfIon cnusod by IndIvId-
unIs who fnII fo obfnIn Insurnnco. Iy roquIrIng fhoso who
do nof cnrry Insurnnco fo µny n foII, fho mInImum covor-
ngo µrovIsIon gIvos IndIvIdunIs n sfrong InconfIvo fo In-
suro. ThIs InconfIvo, Congross hnd good ronson fo boIIovo,
wouId roduco fho numbor of unInsurod nnd, corrosµond-
IngIy, mIfIgnfo fho ndvorso Imµncf 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 µny fho sµocIfIod µonnIfy. As onrIIor ob-
sorvod, bocnuso ovory µorson Is nf rIsk of noodIng cnro nf
nny momonf, nII fhoso who Inck Insurnnco, rognrdIoss of
fhoIr curronf honIfh sfnfus, ndvorsoIy nffocf fho µrIco of
honIfh cnro nnd honIfh Insurnnco. Soo eupro, nf 6?.
Moroovor, nn Insurnnco-µurchnso roquIromonf IImIfod fo
fhoso In nood of ImmodInfo cnro sImµIy couId nof work.
Insurnnco comµnnIos wouId oIfhor chnrgo fhoso IndIvIdu-
nIs µrohIbIfIvoIy oxµonsIvo µromIums, or, If communIfy-
rnfIng roguInfIons woro In µInco, cIoso uµ shoµ. Soo eupro,
nf 9ll. Soo nIso IrIof for Sfnfo of MnryInnd nnd l0
Ofhor Sfnfos of nI. ns Anici Curioe In Þo. ll398, µ. 28
(horoInnffor MnryInnd IrIof) (¨Þo Insurnnco rogImo cnn
survIvo If µooµIo cnn oµf ouf whon fho rIsk Insurod ngnInsf
Is onIy n rIsk, buf oµf In whon fho rIsk mnforInIIzos.¨).
¨|W]horo wo fInd fhnf fho IogIsInfors . . . hnvo n rnfIonnI
bnsIs for fIndIng n choson roguInfory schomo nocossnry fo





















l8 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fho µrofocfIon of commorco, our InvosfIgnfIon Is nf nn ond.¨
Ko/cenIocl, 3?9 !. S., nf 303304. Congross` onncfmonf
of fho mInImum covorngo µrovIsIon, whIch nddrossos n
sµocIfIc Inforsfnfo µrobIom In n µrncfIcnI, oxµorIonco-
Informod mnnnor, onsIIy moofs fhIs crIforIon.
Ð
!nfhor fhnn ovnIunfIng fho consfIfufIonnIIfy of fho
mInImum covorngo µrovIsIon In fho mnnnor osfnbIIshod by
our µrocodonfs, THI CHIII J!STICI roIIos on n nowIy
mInfod consfIfufIonnI docfrIno. Tho commorco µowor doos
nof, THI CHIII J!STICI nnnouncos, µormIf Congross
fo ¨comµo|I] IndIvIdunIs fo bocomo ncfIvo In commorco
by µurchnsIng n µroducf.¨ An/e, nf 20 (omµhnsIs doIofod).
l
n
THI CHIII J!STICI`s novoI consfrnInf on Congross`
commorco µowor gnIns no forco from our µrocodonf nnd for
fhnf ronson nIono wnrrnnfs dIsnµµrobnfIon. Soo infro, nf
232?. Iuf ovon nssumIng, for fho momonf, fhnf Congross
Incks nufhorIfy undor fho Commorco CInuso fo ¨comµoI
IndIvIdunIs nof ongngod In commorco fo µurchnso nn
unwnnfod µroducf,¨ on/e, nf l8, such n IImIfnfIon wouId bo
InnµµIIcnbIo horo. Ivoryono wIII, nf somo µoInf, consumo
honIfh-cnro µroducfs nnd sorvIcos. Soo eupro, nf 3. Thus,
If THI CHIII J!STICI Is corrocf fhnf nn Insurnnco-
µurchnso roquIromonf cnn bo nµµIIod onIy fo fhoso who
¨ncfIvoIy¨ consumo honIfh cnro, fho mInImum covorngo
µrovIsIon fIfs fho bIII.
THI CHIII J!STICI doos nof dIsµufo fhnf nII !. S. rosI-
donfs µnrfIcIµnfo 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 µrodIcf.¨). Iuf, THI CHIII J!STICI InsIsfs,
fho unInsurod cnnnof bo consIdorod ncfIvo In fho mnrkof






















l9 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
for honIfh cnro, bocnuso ¨|f]ho µroxImIfy nnd dogroo of
connocfIon bofwoon fho |unInsurod fodny] nnd |fhoIr]
subsoquonf commorcInI ncfIvIfy Is foo InckIng.¨ An/e,
nf 2?.
ThIs nrgumonf hns muIfIµIo fInws. IIrsf, moro fhnn
60° of fhoso wIfhouf Insurnnco vIsIf n hosµIfnI or docfor`s
offIco onch yonr. Soo eupro, nf 5. ÞonrIy 90° wIII wIfhIn
fIvo yonrs.
4
An unInsurod`s consumµfIon of honIfh cnro Is
fhus quIfo µroxImnfo: 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 soµnrnfIng
fhoso unInsurod IndIvIdunIs who wIII nood omorgoncy modI-
cnI cnro fodny (suroIy fhoIr consumµfIon of modIcnI cnro
Is suffIcIonfIy ImmInonf) from fhoso who wIII nof nood
modIcnI sorvIcos for yonrs fo como. Þo ono knows whon nn
omorgoncy wIII occur, yof omorgoncIos InvoIvIng fho unIn-
surod nrIso dnIIy. To cnµfuro IndIvIdunIs who unoxµocf-
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 µrovonf nn ovII fo mnko fho Inw ombrnco moro
fhnn fho µrocIso fhIng fo bo µrovonfod If mny do so.¨ (In-
fornnI quofnfIon mnrks omIffod)).
5

4
Soo Ðoµf. of HonIfh nnd Humnn SorvIcos, ÞnfIonnI Confor for
HonIfh SfnfIsfIcs, Summnry HonIfh SfnfIsfIcs for !. S. AduIfs: ÞnfIonnI
HonIfh InforvIow Survoy 2009, Sor. l0, Þo. 249, µ. l24, TnbIo 3?
(Ðoc. 20l0).
5
IchoIng THI CHIII J!STICI, fho joInf dIssonfors urgo fhnf fho mIn-
Imum covorngo µrovIsIon ImµormIssIbIy roguInfos young µooµIo who
¨hnvo no InfonfIon of µurchnsIng |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 µorson 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 oxµocfIng fo do so.






















20 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
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 (unsµocIfIod)
µroxImIfy fo fho noxf Insfnnf. Iuf Congross couId ronson-
nbIy hnvo vIowod fho mnrkof from n Iong-form µorsµocfIvo,
oncomµnssIng 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
µrocodonf doos Indood suµµorf ¨|f]ho µroµosIfIon fhnf
Congross mny dIcfnfo fho conducf of nn IndIvIdunI fodny
bocnuso of µroµhosIod fufuro ncfIvIfy.¨ An/e, nf 26. In
Wic/orJ, fho Courf uµhoId n µonnIfy fho IodornI Covorn-
monf Imµosod on n fnrmor who grow moro whonf fhnn ho
wns µormIffod fo grow undor fho AgrIcuIfurnI Adjusfmonf
Acf of l938 (AAA). 3l? !. S., nf ll4ll5. Ho couId nof
bo µonnIIzod, fho fnrmor nrguod, ns ho wns growIng fho
whonf for homo consumµfIon, nof for snIo on fho oµon
mnrkof. 1J., nf ll9. Tho Courf rojocfod fhIs nrgumonf.
1J., nf l2?l29. Whonf Infondod for homo consumµfIon,
fho Courf nofod, ¨ovorhnngs fho mnrkof, nnd If Inducod by
rIsIng µrIcos, fonds fo fIow Info fho mnrkof nnd chock µrIco
Incronsos |Infondod by fho AAA].¨ 1J., nf l28.
SImIInr ronsonIng suµµorfod fho Courf`s judgmonf In
Ioicl, whIch uµhoId Congross` nufhorIfy fo roguInfo mnrI-
junnn grown for µorsonnI 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, sfoµµod from
growIng oxcoss whonf; fho µInInfIff In Ioicl, ordorod fo






















2l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
conso cuIfIvnfIng mnrIjunnn) bocnuso of n µroµhosIod
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 consumµfIon of modIcnI cnro) Is corfnIn fo
occur, fho soIo uncorfnInfy boIng fho fImo fho ncfIvIfy wIII
fnko µInco.
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, sImµIy bocnuso ho
or sho mny somodny buy n cnr. An/e, nf 25. Tho nnnIogy
Is Innµf. Tho InovIfnbIo yof unµrodIcfnbIo nood for modI-
cnI cnro nnd fho gunrnnfoo fhnf omorgoncy cnro wIII bo
µrovIdod 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
µny nf fho counfor boforo rocoIvIng fho vohIcIo or nour-
Ishmonf. Sho wIII gof no froo rIdo or food, nf fho oxµonso
of nnofhor consumor forcod fo µny nn InfInfod µrIco. Soo
Tlonoe More Lou Cen/er v. OIono, 65l I. 3d 529, 565
(CA6 20ll) (Suffon, J., concurrIng In µnrf) (¨!oguInfIng
how cIfIzons µny 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) µnrnIIoIs In modorn
IIfo.¨). !µhoIdIng fho mInImum covorngo µrovIsIon on fho
ground fhnf nII nro µnrfIcIµnnfs or wIII bo µnrfIcIµnnfs In
fho honIfh-cnro mnrkof wouId fhoroforo cnrry no ImµIIcn-
fIon fhnf Congross mny jusfIfy undor fho Commorco
CInuso n mnndnfo fo buy ofhor µroducfs nnd sorvIcos.
Þor Is If nccurnfo fo sny fhnf fho mInImum covorngo
µrovIsIon ¨comµoI|s] IndIvIdunIs . . . fo µurchnso nn un-














22 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
wnnfod µroducf,¨ on/e, nf l8, or ¨suIfo of µroducfs,¨ poe/, nf
ll, n. 2 (joInf oµInIon of SCA!IA, KIÞÞIÐY, THOMAS, nnd
A!ITO, JJ.). If unwnnfod fodny, modIcnI sorvIco socurod by
Insurnnco mny bo dosµornfoIy noodod fomorrow. VIrfunIIy
ovoryono, I roIfornfo, consumos honIfh cnro nf somo µoInf
In hIs or hor IIfo. Soo eupro, nf 3. HonIfh Insurnnco Is n
monns of µnyIng for fhIs cnro, nofhIng moro. In roquIrIng
IndIvIdunIs fo obfnIn Insurnnco, Congross Is fhoroforo nof
mnndnfIng fho µurchnso of n dIscrofo, unwnnfod µroducf.
!nfhor, Congross Is moroIy dofInIng fho forms on whIch
IndIvIdunIs µny for nn Inforsfnfo good fhoy consumo:
Iorsons subjocf fo fho mnndnfo musf now µny for modIcnI
cnro In ndvnnco (Insfond of nf fho µoInf of sorvIco) nnd
fhrough Insurnnco (Insfond of ouf of µockof). IsfnbIIshIng
µnymonf 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
oµInIon of SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ.)
(rocognIzIng fhnf ¨fho IodornI Covornmonf cnn µroscrIbo
|n commodIfy`s] qunIIfy . . . nnd ovon |Ifs µrIco]¨).
THI CHIII J!STICI nIso cnIIs fho mInImum covorngo
µrovIsIon nn IIIogIfImnfo offorf fo mnko young, honIfhy
IndIvIdunIs subsIdIzo Insurnnco µromIums µnId by fho Ioss
hnIo nnd hnrdy. Soo on/e, nf l?, 2526. ThIs comµInInf,
foo, Is sµurIous. !ndor fho curronf honIfh-cnro sysfom,
honIfhy µorsons who Inck Insurnnco rocoIvo n bonofIf for
whIch fhoy do nof µny: 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
µny n µonnIfy sfrucfurod ns n fnx, fho mInImum covorngo
µrovIsIon onds fho froo rIdo fhoso IndIvIdunIs curronfIy
onjoy.
In fho fuIInoss of fImo, moroovor, fodny`s young nnd














23 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
honIfhy wIII bocomo socIofy`s oId nnd InfIrm. VIowod ovor
n IIfosµnn, fho cosfs nnd bonofIfs ovon ouf: Tho young who
µny moro fhnn fhoIr fnIr shnro curronfIy wIII µny Ioss fhnn
fhoIr fnIr shnro whon fhoy bocomo sonIor cIfIzons. And
ovon If, ns undoubfodIy wIII bo fho cnso, somo IndIvIdunIs,
ovor fhoIr IIfosµnns, wIII µny moro for honIfh Insurnnco
fhnn fhoy rocoIvo In honIfh sorvIcos, fhoy hnvo IIffIo fo
comµInIn nbouf, for fhnf Is how Insurnnco works. Ivory
Insurod µorson rocoIvos µrofocfIon ngnInsf n cnfnsfroµhIc
Ioss, ovon fhough onIy n subsof of fho covorod cInss wIII
uIfImnfoIy nood fhnf µrofocfIon.
b
In nny ovonf, THI CHIII J!STICI`s IImIfnfIon of fho
commorco µowor 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 µowor ¨|f]o roguInfo Commorco . . .
nmong fho sovornI Sfnfos.¨ ÞofhIng In fhIs Inngungo Im-
µIIos fhnf Congross` commorco µowor Is IImIfod fo rogu-
InfIng fhoso ncfIvoIy ongngod In commorcInI frnnsncfIons.
Indood, ns fho Ð. 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 µowor fo 'coIn
Monoy,` In nddIfIon fo fho µowor fo 'roguInfo fho VnIuo
fhoroof,` ¨ nnd sImIInrIy ¨gIvos Congross fho µowor fo 'rnIso
nnd suµµorf ArmIos` nnd fo 'µrovIdo nnd mnInfnIn n Þnvy,` In
nddIfIon fo fho µowor 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 soµnrnfIng fho
µowor fo roguInfo from fho µowor fo brIng fho subjocf of
fho roguInfIon Info oxIsfonco, THI CHIII J!STICI nssorfs,
¨|f]ho Inngungo of fho ConsfIfufIon rofIocfs fho nnfurnI























24 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
undorsfnndIng fhnf fho µowor 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 µrohIbIfIons or rosfrIcfIons fhoroon.¨). Thus, fho ¨somo-
fhIng fo bo roguInfod¨ wns suroIy fhoro whon Congross
cronfod fho mInImum covorngo µrovIsIon.
6
Þor doos our cnso Inw foo fho ncfIvIfy vorsus InncfIv-
Ify IIno. In Wic/orJ, for oxnmµIo, wo uµhoId fho µonnIfy
Imµosod on n fnrmor who grow foo much whonf, ovon
fhough fho roguInfIon hnd fho offocf of comµoIIIng fnrmors
fo µurchnso whonf In fho oµon mnrkof. 1J., nf l2?l29.
¨|I]orcIng somo fnrmors Info fho mnrkof fo buy whnf fhoy
couId µrovIdo for fhomsoIvos¨ wns, fho Courf hoId, n vnIId
monns of roguInfIng commorco. 1J., nf l28l29. In nn-
ofhor confoxf, fhIs Courf sImIInrIy uµhoId Congross` nufhor-
Ify undor fho commorco µowor fo comµoI 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)
(¨|!]µon /le [greo/] pouer /o regulo/e connerce|,]¨ Con-
gross hns fho nufhorIfy fo mnndnfo fho snIo of ronI µroµ-
orfy fo fho Covornmonf, whoro fho snIo Is ossonfInI fo fho
Imµrovomonf of n nnvIgnbIo wnforwny (omµhnsIs nddod));
Clero/ee Ao/ion v. Sou/lern Koneoe I. Co., l35 !. S. 64l,

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




















25 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
65?659 (l890) (sImIInr roIInnco on fho commorco µowor
rognrdIng mnndnfod snIo of µrIvnfo µroµorfy for rnIIrond
consfrucfIon).
In concIudIng fhnf fho Commorco CInuso doos nof µor-
mIf Congross fo roguInfo commorcInI ¨InncfIvIfy,¨ nnd fhoro-
foro doos nof nIIow Congross fo ndoµf fho µrncfIcnI soIu-
fIon If dovIsod for fho honIfh-cnro µrobIom, THI CHIII
J!STICI vIows fho CInuso ns n ¨fochnIcnI IognI concoµfIon,¨
µrocIsoIy 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
Imµoso cnfogorIcnI IImIfs on fho commorco µowor hnvo nof
fnrod woII. In sovornI µro-Þow ÐonI cnsos, fho Courf
nffomµfod fo cnbIn Congross` Commorco CInuso nufhorIfy
by dIsfInguIshIng ¨commorco¨ from ncfIvIfy onco concoIvod
fo bo noncommorcInI, nofnbIy, ¨µroducfIon,¨ ¨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 µnrf of If.¨); Cor/er v. Cor/er Cool Co.,
298 !. S. 238, 304 (l936) (¨MInIng brIngs fho subjocf
mnffor of commorco Info oxIsfonco. Commorco dIsµosos 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 uµon 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 µowor
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 'µroducfIon` nnd 'IndIrocf` nnd forocIoso consIdornfIon of




















26 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fho ncfunI offocfs of fho ncfIvIfy In quosfIon uµon Infor-
sfnfo commorco.¨ 3l? !. S., nf l20. Soo nIso Morrieon,
529 !. S., nf 64l644 (Soufor, J., dIssonfIng) (rocounfIng
fho Courf`s ¨nonrIy dIsnsfrous oxµorImonf¨ wIfh formnIIs-
fIc IImIfs on Congross` commorco µowor). InIIIng fo Ionrn
from fhIs hIsfory, THI CHIII J!STICI µIows 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 µossIbIo fo rosfnfo mosf
ncfIons ns corrosµondIng InncfIons wIfh fho snmo offocf.¨
Arclie v. Iocine, 84? I. 2d l2ll, l2l3 (CA? l988) (on
bnnc). Tnko fhIs cnso ns nn oxnmµIo. An IndIvIdunI who
oµfs nof fo µurchnso Insurnnco from n µrIvnfo 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 µnrf) (¨Þo ono Is In-
ncfIvo whon docIdIng how fo µny for honIfh cnro, ns soIf-
Insurnnco nnd µrIvnfo Insurnnco nro fwo forms of ncfIon
for nddrossIng fho snmo rIsk.¨). Tho mInImum covorngo
µrovIsIon couId fhoroforo bo doscrIbod ns roguInfIng ncfIv-
Isfs In fho soIf-Insurnnco mnrkof.
?
Wic/orJ Is nnofhor
oxnmµIo. ÐId fho sfnfufo fhoro nf Issuo fnrgof ncfIvIfy
(fho growIng of foo much whonf) or InncfIvIfy (fho fnrmor`s
fnIIuro fo µurchnso whonf In fho mnrkofµInco)¨ 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 µurchnso µrIvnfo Insurnnco ns ¨doIng nofhIng,¨ on/e, nf 20, Is sImI-
InrIy quosfIonnbIo. A µorson who soIf-Insuros oµfs ngnInsf µroµnymonf for
n µroducf fho µorson wIII In fImo consumo. Whon nggrognfod, oxorcIso
of fhnf oµfIon hns n subsfnnfInI Imµncf on fho honIfh-cnro mnrkof. Soo
eupro, nf 5?, l6l?.

















2? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
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 oxµrossos n concorn for IndIvIdunI IIborfy fhnf |Is]
moro rodoIonf of Ðuo Irocoss CInuso nrgumonfs.¨ Seten-
S/,, 66l I. 3d, nf l9. Soo nIso Troxel v. Grontille, 530
!. S. 5?, 65 (2000) (µIurnIIfy oµInIon) (¨Tho |Ðuo Irocoss]
CInuso nIso IncIudos n subsfnnfIvo comµononf fhnf µro-
vIdos hoIghfonod µrofocfIon ngnInsf govornmonf Inforfor-
onco wIfh corfnIn fundnmonfnI rIghfs nnd IIborfy Infor-
osfs.¨ (InfornnI quofnfIon mnrks omIffod)). IInInfIffs hnvo
nbnndonod nny nrgumonf µInnod fo subsfnnfIvo duo µro-
coss, howovor, soo 648 I. 3d l235, l29l, n. 93 (CAll
20ll), nnd now concodo fhnf fho µrovIsIons horo nf Issuo
do nof offond fho Ðuo Irocoss CInuso.
8
2
!ndorIyIng THI CHIII J!STICI`s vIow fhnf fho Com-
morco CInuso musf bo confInod fo fho roguInfIon of ncfIvo
µnrfIcIµnnfs In n commorcInI mnrkof Is n fonr fhnf fho
commorco µowor wouId ofhorwIso know no IImIfs. Soo,
e.g., on/e, nf 23 (AIIowIng Congross fo comµoI nn IndIvId-
unI nof ongngod In commorco fo µurchnso n µroducf wouId
¨µormI|f] Congross fo ronch boyond fho nnfurnI oxfonf
of Ifs nufhorIfy, ovorywhoro oxfondIng fho sµhoro of Ifs
ncfIvIfy, nnd drnwIng nII µowor Info Ifs Imµofuous vorfox.¨
(InfornnI quofnfIon mnrks omIffod)). Tho joInf dIssonfors

8
Somo ndhoronfs fo fho joInf dIssonf hnvo quosfIonod fho oxIsfonco of
subsfnnfIvo duo µrocoss rIghfs. Soo McDonolJ v. Clicogo, 56l !. S.
___, ___ (20l0) (THOMAS, J., concurrIng) (sIIµ oµ., nf ?) (Tho nofIon fhnf
fho Ðuo 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 µroµosIfIon fhnf fho Ðuo Irocoss
CInuso gunrnnfoos corfnIn (unsµocIfIod) IIborfIos|.]¨). CIvon fhoso
JusfIcos` roIucfnnco fo Inforµrof fho Ðuo Irocoss CInuso ns gunrnnfoo-
Ing IIborfy Inforosfs, fhoIr wIIIIngnoss fo µInnf such µrofocfIons In fho
Commorco CInuso Is sfrIkIng.



















28 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
oxµross n sImIInr nµµrohonsIon. Soo poe/, nf 8 (If fho
mInImum covorngo µrovIsIon Is uµhoId undor fho com-
morco µowor fhon ¨fho Commorco CInuso bocomos n fonf of
unIImIfod µowor, . . . fho hIdoous monsfor whoso dovour-
Ing jnws . . . sµnro noIfhor sox nor ngo, nor hIgh nor Iow,
nor sncrod nor µrofnno.¨ (InfornnI quofnfIon mnrks omIf-
fod)). ThIs concorn Is unfoundod.
IIrsf, THI CHIII J!STICI couId corfnInIy uµhoId fho
IndIvIdunI mnndnfo wIfhouf gIvIng Congross cor/e Iloncle
fo onncf nny nnd nII µurchnso 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 µrobIom fhnf doos nof occur In ofhor
mnrkofs. Soo eupro, nf 3?, l6l8, 2l.
Þor wouId fho commorco µowor 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
oxnmµIo, fho Courf hoId fhnf fho IodornI Covornmonf
Inckod µowor, undor fho Commorco CInuso, fo crImInnIIzo
fho µossossIon 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 roµofIfIon oIso-
whoro, subsfnnfInIIy nffocf nny sorf of Inforsfnfo com-
morco.¨ 5l4 !. S., nf 56?; iIiJ. (nofIng fhnf fho Courf
wouId hnvo ¨fo µIIo Inforonco uµon Inforonco¨ fo concIudo
fhnf gun µossossIon 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 uµon Inforsfnfo commorco.¨ 529 !. S., nf 6l5.
An IndIvIdunI`s docIsIon fo soIf-Insuro, I hnvo oxµInInod,
Is nn oconomIc ncf wIfh fho roquIsIfo connocfIon fo Infor-
sfnfo commorco. Soo eupro, nf l6l?. Ofhor choIcos




















29 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
IndIvIdunIs mnko nro unIIkoIy fo fIf fho snmo or sImIInr
doscrIµfIon. As nn oxnmµIo of fho fyµo of roguInfIon ho
fonrs, THI CHIII J!STICI cIfos n Covornmonf mnndnfo fo
µurchnso groon vogofnbIos. An/e, nf 2223. Ono couId cnII
fhIs concorn ¨fho broccoII horrIbIo.¨ Congross, THI CHIII
J!STICI µosIfs, mIghf ndoµf such n mnndnfo, ronsonIng
fhnf nn IndIvIdunI`s fnIIuro fo onf n honIfhy dIof, IIko fho
fnIIuro fo µurchnso honIfh Insurnnco, Imµosos cosfs on
ofhors. Soo iIiJ.
ConsIdor fho chnIn of Inforoncos fho Courf wouId hnvo
fo nccoµf fo concIudo fhnf n vogofnbIo-µurchnso 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 µroµnro fho vogofnbIos In n honIfhy wny (sfonmod
or rnw, nof dooµ-frIod), wouId cuf bnck on unhonIfhy foods,
nnd wouId nof nIIow ofhor fncfors (such ns Inck of oxorcIso
or IIffIo sIooµ) fo frumµ fho Imµrovod dIof.
9
Such ¨µII|Ing
of] Inforonco uµon Inforonco¨ Is jusf whnf fho Courf ro-
fusod fo do In Lopec nnd Morrieon.
Ofhor µrovIsIons of fho ConsfIfufIon nIso chock congros-
sIonnI ovorronchIng. A mnndnfo fo µurchnso n µnrfIcu-
Inr µroducf wouId bo unconsfIfufIonnI If, for oxnmµIo, fho
odIcf ImµormIssIbIy nbrIdgod fho froodom of sµooch, Infor-
forod wIfh fho froo oxorcIso of roIIgIon, or InfrIngod on n
IIborfy Inforosf µrofocfod by fho Ðuo Irocoss CInuso.

9
Tho fnIIuro fo µurchnso vogofnbIos In THI CHIII J!STICI`s hyµofhof-
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 µrobIom. Soo on/e,
nf 2223. !oquIrIng IndIvIdunIs fo µurchnso vogofnbIos Is fhus
sovornI sfoµs romovod from soIvIng fho µrobIom. 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
µrobIom dIrocfIy, In n sIngIo sfoµ.

















30 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
SuµµIomonfIng fhoso IognI rosfrnInfs Is n formIdnbIo
chock on congrossIonnI µowor: fho domocrnfIc µrocoss. Soo
Ioicl, 545 !. S., nf 33; Wic/orJ, 3l? !. S., nf l20 (roµonf-
Ing ChIof JusfIco MnrshnII`s ¨wnrnIng fhnf offocfIvo ro-
sfrnInfs on |fho commorco µowor`s] oxorcIso musf µrocood
from µoIIfIcnI rnfhor fhnn judIcInI µrocossos¨ (cIfIng GiI-
Ione v. OgJen, 9 Whonf. l, l9? (l824)). As fho confrovorsy
surroundIng fho µnssngo of fho AffordnbIo Cnro Acf nf-
fosfs, µurchnso mnndnfos nro IIkoIy fo ongondor µoIIfIcnI
rosIsfnnco. ThIs µrosµocf Is borno ouf by fho bohnvIor of
sfnfo IogIsInfors. ÐosµIfo fhoIr µossossIon of unquosfIonod
nufhorIfy fo Imµoso mnndnfos, sfnfo govornmonfs hnvo
rnroIy dono so. Soo HnII, Commorco CInuso ChnIIongos fo
HonIfh Cnro !oform, l59 !. In. !. !ov. l825, l838 (20ll).
Whon confomµInfod In Ifs oxfromo, nImosf nny µowor
Iooks dnngorous. Tho commorco µowor, hyµofhofIcnIIy,
wouId onnbIo Congross fo µrohIbIf fho µurchnso nnd homo
µroducfIon of nII monf, fIsh, nnd dnIry goods, offocfIvoIy
comµoIIIng AmorIcnns fo onf onIy vogofnbIos. Cf. Ioicl,
545 !. S., nf 9; Wic/orJ, 3l? !. S., nf l2?l29. Yof no ono
wouId offor fho ¨hyµofhofIcnI nnd unronI µossIbIIIf|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 µossossIon nnd snIo of goods. THI
CHIII J!STICI nccoµfs jusf such sµocIous IogIc whon ho
cIfos fho broccoII horrIbIo ns n ronson fo dony Congross
fho µowor fo µnss fho IndIvIdunI mnndnfo. Cf. !. Iork,
Tho TomµfIng of AmorIcn l69 (l990) (¨Judgos nnd Inwyors
IIvo on fho sIIµµory sIoµo of nnnIogIos; fhoy nro nof suµµosod
fo skI If fo fho boffom.¨). Iuf soo, e.g., poe/, nf 3 (joInf oµIn-
Ion of SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ.) (nssorf-
Ing, oufInndIshIy, fhnf If fho mInImum covorngo µrovIsIon
Is susfnInod, fhon Congross couId mnko ¨bronfhIng In nnd
ouf fho bnsIs for fodornI µroscrIµfIon¨).















3l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
3
To boIsfor hIs nrgumonf fhnf fho mInImum covorngo
µrovIsIon Is nof vnIId Commorco CInuso IogIsInfIon, THI
CHIII J!STICI omµhnsIzos fho µrovIsIon`s novoIfy. Soo
on/e, nf l8 (nssorfIng fhnf ¨somofImos fho mosf foIIIng
IndIcnfIon of |n] sovoro consfIfufIonnI µrobIom . . . Is fho
Inck of hIsforIcnI µrocodonf for Congross`s ncfIon¨ (InfornnI
quofnfIon mnrks omIffod)). WhIIo nn Insurnnco-µurchnso
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] µowor dIfforoncos nro nssorfod from
µrovIous 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,
Þo. 600, µ. 5 (¨unµrocodonfod oxorcIso of µowor¨); Suµ-
µIomonfnI IrIof for AµµoIIoos In Ko/cenIocl v. McClung,
O. T. l964, Þo. 543, µ. 40 (¨novoI nssorfIon of fodornI
µowor¨); IrIof for AµµoIIoo In Wic/orJ v. IilIurn, O. T.
l94l, Þo. 59, µ. 6 (¨comµIofo doµnrfuro¨). 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
ndnµf 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 oxµInInod nbovo, fho mInImum covorngo
µrovIsIon Is vnIId Commorco CInuso IogIsInfIon. Soo eu-
pro, Inrf II. Whon vIowod ns n comµononf of fho onfIro
ACA, fho µrovIsIon`s consfIfufIonnIIfy bocomos ovon µInIn-
or.
Tho Þocossnry nnd Iroµor CInuso ¨omµowors Congross




















32 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fo onncf Inws In offocfunfIon of Ifs |commorco] µowo|r]
fhnf nro nof wIfhIn Ifs nufhorIfy fo onncf In IsoInfIon.¨
Ioicl, 545 !. S., nf 39 (SCA!IA, J., concurrIng In judgmonf).
Honco, ¨|n] comµIox roguInfory µrogrnm . . . cnn survIvo n
Commorco CInuso chnIIongo wIfhouf n showIng fhnf ovory
sIngIo fncof of fho µrogrnm Is IndoµondonfIy nnd dIrocfIy
roInfod fo n vnIId congrossIonnI gonI.¨ 1nJiono, 452 !. S.,
nf 329, n. l?. ¨If Is onough fhnf fho chnIIongod µrovIsIons
nro nn InfogrnI µnrf of fho roguInfory µrogrnm 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 µrovIsIon
fIfs wIfhIn Congross` commorco nufhorIfy If If Is nn ¨osson-
fInI µnr|f] of n Inrgor roguInfIon of oconomIc ncfIvIfy,¨
such fhnf, In fho nbsonco of fho µrovIsIon, ¨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 µnrf of
n moro gonornI roguInfIon of Inforsfnfo commorco. Tho
roIovnnf quosfIon Is sImµIy whofhor fho monns choson nro
'ronsonnbIy ndnµfod` fo fho nffnInmonf of n IogIfImnfo ond
undor fho commorco µowor.¨ (cIfnfIon omIffod)).
!ocnII fhnf ono of Congross` gonIs In onncfIng fho Af-
fordnbIo Cnro Acf wns fo oIImInnfo fho Insurnnco Indus-
fry`s µrncfIco of chnrgIng hIghor µrIcos or donyIng covorngo
fo IndIvIdunIs wIfh µrooxIsfIng modIcnI condIfIons. Soo
eupro, nf 9l0. Tho commorco µowor nIIows Congross fo
bnn fhIs µrncfIco, n µoInf no ono dIsµufos. 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 comµnnIos do busInoss.¨).
Congross know, howovor, fhnf sImµIy bnrrIng Insurnnco
comµnnIos from roIyIng on nn nµµIIcnnf`s modIcnI hIsfory
wouId nof work In µrncfIco. WIfhouf fho IndIvIdunI mnn-
dnfo, Congross Ionrnod, gunrnnfood-Issuo nnd communIfy-

























33 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
rnfIng roquIromonfs wouId frIggor nn ndvorso-soIocfIon
donfh-sµIrnI In fho honIfh-Insurnnco mnrkof: Insurnnco
µromIums wouId skyrockof, fho numbor of unInsurod
wouId Incronso, nnd Insurnnco comµnnIos wouId oxIf fho
mnrkof. Soo eupro, nf l0ll. Whon comµIomonfod by nn
Insurnnco mnndnfo, on fho ofhor hnnd, gunrnnfood Issuo
nnd communIfy rnfIng wouId work ns Infondod, IncronsIng
nccoss fo Insurnnco nnd roducIng uncomµonsnfod cnro.
Soo eupro, nf lll2. Tho mInImum covorngo µrovIsIon Is
fhus nn ¨ossonfInI µnr|f] of n Inrgor roguInfIon of oconomIc
ncfIvIfy¨; wIfhouf fho µrovIsIon, ¨fho roguInfory schomo
|w]ouId bo undorcuf.¨ Ioicl, 545 !. S., nf 2425 (Infor-
nnI quofnfIon mnrks omIffod). Iuf dIfforonfIy, fho mInI-
mum covorngo µrovIsIon, fogofhor wIfh fho gunrnnfood-
Issuo nnd communIfy-rnfIng roquIromonfs, Is ¨ 'ronsonnbIy
ndnµfod` fo fho nffnInmonf of n IogIfImnfo ond undor
fho commorco µowor¨: fho oIImInnfIon of µrIcIng nnd
snIos µrncfIcos fhnf fnko nn nµµIIcnnf`s modIcnI hIsfory
Info nccounf. Soo iJ., nf 3? (SCA!IA, J., concurrIng In
judgmonf).
I
AssorfIng fhnf fho Þocossnry nnd Iroµor CInuso doos
nof nufhorIzo fho mInImum covorngo µrovIsIon, THI CHIII
J!STICI focusos on fho word ¨µroµor.¨ A mnndnfo fo
µurchnso honIfh Insurnnco Is nof ¨µroµor¨ 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 ImµormIssIbIy
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


















34 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
bofh cnsos, howovor, comµoIIod 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 ImµIomonf n fodornI gun-confroI Inw);
Aeu Yor/, 505 !. S., nf l?6l?? (sfrIkIng down n sfnfufo
roquIrIng sfnfo IogIsInfors fo µnss roguInfIons µursunnf fo
Congross` InsfrucfIons). ¨|IodornI] Inws conscrIµfIng 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 µrovIsIon, In confrnsf, ncfs
¨dIrocfIy uµon IndIvIdunIs, wIfhouf omµIoyIng fho Sfnfos
ns InformodInrIos.¨ Aeu Yor/, 505 !. S., nf l64. Tho
µrovIsIon Is fhus onfIroIy consIsfonf wIfh fho ConsfI-
fufIon`s dosIgn. Soo Prin/c, 52l !. S., nf 920 (¨|T]ho
Irnmors oxµIIcIfIy choso n ConsfIfufIon fhnf confors uµon
Congross fho µowor fo roguInfo IndIvIdunIs, nof Sfnfos.¨
(InfornnI quofnfIon mnrks omIffod)).
!nckIng cnso Inw suµµorf for hIs hoIdIng, THI CHIII
J!STICI novorfhoIoss docInros fho mInImum covorngo
µrovIsIon nof ¨µroµor¨ bocnuso If Is Ioss ¨nnrrow In scoµo¨
fhnn ofhor Inws fhIs Courf hns uµhoId undor fho Þocos-
snry nnd Iroµor 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 Þocossnry nnd
Iroµor CInuso, Cone/oc/, 560 !. S., nf ___ (sIIµ oµ., nf 5),
Is undorwhoImIng.
Þor doos THI CHIII J!STICI µnuso fo oxµInIn ul, fho
µowor fo dIrocf oIfhor fho µurchnso of honIfh Insurnnco or,
nIfornnfIvoIy, fho µnymonf of n µonnIfy coIIocfIbIo ns n fnx
Is moro fnr-ronchIng fhnn ofhor ImµIIod µowors fhIs Courf
hns found moof undor fho Þocossnry nnd Iroµor CInuso.
Thoso µowors IncIudo fho µowor fo onncf crImInnI Inws,






















35 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
soo, e.g., Ini/eJ S/o/ee v. Iox, 95 !. S. 6?0, 6?2 (l8?8); fho
µowor fo ImµrIson, IncIudIng cIvII ImµrIsonmonf, soo, e.g.,
Cone/oc/, 560 !. S., nf ___ (sIIµ oµ., nf l); nnd fho µowor
fo cronfo n nnfIonnI bnnk, soo McCullocl, 4 Whonf., nf 425.
Soo nIso Jin/e, 538 !. S., nf 463 (nffIrmIng Congross`
µowor fo nIfor fho wny n sfnfo Inw Is nµµIIod In sfnfo courf,
whoro fho nIfornfIon ¨µromofos fnIr nnd offIcIonf oµornfIon
of fho fodornI courfs¨).
l0
In fnIIIng fo oxµInIn 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 omµIoyod nn ¨Indoµondonf µowor,¨ on/e, nf 28, or
moroIy n ¨dorIvnfIvo¨ ono, on/e, nf 29. Whofhor fho µowor
usod Is ¨subsfnnfIvo,¨ on/e, nf 30, or jusf ¨IncIdonfnI,¨ on/e,
nf 29¨ Tho InsfrucfIon THI CHIII J!STICI, In offocf,
µrovIdos Iowor courfs: You wIII know If whon you soo If.
If Is moro fhnn oxnggornfIon fo suggosf fhnf fho mInI-
mum covorngo µrovIsIon ImµroµorIy Infrudos on ¨ossonfInI
nffrIbufos of sfnfo sovoroIgnfy.¨ 1IiJ. (InfornnI quofnfIon
mnrks omIffod). IIrsf, fho AffordnbIo Cnro Acf doos nof
oµornfo ¨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 ImµIoyoo !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-
µIos IncIudo fodornI roquIromonfs fo roµorf for jury dufy, 28 !. S. C.
§l866(g) (2006 od., Suµµ. IV); fo rogIsfor for soIocfIvo sorvIco, 50
!. S. C. Aµµ. §453; fo µurchnso fIronrms nnd gonr In nnfIcIµnfIon 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 µnµor
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., Suµµ. IV).
























36 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
monf µInys n Iond roIo In fho honIfh-cnro socfor, bofh ns n
dIrocf µnyor nnd ns n roguInfor.
Socond, nnd µorhnµs mosf Imµorfnnf, fho mInImum
covorngo µrovIsIon, nIong wIfh ofhor µrovIsIons of fho
ACA, nddrossos fho vory sorf of Inforsfnfo µrobIom fhnf
mndo fho commorco µowor 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 ¨soµnrnfoIy Incomµo-
fonf¨ fo hnndIo. Soo eupro, nf ?8, l3. Soo nIso MnryInnd
IrIof l526 (doscrIbIng ¨fho ImµodImonfs fo offocfIvo sfnfo
µoIIcymnkIng fhnf fIow from fho Inforconnocfodnoss of
onch sfnfo`s honIfhcnro oconomy¨ nnd omµhnsIzIng fhnf
¨sfnfo-IovoI roforms cnnnof fuIIy nddross fho µrobIoms
nssocInfod wIfh uncomµonsnfod cnro¨). Inr from frnm-
µIIng on Sfnfos` sovoroIgnfy, fho ACA nffomµfs n fodornI
soIufIon for fho vory ronson fhnf fho Sfnfos, ncfIng soµn-
rnfoIy, cnnnof moof fho nood. ÞofnbIy, fho ACA sorvos fho
gonornI woIfnro of fho µooµIo of fho !nIfod Sfnfos whIIo
rofnInIng n µromInonf roIo for fho Sfnfos. Soo iJ., nf 3l
36 (oxµInInIng nnd IIIusfrnfIng how fho ACA nffords Sfnfos
wIdo InfIfudo In ImµIomonfIng koy oIomonfs of fho Acf`s
roforms).
ll

ll
In n soµnrnfo nrgumonf, fho joInf dIssonfors confond fhnf fho mIn-
Imum covorngo µrovIsIon Is nof nocossnry nnd µroµor 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 sµIrnI, fho dIssonfors mnIn-
fnIn, by ImµosIng n surchnrgo on fhoso who dId nof µrovIousIy µurchnso
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 µurchnso Insurnnco. 1IiJ.
ÞoIfhor n surchnrgo on fhoso who µurchnso Insurnnco nor fho do-
nInI of n fnx crodIf fo fhoso who do nof wouId soIvo fho µrobIom cronfod
by gunrnnfood-Issuo nnd communIfy-rnfIng roquIromonfs. ÞoIfhor
wouId µromµf fho µurchnso of Insurnnco boforo sIcknoss or Injury
occurrod.


























3? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
IV
In fho onrIy 20fh confury, fhIs Courf roguInrIy sfruck
down oconomIc roguInfIon onncfod by fho µooµIos` roµro-
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 oµInIon, 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 uµhoIds fho IndIvIdunI mnndnfo
ns n µroµor oxorcIso of Congross` µowor fo fnx nnd sµond
¨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 µuzzIIng. Why shouId THI CHIII
J!STICI sfrIvo so mIghfIIy fo hom In Congross` cnµncIfy fo
moof fho now µrobIoms nrIsIng consfnnfIy In our ovor-
dovoIoµIng modorn oconomy¨ I fInd no snfIsfyIng rosµonso
fo fhnf quosfIon In hIs oµInIon.
l2

Iuf ovon nssumIng fhoro woro ¨µrncfIcnbIo¨ nIfornnfIvos fo fho
mInImum covorngo µrovIsIon, ¨wo Iong ngo rojocfod fho vIow fhnf fho
Þocossnry nnd Iroµor CInuso domnnds fhnf nn Acf of Congross bo
'oIeolu/el, nocossnry` fo fho oxorcIso of nn onumornfod µowor.¨ Jin/e
v. IicllonJ Coun/,, 538 !. S. 456, 462 (2003) (quofIng McCullocl
v. Mor,lonJ, 4 Whonf. 3l6, 4l44l5 (l8l9)). !nfhor, fho sfnfufory
µrovIsIon nf Issuo nood onIy bo ¨conducIvo¨ nnd ¨|ronsonnbIy] ndnµfod¨
fo fho gonI Congross sooks fo nchIovo. Jin/e, 538 !. S., nf 462 (InfornnI
quofnfIon mnrks omIffod). Tho mInImum covorngo µrovIsIon moofs fhIs
roquIromonf. Soo eupro, nf 3l33.
l2
THI CHIII J!STICI sfnfos fhnf ho musf ovnIunfo fho consfIfufIon-
nIIfy of fho mInImum covorngo µrovIsIon undor fho Commorco CInuso
bocnuso fho µrovIsIon ¨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 InforµrofIng fho µrovIsIon ns n fnx Is n ¨fnIrIy
µossIbIo¨ 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.



















38 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
V
Through ModIcnId, Congross hns offorod fho Sfnfos nn
oµµorfunIfy fo furnIsh honIfh cnro fo fho µoor wIfh fho nId
of fodornI fInnncIng. To rocoIvo fodornI ModIcnId funds,
Sfnfos musf µrovIdo honIfh bonofIfs fo sµocIfIod cnfogorIos
of noody µorsons, IncIudIng µrognnnf womon, chIIdron,
µnronfs, nnd nduIfs wIfh dIsnbIIIfIos. Cunrnnfood oIIgIbII-
Ify vnrIos by cnfogory: for somo If Is fIod fo fho fodornI
µovorfy IovoI (Incomos uµ fo l00° or l33°); for ofhors If
doµonds on crIforIn such ns oIIgIbIIIfy for dosIgnnfod sfnfo
or fodornI nssIsfnnco µrogrnms. Tho ACA onInrgos fho
µoµuInfIon of noody µooµIo Sfnfos musf covor fo IncIudo
nduIfs undor ngo 65 wIfh Incomos uµ fo l33° of fho fod-
ornI µovorfy IovoI. Tho sµondIng µowor conforrod by fho
ConsfIfufIon, fho Courf hns novor doubfod, µormIfs Con-
gross fo dofIno fho confours of µrogrnms 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 oxµnnd
covorngo, Congross couId hnvo rocnIIod fho oxIsfIng IogIs-
InfIon, nnd roµIncod If wIfh n now Inw mnkIng ModIcnId ns
ombrncIvo of fho µoor ns Congross choso.
Tho quosfIon µosod by fho 20l0 ModIcnId oxµnnsIon,
fhon, Is ossonfInIIy fhIs: To covor n nofnbIy Inrgor µoµuIn-
fIon, musf Congross fnko fho roµonI/roonncf roufo, or mny
If nchIovo fho snmo rosuIf by nmondIng oxIsfIng Inw¨ Tho
nnswor shouId bo fhnf Congross mny oxµnnd by nmond-
monf fho cInssos of noody µorsons onfIfIod fo ModIcnId
bonofIfs. A rIfunIIsfIc roquIromonf fhnf Congross roµonI
nnd roonncf sµondIng IogIsInfIon In ordor fo onInrgo fho
µoµuInfIon sorvod by n fodornIIy fundod µrogrnm wouId
ndvnnco no consfIfufIonnI µrIncIµIo nnd wouId scnrcoIy
sorvo fho Inforosfs of fodornIIsm. To fho confrnry, such n
roquIromonf wouId rIgIdIfy Congross` offorfs fo omµowor
Sfnfos by µnrfnorIng wIfh fhom In fho ImµIomonfnfIon of
fodornI µrogrnms.
ModIcnId Is n µrofofyµIcnI oxnmµIo of fodornI-sfnfo cooµ-
















39 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
ornfIon In sorvIng fho ÞnfIon`s gonornI woIfnro. !nfhor
fhnn nufhorIzIng n fodornI ngoncy fo ndmInIsfor n unI-
form nnfIonnI honIfh-cnro sysfom for fho µoor, Con-
gross offorod Sfnfos fho oµµorfunIfy fo fnIIor ModIcnId
grnnfs fo fhoIr µnrfIcuInr noods, so Iong ns fhoy romnIn
wIfhIn bounds sof by fodornI Inw. In shnµIng ModIcnId,
Congross dId nof ondonvor fo fIx µormnnonfIy fho forms
µnrfIcIµnfIng sfnfos musf moof; Insfond, Congross ro-
sorvod fho ¨rIghf fo nIfor, nmond, or roµonI¨ nny µrovIsIon
of fho ModIcnId Acf. 42 !. S. C. §l304. Sfnfos, for fhoIr
µnrf, ngrood fo nmond fhoIr own ModIcnId µInns 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
µrosonf, Sfnfos hnvo roguInrIy conformod fo Congross`
nIfornfIons of fho ModIcnId Acf.
THI CHIII J!STICI ncknowIodgos fhnf Congross mny
¨condIfIon fho rocoIµf of |fodornI] funds on fho Sfnfos`
comµIyIng wIfh rosfrIcfIons on fho uso of fhoso funds,¨
on/e, nf 50, buf novorfhoIoss concIudos fhnf fho 20l0
oxµnnsIon Is unduIy coorcIvo. HIs concIusIon rosfs on
fhroo µromIsos, onch of fhom ossonfInI fo hIs fhoory. IIrsf,
fho ModIcnId oxµnnsIon Is, In THI CHIII J!STICI`s vIow, n
now grnnf µrogrnm, nof nn nddIfIon fo fho ModIcnId µro-
grnm oxIsfIng boforo fho ACA`s onncfmonf. Congross, THI
CHIII J!STICI mnInfnIns, hns fhronfonod Sfnfos wIfh fho
Ioss of funds from nn oId µrogrnm In nn offorf fo gof fhom
fo ndoµf n now ono. Socond, fho oxµnnsIon 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 µnrfIcIµnfo In fho ModI-
cnId oxµnnsIon. THI CHIII J!STICI fhoroforofor /le
fire/ /ine eterfInds nn oxorcIso of Congross` sµondIng
µowor unconsfIfufIonnIIy coorcIvo.
ModIcnId, ns nmondod by fho ACA, howovor, Is nof fwo
sµondIng µrogrnms; If Is n sIngIo µrogrnm wIfh n consfnnf
nImfo onnbIo µoor µorsons fo rocoIvo bnsIc honIfh cnro


















40 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
whon fhoy nood If. CIvon µnsf oxµnnsIons, µIus oxµross
sfnfufory wnrnIng fhnf Congross mny chnngo fho ro-
quIromonfs µnrfIcIµnfIng 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 oµµorfunIfy fo nccoµf funds
on Congross` forms. Iufuro Congrossos nro nof bound
by fhoIr µrodocossors` dIsµosIfIons; fhoy hnvo nufhorIfy fo
sµond 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 sµondIng µrogrnm In ordor fo Induco fhom fo oµf Info
nnofhor µrogrnm. Congross Is sImµIy roquIrIng Sfnfos fo
do whnf Sfnfos hnvo Iong boon roquIrod fo do fo rocoIvo
ModIcnId fundIng: comµIy wIfh fho condIfIons Congross
µroscrIbos for µnrfIcIµnfIon.
A mnjorIfy of fho Courf, howovor, buys fho nrgumonf
fhnf µrosµocfIvo wIfhhoIdIng of funds formorIy nvnIInbIo
oxcoods Congross` sµondIng µowor. CIvon fhnf hoIdIng, I
onfIroIy ngroo wIfh THI CHIII J!STICI ns fo fho nµµroµrI-
nfo romody. If Is fo bnr fho wIfhhoIdIng found ImµormIs-
sIbIonof, ns fho joInf dIssonfors wouId hnvo If, fo scrnµ
fho oxµnnsIon nIfogofhor, soo poe/, nf 4648. Tho dIssonf-
ors` vIow fhnf fho ACA musf fnII In Ifs onfIrofy Is n rndIcnI
doµnrfuro from fho Courf`s normnI courso. Whon n consfI-
fufIonnI InfIrmIfy mnrs n sfnfufo, fho Courf ordInnrIIy
romovos fho InfIrmIfy. If undorfnkos n snIvngo oµornfIon;
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 µInInIy In ordor whoro, ns In fhIs
cnso, Congross hns oxµrossIy Insfrucfod courfs fo Ionvo
unfouchod ovory µrovIsIon 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)
OµInIon of CIÞSI!!C, J.
µnfIbIo wIfh fho SµondIng CInuso, Congross` oxfonsIon of
ModIcnId romnIns nvnIInbIo fo nny Sfnfo fhnf nffIrms Ifs
wIIIIngnoss fo µnrfIcIµnfo.
A
IxµnnsIon hns boon chnrncforIsfIc of fho ModIcnId µro-
grnm. AkIn fo fho ACA In 20l0, fho ModIcnId Acf ns
µnssod In l965 nugmonfod oxIsfIng fodornI grnnf µrogrnms
joInfIy ndmInIsforod wIfh fho Sfnfos.
l3
Sfnfos woro nof
roquIrod fo µnrfIcIµnfo In ModIcnId. Iuf If fhoy dId, fho
IodornI Covornmonf µnId 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 µrogrnms: AId fo InmIIIos wIfh
Ðoµondonf ChIIdron; OId Ago AssIsfnnco; AId fo fho IIInd;
nnd AId fo fho IormnnonfIy nnd TofnIIy ÐIsnbIod. Soo
SocInI SocurIfy Amondmonfs of l965, §l2l(n), ?9 Sfnf.
343; Scluei/er v. Gro, Pon/lere, 453 !. S. 34, 3? (l98l).
Af fhoIr oµfIon, Sfnfos couId onroII nddIfIonnI ¨modIcnIIy
noody¨ IndIvIdunIs; fhoso cosfs, foo, woro µnrfInIIy borno by
fho IodornI Covornmonf nf fho snmo, nf Ionsf 50°, rnfo.
1IiJ.
SInco l965, Congross hns nmondod fho ModIcnId µro-
grnm on moro fhnn 50 occnsIons, somofImos quIfo sIznbIy.
Mosf roIovnnf horo, bofwoon l988 nnd l990, Congross

l3
ModIcnId wns ¨µInInIy nn oxfonsIon of fho oxIsfIng Korr-MIIIs¨
grnnf µrogrnm. HuborfoId, IodornIIzIng ModIcnId, l4 !. In. J. Consf.
!. 43l, 444445 (20ll). Indood, fho ¨socfIon of fho Sonnfo roµorf
donIIng wIfh TIfIo XIX¨fho fIfIo osfnbIIshIng ModIcnId¨wns onfIfIod,
'Imµrovomonf nnd IxfonsIon of Korr-MIIIs ModIcnI AssIsfnnco Iro-
grnm.` ¨ Sfovons & Sfovons, WoIfnro ModIcIno In AmorIcn 5l (l9?4)
(quofIng S. !oµ. Þo. 404, 89fh Cong., lsf Soss., µf. l, µ. 9 (l965)).
SoffIng fho µnfforn for ModIcnId, Korr-MIIIs roImbursod Sfnfos for n
µorfIon of fho cosf of honIfh cnro µrovIdod fo woIfnro rocIµIonfs If
Sfnfos mof condIfIons sµocIfIod In fho fodornI Inw, e.g., µnrfIcIµnfIng
Sfnfos woro obIIgod fo offor mInImum covorngo for hosµIfnIIznfIon nnd
µhysIcInn sorvIcos. Soo HuborfoId, eupro, nf 443444.



















42 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
roquIrod µnrfIcIµnfIng Sfnfos fo IncIudo nmong fhoIr bono-
fIcInrIos µrognnnf womon wIfh fnmIIy Incomos uµ fo l33°
of fho fodornI µovorfy IovoI, chIIdron uµ fo ngo 6 nf fho
snmo Incomo IovoIs, nnd chIIdron ngos 6 fo l8 wIfh fnmIIy
Incomos uµ fo l00° of fho µovorfy IovoI. Soo 42 !. S. C.
§§l396n(n)(l0)(A)(I), l396n(l); ModIcnro CnfnsfroµhIc 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 µoµuInfIon. Ðubny & Konnoy, !ossons
from fho ModIcnId IxµnnsIons for ChIIdron nnd Irognnnf
Womon 5 (Aµr. l99?).
Iofwoon l966 nnd l990, nnnunI fodornI ModIcnId sµond-
Ing grow from $63l.6 mIIIIon fo $42.6 bIIIIon; sfnfo
sµondIng roso fo $3l bIIIIon ovor fho snmo µorIod. Soo Ðoµf.
of HonIfh nnd Humnn SorvIcos, ÞnfIonnI HonIfh IxµondI-
furos by Tyµo of SorvIco nnd Sourco of Iunds: CnIondnr
Yonrs l960 fo 20l0 (fnbIo).
l4
And bofwoon l990 nnd 20l0,
fodornI sµondIng Incronsod fo $269.5 bIIIIon. 1IiJ. In-
Inrgomonf of fho µoµuInfIon nnd sorvIcos covorod by ModI-
cnId, In shorf, hns boon fho frond.
Comµnrod fo µnsf nIfornfIons, fho ACA Is nofnbIo for fho
oxfonf fo whIch fho IodornI Covornmonf wIII µIck uµ fho
fnb. ModIcnId`s 20l0 oxµnnsIon 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., Suµµ. IV). Iy comµnrIson,
fodornI confrIbufIons fownrd fho cnro of bonofIcInrIos
oIIgIbIo µro-ACA rnngo from 50° fo 83°, nnd nvorngod
5?° bofwoon 2005 nnd 2008. §l396d(b) (2006 od., Suµµ.

l4
AvnIInbIo onIIno nf hffµ://www.cms.gov/!osonrch-SfnfIsfIcs-Ðnfn-
nnd-Sysfoms/SfnfIsfIcs-Tronds-nnd-!oµorfs/ÞnfIonnIHonIfhIxµondÐnfn/
ÞnfIonnIHonIfhAccounfsHIsforIcnI.hfmI.
























43 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
IV); Ðoµf. of HonIfh nnd Humnn SorvIcos, Confors for
ModIcnro nnd ModIcnId SorvIcos, C. Truffor of nI., 20l0
AcfunrInI !oµorf on fho IInnncInI OufIook for ModIcnId,
µ. 20.
Þor wIII fho oxµnnsIon oxorbIfnnfIy Incronso sfnfo ModI-
cnId sµondIng. Tho CongrossIonnI Iudgof OffIco (CIO)
µrojocfs fhnf Sfnfos wIII sµond 0.8° moro fhnn fhoy wouId
hnvo, nbsonf fho ACA. Soo CIO, SµondIng & InroIImonf
ÐofnII 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 oµInIon of SCA!IA,
KIÞÞIÐY, THOMAS, nnd A!ITO, JJ.) (¨|A]ccoµfnnco of fho
|ACA oxµnnsIon] wIII Imµoso vory subsfnnfInI cosfs on
µnrfIcIµnfIng Sfnfos.¨). Whnfovor fho Incronso In sfnfo
obIIgnfIons nffor fho ACA, If wIII µnIo In comµnrIson fo fho
Incronso In fodornI fundIng.
l5
IInnIIy, nny fnIr nµµrnIsnI of ModIcnId wouId roquIro
ncknowIodgmonf of fho consIdornbIo nufonomy Sfnfos
onjoy undor fho Acf. Inr from ¨conscrIµf|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 µnrf nnd dIssonf-
Ing In µnrf) (brnckofs In orIgInnI nnd InfornnI quofnfIon
mnrks omIffod)), ModIcnId ¨Is dosIgnod fo ndvnnco cooµor-
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 µInInfIffs roIy, soo IrIof for IofIfIonors
l0, concIudos fhnf ¨|w]hIIo mosf sfnfos wIII oxµorIonco somo Incronso In
sµondIng, fhIs Is quIfo smnII roInfIvo fo fho fodornI mnfchIng µnymonfs
nnd Iow roInfIvo fo fho cosfs of uncomµonsnfod cnro fhnf |fho sfnfos]
wouId bonr If fho|ro] woro no honIfh roform.¨ Soo KnIsor CommIssIon
on ModIcnId & fho !nInsurod, ModIcnId Covorngo & SµondIng In
HonIfh !oform l6 (Mny 20l0). Thus fhoro cnn bo no objocfIon fo fho
ACA`s oxµnnsIon of ModIcnId ns nn ¨unfundod mnndnfo.¨ QuIfo fho
confrnry, fho µrogrnm Is ImµrossIvoIy woII fundod.















44 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
roquIromonfs, fho ModIcnId Acf omµowors Sfnfos fo ¨soIocf
drnmnfIcnIIy dIfforonf IovoIs of fundIng nnd covorngo,
nIfor nnd oxµorImonf wIfh dIfforonf fInnncIng nnd doIIvory
modos, nnd oµf fo covor (or nof fo covor) n rnngo of µnrfI-
cuInr µrocoduros nnd fhornµIos. Sfnfos hnvo Iovorngod
fhIs µoIIcy dIscrofIon fo gonornfo n myrInd of drnmnfIcnIIy
dIfforonf ModIcnId µrogrnms ovor fho µnsf sovornI doc-
ndos.¨ !ugor, Of Icoborgs nnd CIncIors, ?5 !nw & Con-
fomµ. Irobs. 2l5, 233 (20l2) (foofnofo omIffod). Tho ACA
doos nof joffIson fhIs nµµronch. Sfnfos, ns fIrsf-IIno nd-
mInIsfrnfors, wIII confInuo fo guIdo fho dIsfrIbufIon of
subsfnnfInI rosourcos nmong fhoIr noody µoµuInfIons.
Tho nIfornnfIvo fo condIfIonnI fodornI sµondIng, If bonrs
omµhnsIs, 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 µro-
grnm. Insfond, Congross gnvo fho Sfnfos fho oµµorfunIfy
fo µnrfnor In fho µrogrnm`s ndmInIsfrnfIon nnd dovoIoµ-
monf. Absonf from fho nnfIonnIIzod modoI, of courso, Is
fho sfnfo-IovoI µoIIcy dIscrofIon nnd oxµorImonfnfIon fhnf
Is ModIcnId`s hnIImnrk; undoubfodIy fho Inforosfs of fod-
ornIIsm nro boffor sorvod whon Sfnfos rofnIn n monnIng-
fuI roIo In fho ImµIomonfnfIon of n µrogrnm of such
Imµorfnnco. Soo CnmInkor, Sfnfo SovoroIgnfy nnd Sub-
ordInncy, 95 CoIum. !. !ov. l00l, l002l003 (l995) (cooµorn-
fIvo fodornIIsm cnn µrosorvo ¨n sIgnIfIcnnf roIo for sfnfo
dIscrofIon In nchIovIng sµocIfIod fodornI gonIs, whoro fho
nIfornnfIvo Is comµIofo fodornI µroomµfIon of nny sfnfo

l6
In l9?2, for oxnmµIo, Congross ondod fho fodornI cnsh-nssIsfnnco
µrogrnm for fho ngod, bIInd, nnd dIsnbIod. Thnf µrogrnm µrovIousIy
hnd boon oµornfod joInfIy by fho IodornI nnd Sfnfo Covornmonfs, ns
Is fho cnso wIfh ModIcnId fodny. Congross roµIncod fho cooµornfIvo
fodornI µrogrnm wIfh fho nnfIonnIIzod SuµµIomonfnI SocurIfy In-
como (SSI) µrogrnm. Soo Scluei/er v. Gro, Pon/lere, 453 !. S. 34, 38
(l98l).
























45 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
roguInfory roIo¨); !oso-Ackormnn, CooµornfIvo IodornIIsm
nnd Co-oµfnfIon, 92 YnIo !. J. l344, l346 (l983) (¨If
fho fodornI govornmonf bogIns fo fnko fuII rosµonsIbIIIfy
for socInI woIfnro sµondIng nnd µroomµfs fho sfnfos, fho
rosuIf Is IIkoIy fo bo wonkor . . . sfnfo govornmonfs.¨).
l?
AIfhough Congross ¨hns no obIIgnfIon fo uso Ifs Sµond-
Ing CInuso µowor 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 µrovIdod 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 oxµnn-
sIon In fhoIr sIzo nnd scoµo.
I
Tho SµondIng CInuso nufhorIzos Congross ¨fo µny fho
Ðobfs nnd µrovIdo for fho . . . gonornI WoIfnro of fho
!nIfod Sfnfos.¨ Arf. I, §8, cI. l. To onsuro fhnf fodornI funds
grnnfod fo fho Sfnfos nro sµonf ¨fo 'µrovIdo for fho . . .
gonornI WoIfnro` In fho mnnnor Congross Infondod,¨ on/e,
nf 46, Congross musf of courso hnvo nufhorIfy fo Imµoso
IImIfnfIons on fho Sfnfos` uso of fho fodornI doIInrs. ThIs
Courf, fImo nnd ngnIn, hns rosµocfod Congross` µroscrIµ-
fIon of sµondIng 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 µnrfIcuInr, wo hnvo rocognIzod Congross`
µrorognfIvo fo condIfIon n Sfnfo`s rocoIµf of ModIcnId

l?
THI CHIII J!STICI nnd fho joInf dIssonfors µorcoIvo In cooµornfIvo
fodornIIsm n ¨fhron|f]¨ fo ¨µoIIfIcnI nccounfnbIIIfy.¨ An/e, nf 48; soo
poe/, nf 3435. Iy fhnf, fhoy monn vofor confusIon: CIfIzons uµsof by
unµoµuInr govornmonf ncfIon, fhoy µosIf, mny nscrIbo fo sfnfo offIcInIs
bInmo moro nµµroµrInfoIy InId nf Congross` door. Iuf no such confu-
sIon Is nµµnronf In fhIs cnso: ModIcnId`s sfnfus ns n fodornIIy fundod,
sfnfo-ndmInIsforod µrogrnm Is hnrdIy hIddon from vIow.






















46 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fundIng on comµIInnco wIfh fho forms Congross sof for
µnrfIcIµnfIon In fho µrogrnm. Soo, e.g., Horrie, 448 !. S.,
nf 30l (¨|O]nco n Sfnfo oIocfs fo µnrfIcIµnfo |In ModIcnId],
If musf comµIy 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 sµondIng µrogrnms ns fIrsf Inunchod.
Tho IogIsInfuro mny, nnd offon doos, nmond fho Inw, Im-
µosIng now condIfIons grnnf rocIµIonfs 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 ndoµfIon of oducnfIonnI µrogrnm)).
Yos, fhoro nro fodornIIsm-bnsod IImIfs on fho uso of
Congross` condIfIonnI sµondIng µowor. 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
µIncod on fodornI grnnfs fo Sfnfos musf (n) µromofo fho
¨gonornI woIfnro,¨ (b) ¨unnmbIguousIy¨ Inform Sfnfos whnf
Is domnndod of fhom, (c) bo gormnno ¨fo fho fodornI Infor-
osf In µnrfIcuInr nnfIonnI µrojocfs or µrogrnms,¨ 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 ndoµf, n fur-
fhor IImIfnfIon, ono hyµofhofIcnIIy rnIsod n hnIf-confury
onrIIor: In ¨somo cIrcumsfnncos,¨ Congross mIghf bo µro-
hIbIfod from offorIng n ¨fInnncInI Inducomonf . . . so coor-

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

















4? CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
cIvo ns fo µnss fho µoInf nf whIch 'µrossuro furns Info
comµuIsIon.` ¨ 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 fomµfnfIon
nnd coorcIon.
Dole InvoIvod fho ÞnfIonnI MInImum ÐrInkIng Ago Acf,
23 !. S. C. §l58, onncfod In l984. Thnf Acf dIrocfod fho
Socrofnry of TrnnsµorfnfIon fo wIfhhoId 5° of fho fodornI
hIghwny funds ofhorwIso µnynbIo fo n Sfnfo If fho Sfnfo
µormIffod µurchnso of nIcohoIIc bovorngos by µorsons
Ioss fhnn 2l yonrs oId. ÐrInkIng ngo wns nof wIfhIn fho
nufhorIfy of Congross fo roguInfo, Soufh Ðnkofn nrguod,
bocnuso fho Twonfy-IIrsf Amondmonf gnvo fho Sfnfos
oxcIusIvo µowor fo confroI fho mnnufncfuro, frnnsµorfn-
fIon, nnd consumµfIon of nIcohoIIc bovorngos. Tho smnII
µorconfngo of hIghwny-consfrucfIon funds Soufh Ðnkofn
sfood fo Ioso by ndhorIng fo l9 ns fho ngo of oIIgIbIIIfy fo
µurchnso 3.2° boor, howovor, wns nof onough fo qunIIfy ns
coorcIon, fho Courf concIudod.
ThIs cnso doos nof µrosonf fho concorns fhnf Iod fho
Courf In Dole ovon fo consIdor fho µrosµocf of coorcIon. In
Dole, fho condIfIonsof 2l ns fho mInImum drInkIng ngo
dId nof foII fho Sfnfos how fo uso funds Congross µro-
vIdod for hIghwny consfrucfIon. Iurfhor, In vIow of fho
Twonfy-IIrsf Amondmonf, If wns nn oµon quosfIon whofhor
Congross couId dIrocfIy Imµoso n nnfIonnI mInImum
drInkIng ngo.
Tho ACA, In confrnsf, roInfos soIoIy fo fho fodornIIy
fundod ModIcnId µrogrnm; If Sfnfos chooso nof fo comµIy,
Congross hns nof fhronfonod fo wIfhhoId funds onrmnrkod
for nny ofhor µrogrnm. Þor doos fho ACA uso ModIcnId
fundIng fo Induco Sfnfos fo fnko ncfIon Congross IfsoIf
couId nof undorfnko. Tho IodornI Covornmonf undoubf-
odIy couId oµornfo Ifs own honIfh-cnro µrogrnm for µoor
µorsons, jusf ns If oµornfos ModIcnro for sonIors` honIfh



















48 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
cnro. Soo eupro, nf 44.
Thnf Is whnf mnkos fhIs such n sImµIo cnso, nnd fho
Courf`s docIsIon so unsoffIIng. Congross, nImIng fo nssIsf
fho noody, hns nµµroµrInfod fodornI monoy fo subsIdIzo
sfnfo honIfh-Insurnnco µrogrnms fhnf moof fodornI sfnnd-
nrds. Tho µrIncIµnI sfnndnrd fho ACA sofs Is fhnf fho
sfnfo µrogrnm covor nduIfs onrnIng no moro fhnn l33° of
fho fodornI µovorfy IIno. InforcIng fhnf µroscrIµfIon on-
suros fhnf fodornI funds wIII bo sµonf on honIfh cnro for
fho µoor In furfhornnco of Congross` µrosonf µorcoµfIon of
fho gonornI woIfnro.
C
THI CHIII J!STICI nssorfs fhnf fho ModIcnId oxµnn-
sIon cronfos n ¨now honIfh cnro µrogrnm.¨ An/e, nf 54.
Moroovor, Sfnfos couId ¨hnrdIy nnfIcIµnfo¨ fhnf Congross
wouId ¨frnnsform |fho µrogrnm] 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 µnrfIcIµnfo In fho ¨now¨ µrogrnm Is n ¨fhron|f] fo
formInnfo |nn]ofhor . . . Indoµondonf grnn|f].¨ An/e, nf 50,
5253. And bocnuso fho fhronf fo wIfhhoId n Inrgo nmounf
of funds from ono µrogrnm ¨Ionvos fho Sfnfos wIfh no ronI
oµfIon buf fo ncquIosco |In n nowIy cronfod µrogrnm],¨ THI
CHIII J!STICI concIudos, fho ModIcnId oxµnnsIon Is un-
consfIfufIonnIIy coorcIvo. An/e, nf 52.
l
Tho sfnrfIng µromIso 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 µrogrnm fo co-oxIsf wIfh fho oId. THI CHIII J!STICI
cnIIs fho ACA now, buf In frufh, If sImµIy ronchos moro of
AmorIcn`s µoor fhnn Congross orIgInnIIy covorod.
ModIcnId wns cronfod fo onnbIo Sfnfos fo µrovIdo modI-
cnI nssIsfnnco fo ¨noody µorsons.¨ Soo S. !oµ. Þo. 404,




















49 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
89fh Cong., lsf Soss., µf. l, µ. 9 (l965). Soo nIso §l2l(n),
?9 Sfnf. 343 (Tho µurµoso of ModIcnId Is fo onnbIo Sfnfos
¨fo furnIsh . . . modIcnI nssIsfnnco on bohnIf of |corfnIn
µorsons] 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 µoµuInfIon of
AmorIcnns unnbIo fo nfford If, fho ModIcnId oxµnnsIon Is
nn oxfonsIon of fhnf bnsIc nIm.
Tho ModIcnId Acf confnIns hundrods of µrovIsIons gov-
ornIng oµornfIon of fho µrogrnm, soffIng condIfIons rnng-
Ing from ¨!ImIfnfIon on µnymonfs fo Sfnfos for oxµond-
Ifuros nffrIbufnbIo fo fnxos,¨ 42 !. S. C. §l396n(f) (2006
od.), fo ¨ModIcnI nssIsfnnco fo nIIons nof InwfuIIy ndmIffod
for µormnnonf rosIdonco,¨ §l396b(v) (2006 od. nnd Suµµ.
IV). Tho ModIcnId oxµnnsIon Ionvos unchnngod fho vnsf
mnjorIfy of fhoso µrovIsIons; If ndds bonofIcInrIos fo fho
oxIsfIng µrogrnm nnd sµocIfIos fho rnfo nf whIch Sfnfos
wIII bo roImbursod for sorvIcos µrovIdod fo fho nddod bono-
fIcInrIos. Soo ACA §§200l(n)(l), (3), l24 Sfnf. 2?l2?2.
Tho ACA doos nof doscrIbo oµornfIonnI nsµocfs of fho
µrogrnm for fhoso nowIy oIIgIbIo µorsons; for fhnf Infor-
mnfIon, ono musf rond fho oxIsfIng ModIcnId Acf. Soo 42
!. S. C. §§l396l396v(b) (2006 od. nnd Suµµ. IV).
Congross sfyIod nnd cIonrIy vIowod fho ModIcnId oxµnn-
sIon ns nn nmondmonf fo fho ModIcnId Acf, nof ns n ¨now¨
honIfh-cnro µrogrnm. 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
µovorfy IovoI. Tho oxµnnsIon Is offocfunfod by §200l of fho
ACA, nµfIy fIfIod: ¨ModIcnId Covorngo for fho !owosf
Incomo IoµuInfIons.¨ l24 Sfnf. 2?l. Thnf socfIon nmonds
TIfIo 42, Chnµfor ?, Subchnµfor XIX: Crnnfs fo Sfnfos for
ModIcnI AssIsfnnco Irogrnms. CommonIy known ns fho
ModIcnId Acf, Subchnµfor XIX fIIIod somo 2?8 µngos In




















50 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
2006. SocfIon 200l of fho ACA wouId ndd nµµroxImnfoIy
fhroo µngos.
l9
Congross hns brond nufhorIfy fo consfrucf or ndjusf
sµondIng µrogrnms fo moof Ifs confomµornry undorsfnnd-
Ing of ¨fho gonornI WoIfnro.¨ Heltering v. Dotie, 30l !. S.
6l9, 64064l (l93?). Courfs owo n Inrgo monsuro of ro-
sµocf fo Congross` chnrncforIznfIon of fho grnnf µrogrnms
If osfnbIIshos. Soo S/euorJ Mocline, 30l !. S., nf 594.
Ivon If courfs woro IncIInod fo socond-guoss Congross`
concoµfIon of fho chnrncfor of Ifs IogIsInfIon, how wouId
rovIowIng judgos dIvIno whofhor nn Acf of Congross, µur-
µorfIng fo nmond n Inw, Is In ronIIfy nof nn nmondmonf,
buf n now cronfIon¨ Af whnf µoInf doos nn oxfonsIon
bocomo so Inrgo fhnf If ¨frnnsforms¨ fho bnsIc Inw¨
IndonvorIng fo show fhnf Congross cronfod n now µro-
grnm, THI CHIII J!STICI cIfos fhroo nsµocfs of fho ox-
µnnsIon. IIrsf, ho nssorfs fhnf, In covorIng fhoso onrnIng
no moro fhnn l33° of fho fodornI µovorfy IIno, fho ModI-
cnId oxµnnsIon, unIIko µro-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 µor
yonrl33° of fho curronf fodornI µovorfy IovoIsuroIy
rnnk nmong fho ÞnfIon`s µoor.
Socond, nccordIng fo THI CHIII J!STICI, ¨Congross
mnndnfod fhnf nowIy oIIgIbIo µorsons rocoIvo n IovoI of
covorngo fhnf Is Ioss comµrohonsIvo fhnn fho frndIfIonnI
ModIcnId bonofIf µnckngo.¨ 1IiJ. Thnf Ioss comµrohonsIvo
bonofIf µnckngo, 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
Comµnro Subchnµfor XIX, 42 !. S. C. §§l396l396v(b) (2006 od.
nnd Suµµ. IV) wIfh §§l396n(n) (l0)(A)(I)(VIII) (2006 od. nnd Suµµ.
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 ÐofIcIf !oducfIon Acf of 2005 nufhorIzod Sfnfos fo µrovIdo
¨bonchmnrk covorngo¨ or ¨bonchmnrk oquIvnIonf covorngo¨ fo corfnIn





















5l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
fIfs offorod fhoroforo doos nof sof nµnrf µosf-ACA ModIcnId
rocIµIonfs from nII fhoso onfIfIod fo bonofIfs µro-ACA.
ThIrd, THI CHIII J!STICI corrocfIy nofos fhnf fho
roImbursomonf rnfo for µnrfIcIµnfIng Sfnfos Is dIffor-
onf rognrdIng IndIvIdunIs who bocnmo ModIcnId-oIIgIbIo
fhrough fho ACA. 1IiJ. Iuf fho rnfo dIffors onIy In Ifs
gonorosIfy fo µnrfIcIµnfIng Sfnfos. !ndor µro-ACA ModI-
cnId, fho IodornI Covornmonf µnys uµ fo 83° of fho cosfs
of covorngo for curronf onroIIoos, §l396d(b) (2006 od. nnd
Suµµ. 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 ? µorconf-
ngo µoInfs cnrrIos consfIfufIonnI sIgnIfIcnnco, Is If nof
µnssIng sfrnngo fo suggosf fhnf fho µurµorfod 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 roµonIod ModI-
cnId. Soo eupro, nf 3839 (cIfIng 42 !. S. C. §l304); IrIof
for IofIfIonors In Þo. ll400, µ. 4l. Thoronffor, Congross
couId hnvo onncfod ModIcnId II, n now µrogrnm combIn-
Ing fho µro-20l0 covorngo wIfh fho oxµnndod covorngo
roquIrod by fho ACA. Iy whnf rIghf doos n courf sfoµ
Congross from buIIdIng uµ wIfhouf fIrsf fonrIng down¨
2
THI CHIII J!STICI fInds fho ModIcnId oxµnnsIon vuI-
nornbIo bocnuso If fook µnrfIcIµnfIng Sfnfos by surµrIso.
An/e, nf 54. ¨A Sfnfo couId hnrdIy nnfIcIµnfo fhnf Con-
gros|s]¨ wouId ondonvor fo ¨frnnsform |fho ModIcnId µro-
grnm] so drnmnfIcnIIy,¨ ho sfnfos. An/e, nf 5455. Ior fho
nofIon fhnf Sfnfos musf bo nbIo fo forosoo, whon fhoy sIgn
uµ, nIfornfIons Congross mIghf mnko Infor on, THI CHIII

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




















52 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
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 comµInInod of nbu-
sIvo fronfmonf nnd Inhumnno condIfIons In nIIogod vIoIn-
fIon of fho ÐovoIoµmonfnIIy ÐIsnbIod 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 nccoµ|f].¨ 1J., nf l?,
2?. InsµocfIng fho sfnfufory Inngungo nnd IogIsInfIvo hIs-
fory, wo found fhnf fho Acf dId nof ¨unnmbIguousIy¨ Im-
µoso fho roquIromonf on whIch fho µInInfIffs roIIod: fhnf
fhoy rocoIvo nµµroµrInfo fronfmonf In fho Ionsf rosfrIcfIvo
onvIronmonf. 1J., nf l?l8. SnfIsfIod fhnf Congross hnd
nof cIonrIy condIfIonod fho Sfnfos` rocoIµf of fodornI funds
on fho Sfnfos` µrovIsIon of such fronfmonf, wo docIInod fo
rond such n roquIromonf Info fho Acf. Congross` sµondIng
µowor, wo concIudod, ¨doos nof IncIudo surµrIsIng µnrfIcI-
µnfIng Sfnfos wIfh µosfnccoµfnnco or 'rofroncfIvo` condI-
fIons.¨ 1J., nf 2425.
Pennlure/ fhus Insfrucfs fhnf ¨If Congross Infonds fo
Imµoso 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 µorfocfIy cIonr whnf wIII bo roquIrod of Sfnfos fhnf
nccoµf ModIcnId fundIng nffor fhnf dnfo: Thoy musf oxfond
oIIgIbIIIfy fo nduIfs wIfh Incomos no moro fhnn l33° of
fho fodornI µovorfy IIno. Soo 42 !. S. C. §l396n(n)(l0)(A)
(I)(VIII) (2006 od. nnd Suµµ. IV).
THI CHIII J!STICI nµµonrs fo fInd In Pennlure/ n
roquIromonf fhnf, whon sµondIng IogIsInfIon Is fIrsf
µnssod, or whon Sfnfos fIrsf onIIsf In fho fodornI µrogrnm,
Congross musf µrovIdo cIonr nofIco of condIfIons If mIghf
Infor Imµoso. If I undorsfnnd hIs µoInf corrocfIy, If wns
Incumbonf on Congross, In l965, fo wnrn fho Sfnfos cIonrIy
























53 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
of fho sIzo nnd shnµo µofonfInI chnngos fo ModIcnId mIghf
fnko. And nbsonf such nofIco, sIznbIo chnngos couId nof bo
mndo mnndnfory. Our docIsIons do nof suµµorf such n
roquIromonf.
2l
In Benne// v. Aeu Jeree,, 4?0 !. S. 632 (l985), fho
Socrofnry of IducnfIon soughf fo rocouµ TIfIo I funds
22
bnsod on fho Sfnfo`s noncomµIInnco, from l9?0 fo l9?2,
wIfh n l9?8 nmondmonf fo TIfIo I. !oIyIng on Pennlure/,
wo rojocfod fho Socrofnry`s nffomµf fo rocovor funds bnsod
on fho Sfnfos` nIIogod vIoInfIon of n ruIo fhnf dId nof oxIsf
whon fho Sfnfo nccoµfod nnd sµonf fho funds. Soo 4?0
!. S., nf 640 (¨Þow Jorsoy|,] whon If nµµIIod for nnd ro-
coIvod TIfIo I funds for fho yonrs l9?0l9?2|,] hnd no
bnsIs fo boIIovo fhnf fho µroµrIofy of fho oxµondIfuros
wouId bo judgod by nny sfnndnrds ofhor fhnn fho onos In
offocf o/ /le /ine.¨ (cIfIng Pennlure/, 45l !. S., nf l?, 24
25; omµhnsIs nddod)).
Whon nmondmonf of nn oxIsfIng grnnf µrogrnm hns no
such rofroncfIvo offocf, howovor, wo hnvo uµhoId Congross`
InsfrucfIon. In Benne// v. Ken/uc/, Dep/. of 1J., 4?0 !. S.
656 (l985), fho Socrofnry suod fo rocnµfuro TIfIo I funds
bnsod on fho CommonwonIfh`s l9?4 vIoInfIon of n sµond-
Ing condIfIon Congross nddod fo TIfIo I In l9?0. !ojocfIng
Konfucky`s nrgumonf µInnod fo Pennlure/, wo hoId fhnf

2l
THI CHIII J!STICI obsorvos fhnf ¨SµondIng 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 oµInIon of SCA!IA, KIÞÞIÐY,
THOMAS, nnd A!ITO, JJ.) (snmo). Iuf fho Courf µrovIousIy hns roc-
ognIzod fhnf ¨|u]nIIko normnI confrncfunI undorfnkIngs, fodornI grnnf
µrogrnms orIgInnfo In nnd romnIn govornod by sfnfufory µrovIsIons
oxµrossIng fho judgmonf of Congross concornIng dosIrnbIo µubIIc
µoIIcy.¨ 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
µrovIdod fodornI grnnfs fo fInnnco suµµIomonfnI oducnfIonnI µrogrnms
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. !. Þo. 89l0, ?9 Sfnf. 2?).





















54 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fho CommonwonIfh sufforod no surµrIso nffor nccoµfIng
fho fodornI funds. Konfucky wns fhoroforo obIIgod fo ro-
furn fho monoy. 4?0 !. S., nf 665666, 6?36?4. Tho
condIfIons Imµosod woro fo bo nssossod ns of l9?4, In IIghf
of ¨fho IognI roquIromonfs In µInco 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,
µorhnµs yonrs onrIIor, whon Congross µnssod fho Inw
osfnbIIshIng fho µrogrnm. 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 ndoµfIon).
In nny ovonf, from fho sfnrf, fho ModIcnId Acf µuf
Sfnfos on nofIco fhnf fho µrogrnm couId bo chnngod: ¨Tho
rIghf fo nIfor, nmond, or roµonI nny µrovIsIon of |ModI-
cnId],¨ fho sfnfufo hns rond sInco l965, ¨Is horoby rosorvod
fo fho Congross.¨ 42 !. S. C. §l304. Tho ¨offocf of fhoso
fow sImµIo 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] roµonI¨ n sµondIng µrogrnm,
Congross ¨hns gIvon sµocInI nofIco of Ifs InfonfIon fo rofnIn
. . . fuII nnd comµIofo µowor fo mnko such nIfornfIons nnd
nmondmonfs . . . ns como wIfhIn fho jusf scoµo of IogIsIn-
fIvo µowor.¨ 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 omµIoyoos. 1J., nf 44. In rosµonso fo
µrossuro from Sfnfos fhnf wnnfod covorngo for fhoIr om-
µIoyoos, Congross, In l950, nmondod fho Acf fo nIIow
Sfnfos fo oµf Info fho µrogrnm. 1J., nf 45. Tho sfnfufory




















55 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
µrovIsIon gIvIng Sfnfos fhIs oµfIon oxµrossIy µormIffod
fhom fo wIfhdrnw from fho µrogrnm. 1IiJ.
IogInnIng In fho Info l9?0`s, Sfnfos IncronsIngIy oxor-
cIsod fho oµfIon fo wIfhdrnw. 1J., nf 46. Concornod fhnf
wIfhdrnwnIs woro fhronfonIng fho InfogrIfy of SocInI
SocurIfy, Congross roµonIod fho formInnfIon µrovIsIon.
Congross fhoroby chnngod SocInI SocurIfy from n µrogrnm
voIunfnry for fho Sfnfos fo ono from whIch fhoy couId nof
oscnµo. 1J., nf 48. CnIIfornIn objocfod, nrguIng fhnf fho
chnngo ImµormIssIbIy doµrIvod 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 oxµrossIy rosorvIng fo If '|f]ho
rIghf fo nIfor, nmond, or roµonI nny µrovIsIon` of fho Acf,¨
wo hoId, Congross µuf Sfnfos on nofIco fhnf fho Acf
¨cronfod no confrncfunI rIghfs.¨ 1J., nf 5l52. Tho Sfnfos
fhoroforo hnd no Inw-bnsod ground on whIch fo comµInIn
nbouf fho nmondmonf, dosµIfo 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
¨roµonI¨ ModIcnId, wIµIng 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 µrocoodod on fhnf undorsfnndIng. In com-
µIInnco wIfh ModIcnId roguInfIons, onch Sfnfo oxµrossIy
undorfook fo nbIdo by fufuro ModIcnId chnngos. Soo 42
CI! §430.l2(c)(l) (20ll) (¨Tho |sfnfo ModIcnId] µInn musf
µrovIdo fhnf If wIII bo nmondod whonovor nocossnry fo
rofIocf . . . |c]hnngos In IodornI Inw, roguInfIons, µoIIcy





















56 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
InforµrofnfIons, or courf docIsIons.¨). Whonovor n Sfnfo
nofIfIos fho IodornI Covornmonf of n chnngo In Ifs own
ModIcnId µrogrnm, fho Sfnfo corfIfIos bofh fhnf If knows
fho fodornIIy sof forms of µnrfIcIµnfIon mny chnngo, nnd
fhnf If wIII nbIdo by fhoso chnngos ns n condIfIon of con-
fInuod µnrfIcIµnfIon. Soo, e.g., IIorIdn Agoncy for HonIfh
Cnro AdmIn., Sfnfo IInn !ndor TIfIo XIX of fho SocInI
SocurIfy Acf ModIcnI AssIsfnnco Irogrnm §?.l, µ. 86 (Ocf.
6, l992).
THI CHIII J!STICI InsIsfs fhnf fho mosf roconf oxµnn-
sIon, In confrnsf fo Ifs µrodocossors, ¨nccomµIIshos 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
µrognnnf womon¨ Soo eupro, nf 4l42. Congross dId nof
¨moroIy nIfo|r] nnd oxµnn|d] fho boundnrIos of ¨ fho AId fo
InmIIIos wIfh Ðoµondonf ChIIdron µrogrnm. Iuf soo on/e,
nf 5355. !nfhor, Congross roquIrod µnrfIcIµnfIng Sfnfos
fo µrovIdo covorngo fIod fo fho fodornI µovorfy IovoI (ns If
Infor dId In fho ACA), rnfhor fhnn fo fho AIÐC µrogrnm.
Soo IrIof for ÞnfIonnI 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 µuf fo comµInIn fhnf If Inckod fnIr nofIco whon,
In 20l0, Congross nIforod ModIcnId fo ombrnco n Inrgor
µorfIon of fho ÞnfIon`s µoor.
3
THI CHIII J!STICI uIfImnfoIy nsks whofhor ¨fho fInnn-

23
Þofo, In fhIs rognrd, fho oxfonsIon of SocInI SocurIfy, whIch bognn
In l935 ns nn oId-ngo µonsIon µrogrnm, fhon oxµnndod 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)
OµInIon of CIÞSI!!C, J.
cInI Inducomonf offorod by Congross . . . µnss|od] fho µoInf
nf whIch µrossuro furns Info comµuIsIon.¨ An/e, nf 50
(InfornnI quofnfIon mnrks omIffod). Tho fInnncInI In-
ducomonf Congross omµIoyod 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 µorsun-
sIon gIvos wny fo coorcIon,¨ on/e, nf 55. ÞoIfhor do fho
joInf dIssonfors. Soo poe/, nf 36, 38.
25
ÞofnbIy, fho docI-

24
Tho joInf dIssonfors, for fhoIr µnrf, wouId mnko fhIs fho onfIro In-
quIry. ¨|I]f Sfnfos ronIIy hnvo no choIco ofhor fhnn fo nccoµf fho µnck-
ngo,¨ fhoy nssorf, ¨fho offor Is coorcIvo.¨ Poe/, nf 35. THI CHIII J!STICI
rocognIzos Congross` nufhorIfy fo consfrucf n sIngIo fodornI µrogrnm
nnd ¨condIfIon fho rocoIµf of funds on fho Sfnfos` comµIyIng wIfh
rosfrIcfIons on fho uso of fhoso funds.¨ An/e, nf 50. Ior fho joInf
dIssonfors, howovor, nII fhnf mnffors, If nµµonrs, Is whofhor Sfnfos cnn
rosIsf fho fomµfnfIon of n gIvon fodornI grnnf. Poe/, nf 35. On fhIs
IogIc, nny fodornI sµondIng µrogrnm, suffIcIonfIy Inrgo nnd woII-fundod,
wouId bo unconsfIfufIonnI. Tho joInf dIssonfors µoInf fo smnIIor µro-
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 oxµondIfuros,¨ poe/, nf 4l, Is nn nmounf Sfnfos
couId or wouId do wIfhouf¨
SµocuInfIons 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
µubIIc dIsnµµrovnI¨ 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 suµµorf n
fodornI µrogrnm fhnf offors Inrgo grnnfs fo fho Sfnfos . . . no,, ns n
µrncfIcnI mnffor, |Ionvo Sfnfos] unnbIo fo rofuso fo µnrfIcIµnfo¨); iIiJ.
(wIfhdrnwnI from n fodornI µrogrnm ¨wouId li/el, forco fho Sfnfo fo
Imµoso n hugo fnx Incronso¨); poe/, nf 46 (sfnfo shnro of ACA oxµnnsIon
cosfs ¨no, Incronso In fho fufuro¨) (nII omµhnsIs nddod; somo InfornnI
quofnfIon mnrks omIffod). Tho joInf dIssonfors nro Iong on conjocfuro
nnd shorf on ronI-worId oxnmµIos.
25
Tho joInf dIssonfors nIso roIy honvIIy on Congross` µorcoIvod Infonf
fo coorco fho Sfnfos. Poe/, nf 4246; soo, e.g., poe/, nf 42 (¨In crnffIng fho
ACA, Congross cIonrIy oxµrossod Ifs Informod vIow fhnf no Sfnfo couId


























58 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
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 SµondIng 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 nccoµf 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 noncomµIInnco¨ Tho µorfIon of fho
Sfnfo`s budgof nf sfnko¨ And whIch Sfnfo`sor Sfnfos`
budgof Is doformInnfIvo: fho Iond µInInfIff, nII chnIIongIng
Sfnfos (26 In fhIs cnso, mnny wIfh quIfo dIfforonf fIscnI
sIfunfIons), or somo nnfIonnI modInn¨ Ðoos If mnffor fhnf
IIorIdn, unIIko mosf Sfnfos, Imµosos no sfnfo Incomo fnx,
nnd fhoroforo mIghf bo nbIo fo roµInco forogono fodornI
funds wIfh now sfnfo rovonuo¨
26
Or fhnf fho coorcIon sfnfo

µossIbIy 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 µnrfIcuInrIy fruo whon fho ACA couId jusf
ns woII bo comµrohondod ns domonsfrnfIng Congross` moro oxµocfnfIon,
In IIghf of fho unIformIfy of µnsf µnrfIcIµnfIon 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 sImµIy 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 cnµncIfy fo roµInco n fodornI µrogrnm wIfh nn
¨oquIvnIonf¨ sfnfo-fundod nnnIog. Poe/, nf 40. Iuf If cnnnof bo fruo
fhnf ¨fho nmounf of fho fodornI fnxos oxfrncfod from fho fnxµnyors of n
Sfnfo fo µny for fho µrogrnm In quosfIon Is roIovnnf In doformInIng
whofhor fhoro Is ImµormIssIbIo coorcIon.¨ Poe/, nf 3?. Whon fho
!nIfod Sfnfos Covornmonf fnxos !nIfod Sfnfos cIfIzons, If fnxos fhom
¨In fhoIr IndIvIdunI cnµncIfIos¨ ns ¨fho µooµIo of AmorIcn¨nof ns
rosIdonfs of n µnrfIcuInr Sfnfo. Soo I. S. Tern Lini/e, 1nc. v. Tlorn/on,
5l4 !. S. ??9, 839 (l995) (KIÞÞIÐY, J., concurrIng). Thnf Is bocnuso
fho ¨Irnmors sµIIf fho nfom of sovoroIgnfy|,] . . . osfnbIIshIng fwo ordors
of govornmonf¨¨ono sfnfo nnd ono fodornI¨¨onch wIfh Ifs own dIrocf





















59 CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
offIcInIs In fncf fonr Is µunIshmonf nf fho bnIIof box for
furnIng down n µoIIfIcnIIy µoµuInr fodornI grnnf¨
Tho coorcIon InquIry, fhoroforo, nµµonrs fo InvoIvo µoIIf-
IcnI judgmonfs fhnf dofy judIcInI cnIcuInfIon. Soo Bo/er
v. Corr, 369 !. S. l86, 2l? (l962). Ivon commonfnfors
symµnfhofIc fo robusf onforcomonf of Dole`s IImIfnfIons,
soo eupro, nf 46, hnvo concIudod fhnf concoµfIons of
¨ImµormIssIbIo coorcIon¨ µromIsod on Sfnfos` µorcoIvod
InnbIIIfy fo docIIno fodornI funds ¨nro jusf foo nmorµhous
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` µosIfIon Is fhnf fho Sfnfos`
roIInnco on fodornI funds IImIfs Congross` nufhorIfy fo
nIfor Ifs sµondIng µrogrnms. ThIs gofs fhIngs bnckwnrds:
Congross, nof fho Sfnfos, Is fnskod wIfh sµondIng fodornI
monoy In sorvIco of fho gonornI woIfnro. And onch succos-
sIvo Congross Is omµoworod fo nµµroµrInfo funds ns If soos
fIf. Whon fho ll0fh Congross ronchod n concIusIon nbouf
ModIcnId funds fhnf dIfforod from Ifs µrodocossors` vIow,
If nbrIdgod no Sfnfo`s rIghf fo ¨oxIsfIng,¨ or ¨µro-oxIsfIng,¨
funds. Iuf soo on/e, nf 5l52; poe/, nf 4?48 (joInf oµInIon
of SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ.). Ior, In

roInfIonshIµ¨ fo fho µooµIo. 1J., nf 838.
A Sfnfo fhoroforo hns no cInIm on fho monoy Ifs rosIdonfs µny In
fodornI fnxos, nnd fodornI ¨sµondIng µrogrnms nood nof hoIµ µooµIo In
nII sfnfos In fho snmo monsuro.¨ Soo IrIof for ÐnvId Snfchor of nI. ns
Anici Curioe l9. In 2004, for oxnmµIo, Þow Jorsoy rocoIvod 55 confs
In fodornI sµondIng for ovory doIInr Ifs rosIdonfs µnId fo fho IodornI
Covornmonf In fnxos, whIIo MIssIssIµµI rocoIvod $l.?? µor fnx doIInr
µnId. C. Ðubny, Tnx IoundnfIon, IodornI Tnx Iurdons nnd IxµondI-
furos by Sfnfo: WhIch Sfnfos CnIn Mosf from IodornI IIscnI Oµorn-
fIons¨ 2 (Mnr. 2006). Thus no consfIfufIonnI µrobIom wns cronfod whon
ArIzonn docIInod for l6 yonrs fo µnrfIcIµnfo In ModIcnId, ovon fhough
Ifs rosIdonfs` fnx doIInrs fInnncod ModIcnId µrogrnms In ovory ofhor
Sfnfo.


















60 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
OµInIon of CIÞSI!!C, J.
fncf, fhoro nro no such funds. Thoro Is onIy monoy Sfnfos
on/icipo/e rocoIvIng from fufuro Congrossos.
Ð
Congross hns doIognfod fo fho Socrofnry of HonIfh nnd
Humnn SorvIcos fho nufhorIfy fo wIfhhoId, In whoIo or
In µnrf, fodornI ModIcnId funds from Sfnfos fhnf fnII fo
comµIy wIfh fho ModIcnId Acf ns orIgInnIIy comµosod nnd ns
subsoquonfIy nmondod. 42 !. S. C. §l396c.
2?
THI CHIII
J!STICI, howovor, hoIds fhnf fho ConsfIfufIon µrocIudos
fho Socrofnry from wIfhhoIdIng ¨oxIsfIng¨ ModIcnId funds
bnsod on Sfnfos` rofusnI fo comµIy wIfh fho oxµnndod ModI-
cnId µrogrnm. An/e, nf 55. Ior fho forogoIng ronsons, I
dIsngroo fhnf nny such wIfhhoIdIng wouId vIoInfo fho
SµondIng CInuso. AccordIngIy, I wouId nffIrm fho docIsIon
of fho Courf of AµµonIs for fho IIovonfh CIrcuIf In fhIs
rognrd.
Iuf In vIow of THI CHIII J!STICI`s dIsµosIfIon, I ngroo
wIfh hIm fhnf fho ModIcnId Acf`s sovornbIIIfy cInuso do-
formInos fho nµµroµrInfo romody. Thnf cInuso µrovIdos
fhnf ¨|I]f nny µrovIsIon of |fho ModIcnId Acf], or fho nµµII-
cnfIon fhoroof fo nny µorson or cIrcumsfnnco, Is hoId In-
vnIId, fho romnIndor of fho chnµfor, nnd fho nµµIIcnfIon of
such µrovIsIon fo ofhor µorsons or cIrcumsfnncos shnII nof
bo nffocfod fhoroby.¨ 42 !. S. C. §l303.
Tho Courf doos nof sfrIko down nny µrovIsIon 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 µorfIon of fho ModIcnId funds ofhorwIso duo n
noncomµIInnf 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/.¨
(omµhnsIs nddod)). Tho Socrofnry, If Is worfh nofIng, mny horsoIf
oxµorIonco µoIIfIcnI µrossuros, whIch wouId mnko hor nII fho moro
roIucfnnf fo cuf off funds Congross hns nµµroµrInfod for n Sfnfo`s noody
cIfIzons.


















6l CIfo ns: 56? !. S. ____ (20l2)
OµInIon of CIÞSI!!C, J.
ACA. If µrohIbIfs onIy fho ¨nµµIIcnfIon¨ of fho Socrofnry`s
nufhorIfy fo wIfhhoId ModIcnId funds from Sfnfos fhnf
docIIno fo conform fhoIr ModIcnId µInns fo fho ACA`s
roquIromonfs. Thus fho ACA`s nufhorIznfIon of funds fo
fInnnco fho oxµnnsIon romnIns Infncf, nnd fho Socrofnry`s
nufhorIfy fo wIfhhoId funds for ronsons ofhor fhnn non-
comµIInnco wIfh fho oxµnnsIon romnIns unnffocfod.
Ivon nbsonf §l303`s commnnd, wo wouId hnvo no wnr-
rnnf fo InvnIIdnfo fho ModIcnId oxµnnsIon, confrn poe/, nf
4648 (joInf oµInIon of SCA!IA, KIÞÞIÐY, 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 µoor by IncronsIng fho
Sfnfos` nccoss fo fodornI funds. THI CHIII J!STICI Is
undoubfodIy rIghf fo concIudo fhnf Congross mny offor
Sfnfos funds ¨fo oxµnnd fho nvnIInbIIIfy of honIfh cnro, nnd
roquIr|o] fhnf Sfnfos nccoµfIng such funds comµIy wIfh fho
condIfIons on fhoIr uso.¨ An/e, nf 55. I fhoroforo concur
In fho judgmonf wIfh rosµocf fo Inrf IVI of THI CHIII
J!STICI`s oµInIon.
* * *
Ior fho ronsons sfnfod, I ngroo wIfh THI CHIII J!STICI
fhnf, ns fo fho vnIIdIfy of fho mInImum covorngo µrovI-
sIon, fho judgmonf of fho Courf of AµµonIs for fho IIovonfh
CIrcuIf shouId bo rovorsod. In my vIow, fho µrovIsIon on-
counfors no consfIfufIonnI obsfrucfIon. Iurfhor, I wouId
uµhoId fho IIovonfh CIrcuIf`s docIsIon fhnf fho ModIcnId
oxµnnsIon Is wIfhIn Congross` sµondIng µowor.



_________________

_________________























l CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
SUPREME COURT OF THE UNITED STATES
Þos. ll393, ll398 nnd ll400
ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS, IT A!., IITITIOÞI!S
ll393 t.
KATH!IIÞ SIII!I!S, SIC!ITA!Y OI HIA!TH
AÞÐ H!MAÞ SI!VICIS, IT A!.
ÐIIA!TMIÞT OI HIA!TH AÞÐ H!MAÞ
SI!VICIS, IT A!., IITITIOÞI!S
ll398 t.
I!O!IÐA IT A!.
ll400
I!O!IÐA, IT A!., IITITIOÞI!S
t.
ÐIIA!TMIÞT OI HIA!TH AÞÐ
H!MAÞ SI!VICIS IT A!.
OÞ W!ITS OI CI!TIO!A!I TO THI !ÞITIÐ STATIS CO!!T OI
AIIIA!S IO! THI I!IVIÞTH CI!C!IT
|Juno 28, 20l2]
J!STICI SCA!IA, J!STICI KIÞÞIÐY, J!STICI THOMAS,
nnd J!STICI A!ITO, dIssonfIng.
Congross hns sof ouf fo romody fho µrobIom 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 µowors nccordod fo If undor fho ConsfIfufIon. Tho
quosfIon In fhIs cnso, howovor, Is whofhor fho comµIox
sfrucfuros nnd µrovIsIons of fho InfIonf IrofocfIon nnd
AffordnbIo Cnro Acf (AffordnbIo Cnro Acf or ACA) go bo-
yond fhoso µowors. Wo concIudo fhnf fhoy do.
ThIs cnso Is In ono rosµocf dIffIcuIf: If µrosonfs fwo


















2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
quosfIons of fIrsf ImµrossIon. Tho fIrsf of fhoso Is whofhor
fnIIuro fo ongngo In oconomIc ncfIvIfy (fho µurchnso 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 jurIsµrudonco. Iuf In nono of Ifs docIsIons hns fhIs
Courf oxfondod fho CInuso fhnf fnr. Tho socond quosfIon
Is whofhor fho congrossIonnI µowor fo fnx nnd sµond,
!. S. Consf., Arf. I, §8, cI. l, µormIfs fho condIfIonIng of
n Sfnfo`s confInuod rocoIµf of nII funds undor n mnssIvo
sfnfo-ndmInIsforod fodornI woIfnro µrogrnm uµon Ifs nc-
coµfnnco of nn oxµnnsIon fo fhnf µrogrnm. SovornI of our
oµInIons hnvo suggosfod fhnf fho µowor fo fnx nnd sµond
cnnnof bo usod fo coorco sfnfo ndmInIsfrnfIon of n fodornI
µrogrnm, buf wo hnvo novor found n Inw onncfod undor
fho sµondIng µowor fo bo coorcIvo. Thoso quosfIons nro
dIffIcuIf.
Tho cnso Is onsy nnd sfrnIghfforwnrd, howovor, In nn-
ofhor rosµocf. 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 uµon
fodornI µoworuµon whnf If cnn µroscrIbo wIfh rosµocf fo
µrIvnfo conducf, nnd uµon whnf If cnn Imµoso uµon fho
sovoroIgn Sfnfos. Whnfovor mny bo fho concoµfunI IImIfs
uµon fho Commorco CInuso nnd uµon fho µowor fo fnx
nnd sµond, fhoy cnnnof bo such ns wIII onnbIo fho IodornI
Covornmonf fo roguInfo nII µrIvnfo conducf nnd fo com-
µoI fho Sfnfos fo funcfIon ns ndmInIsfrnfors of fodornI
µrogrnms.
Thnf cIonr µrIncIµIo 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 consumµfIon, nffocfod commorco suffIcIonfIy
fhnf If couId bo roguInfod, nIwnys hns boon rognrdod ns



















3 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fho ne plue ul/ro of oxµnnsIvo Commorco CInuso jurIsµru-
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 µroscrIµfIon nnd fo oxfond fodornI
µowor fo vIrfunIIy nII humnn ncfIvIfy.
As for fho consfIfufIonnI µowor fo fnx nnd sµond for
fho gonornI woIfnro: Tho Courf hns Iong sInco oxµnndod
fhnf boyond (whnf MndIson fhoughf If monnf) fnxIng nnd
sµondIng for fhoso nsµocfs of fho gonornI woIfnro fhnf woro
wIfhIn fho IodornI Covornmonf`s onumornfod µowors,
soo Ini/eJ S/o/ee v. Bu/ler, 29? !. S. l, 6566 (l936).
Thus, wo now hnvo sIznbIo fodornI Ðoµnrfmonfs dovofod
fo subjocfs nof monfIonod nmong Congross` onumornfod
µowors, nnd onIy mnrgInnIIy roInfod fo commorco: fho Ðo-
µnrfmonf of IducnfIon, fho Ðoµnrfmonf of HonIfh nnd
Humnn SorvIcos, fho Ðoµnrfmonf of HousIng nnd !rbnn
ÐovoIoµmonf. Tho µrIncIµnI µrncfIcnI obsfncIo fhnf µro-
vonfs Congross from usIng fho fnx-nnd-sµond µowor fo
nssumo nII fho gonornI-woIfnro rosµonsIbIIIfIos frndIfIon-
nIIy oxorcIsod by fho Sfnfos Is fho shoor ImµossIbIIIfy 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 µrogrnm. Thnf Is fnIr nnd consfIfufIonnI onough whon
fho Sfnfos frooIy ngroo fo hnvo fhoIr µowors omµIoyod nnd
fhoIr omµIoyoos 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 µowor bofh In
mnndnfIng fho µurchnso of honIfh Insurnnco nnd In dony-
Ing nonconsonfIng Sfnfos nII ModIcnId fundIng. Thoso
µnrfs of fho Acf nro confrnI fo Ifs dosIgn nnd oµornfIon,
nnd nII fho Acf`s ofhor µrovIsIons wouId nof hnvo boon
onncfod wIfhouf fhom. In our vIow If musf foIIow fhnf fho



















4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
onfIro sfnfufo Is InoµornfIvo.
I
!"# %&'()('*+, -+&'+.#
ArfIcIo I, §8, of fho ConsfIfufIon gIvos Congross fho
µowor fo ¨roguInfo Commorco . . . nmong fho sovornI
Sfnfos.¨ Tho IndIvIdunI Mnndnfo In fho Acf commnnds
fhnf ovory ¨nµµIIcnbIo IndIvIdunI shnII for onch monfh
bogInnIng nffor 20l3 onsuro fhnf fho IndIvIdunI, nnd nny
doµondonf of fho IndIvIdunI who Is nn nµµIIcnbIo IndIvId-
unI, Is covorod undor mInImum ossonfInI covorngo.¨ 26
!. S. C. §5000A(n) (2006 od., Suµµ. IV). If fhIs µrovIsIon
¨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 nccomµnnIod by
µnymonf of n µonnIfy. 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 comµoIIIng Ifs oxIsfonco.
In GiIIone v. OgJen, 9 Whonf. l, l96 (l824), ChIof
JusfIco MnrshnII wrofo fhnf fho µowor fo roguInfo com-
morco Is fho µowor ¨fo µroscrIbo 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 Þ.
Wobsfor, An AmorIcnn ÐIcfIonnry of fho IngIIsh !nn-
gungo (l828); ¨|f]o ndjusf by ruIo or mofhod,¨ 2 S. Johnson,
A ÐIcfIonnry of fho IngIIsh !nngungo (?fh od. l?85); ¨|f]o
ndjusf, fo dIrocf nccordIng fo ruIo,¨ 2 J. Ash, Þow nnd
ComµIofo ÐIcfIonnry of fho IngIIsh !nngungo (l??5); ¨fo
µuf In ordor, sof fo rIghfs, govorn or kooµ In ordor,¨ T.
Ðycho & W. Inrdon, A Þow ConornI IngIIsh ÐIcfIonnry























5 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
(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 µocuIInr 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 suµorfIuous
fho Infor µrovIsIon for nufhorIfy ¨|f]o rnIso nnd suµµorf
ArmIos,¨ iJ., §8, cI. l2, nnd ¨|f]o µrovIdo nnd mnInfnIn n
Þnvy,¨ 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 µrovIdos 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 rosµonso, fho Covornmonf offors fwo fhoorIos ns fo
why fho IndIvIdunI Mnndnfo Is novorfhoIoss consfIfu-
fIonnI. ÞoIfhor 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 Þo. 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 sµocInIIzod IognI monn-
Ing) In fho consfIfufIonnI foxf. Soo !. Iurn, A Þow !nw ÐIcfIonnry 28l
(l?92); C. Jncob, A Þow !nw ÐIcfIonnry (l0fh od. l?82); 2 T. CunnIng-
hnm, A Þow nnd ComµIofo !nw ÐIcfIonnry (2d od. l??l).


















6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
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 µrosonf µurµosos nro fho ¨gunrnnfood Issuo¨
nnd ¨communIfy rnfIng¨ µrovIsIons, §§300gg fo 300gg4.
Tho formor µrovIdos fhnf, wIfh n fow oxcoµfIons, ¨onch
honIfh Insurnnco Issuor fhnf offors honIfh Insurnnco cov-
orngo In fho IndIvIdunI or grouµ mnrkof In n Sfnfo musf
nccoµf ovory omµIoyor nnd IndIvIdunI In fho Sfnfo fhnf
nµµIIos for such covorngo.¨ §300ggl(n). Thnf Is, nn In-
suror mny nof dony covorngo on fho bnsIs of, nmong ofhor
fhIngs, nny µro-oxIsfIng modIcnI condIfIon fhnf fho nµµII-
cnnf mny hnvo, nnd fho rosuIfIng Insurnnco musf covor
fhnf condIfIon. Soo §300gg3.
!ndor ordInnry cIrcumsfnncos, of courso, Insurors wouId
rosµond by chnrgIng hIgh µromIums fo IndIvIdunIs wIfh
µro-oxIsfIng condIfIons. Tho Acf sooks fo µrovonf fhIs
fhrough fho communIfy-rnfIng µrovIsIon. SImµIy µuf, fho
communIfy-rnfIng µrovIsIon roquIros Insurors fo cnIcuInfo
nn IndIvIdunI`s Insurnnco µromIum bnsod on onIy four
fncfors: (I) whofhor fho IndIvIdunI`s µInn 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 µroxIos of ngo nnd fobncco uso (nnd
µossIbIy rnfIng nron), fho Acf doos nof nIIow nn Insuror fo
fncfor fho IndIvIdunI`s honIfh chnrncforIsfIcs Info fho µrIco
of hIs Insurnnco µromIum. ThIs cronfos n now InconfIvo
for young nnd honIfhy IndIvIdunIs wIfhouf µro-oxIsfIng
condIfIons. Tho Insurnnco µromIums for fhoso In fhIs
grouµ wIII nof rofIocf fhoIr own Iow ncfunrInI rIsks buf wIII
subsIdIzo Insurnnco for ofhors In fho µooI. Mnny of fhom
mny docIdo fhnf µurchnsIng honIfh Insurnnco Is nof nn oco-
nomIcnIIy sound docIsIonosµocInIIy sInco fho gunrnnfood-
Issuo µrovIsIon wIII onnbIo fhom fo µurchnso If nf fho
snmo cosf In Infor yonrs nnd ovon If fhoy hnvo dovoIoµod n
















? CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
µro-oxIsfIng condIfIon. Iuf wIfhouf fho confrIbufIon of
nbovo-rIsk µromIums from fho young nnd honIfhy, fho
communIfy-rnfIng µrovIsIon wIII nof onnbIo Insurors fo
fnko on hIgh-rIsk IndIvIdunIs wIfhouf n mnssIvo Incronso
In µromIums.
Tho Covornmonf µrosonfs fho IndIvIdunI Mnndnfo ns n
unIquo fonfuro of n comµIIcnfod roguInfory schomo govorn-
Ing mnny µnrfIos wIfh counforvnIIIng InconfIvos fhnf musf
bo cnrofuIIy bnInncod. Congross hns Imµosod nn oxfonsIvo
sof of roguInfIons on fho honIfh Insurnnco Indusfry, nnd
comµIInnco wIfh fhoso roguInfIons wIII IIkoIy cosf fho In-
dusfry n gronf donI. If fho Indusfry doos nof rosµond by
IncronsIng µromIums, If Is nof IIkoIy fo survIvo. And If
fho Indusfry doos Incronso µromIums, fhon fhoro Is n sorI-
ous rIsk fhnf Ifs µroducfsInsurnnco µInnswIII bocomo
oconomIcnIIy undosIrnbIo for mnny nnd µrohIbIfIvoIy ox-
µonsIvo for fho rosf.
ThIs Is nof n dIIommn unIquo fo roguInfIon of fho honIfh-
Insurnnco Indusfry. Covornmonf roguInfIon fyµIcnIIy
Imµosos cosfs on fho roguInfod IndusfryosµocInIIy rogu-
InfIon fhnf µrohIbIfs oconomIc bohnvIor In whIch mosf
mnrkof µnrfIcIµnnfs nro nIrondy ongngIng, such ns ¨µIoc-
Ing ouf¨ fho mnrkof by soIIIng fho µroducf fo dIfforonf
cInssos of µooµIo nf dIfforonf µrIcos (In fho µrosonf confoxf,
µrovIdIng 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 µowor fo
onncf ¨ 'nII nµµroµrInfo IogIsInfIon` ¨ fo ¨ 'µrofoc|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 µrofocf
fho ImµorIIod Indusfry by µrohIbIfIng Iow-cosf comµofIfIon,
or by nccordIng If µroforonfInI fnx fronfmonf, or ovon by
grnnfIng If n dIrocf subsIdy.
















8 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
Horo, howovor, Congross hns Imµrossod Info sorvIco
fhIrd µnrfIos, 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 µurchnso Insurnnco Is mofIvnfod
by fho fncf fhnf fhoy nro furfhor romovod from fho mnrkof
fhnn unhonIfhy IndIvIdunIs wIfh µro-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
µnrfIcIµnfo In fho mnrkof, fhon fho Commorco CInuso
bocomos n fonf of unIImIfod µowor, or In HnmIIfon`s words,
¨fho hIdoous monsfor whoso dovourIng jnws . . . sµnro
noIfhor sox nor ngo, nor hIgh nor Iow, nor sncrod nor µro-
fnno.¨ Tho IodornIIsf Þo. 33, µ. 202 (C. !ossIfor od. l96l).
Af fho oufor odgo of fho commorco µowor, fhIs Courf hns
InsIsfod on cnrofuI scrufIny of roguInfIons fhnf do nof
ncf dIrocfIy on nn Inforsfnfo mnrkof or Ifs µnrfIcIµnnfs. 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-
µosnI of rndIoncfIvo wnsfo µroducod 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, comµoI sfnfo Inw-onforcomonf offIcInIs fo µorform
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 µrofocfIon of schooIs, bnn fho µossos-
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
µnrfIcIµnfIon of womon In fho Inforsfnfo oconomy, subjocf
µrIvnfo IndIvIdunIs nnd comµnnIos fo suIf for gondor-
mofIvnfod vIoIonf forfs. 1J., nf 6096l9. Tho Iosson of




















9 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fhoso cnsos Is fhnf fho Commorco CInuso, ovon whon suµ-
µIomonfod by fho Þocossnry nnd Iroµor CInuso, Is nof
cor/e Iloncle for doIng whnfovor wIII hoIµ nchIovo fho
onds Congross sooks by fho roguInfIon of commorco. And
fho Insf fwo of fhoso cnsos show fhnf fho scoµo of fho
Þocossnry nnd Iroµor CInuso Is oxcoodod nof onIy whon
fho congrossIonnI ncfIon dIrocfIy vIoInfos fho sovoroIgnfy
of fho Sfnfos buf nIso whon If vIoInfos fho bnckground
µrIncIµIo of onumornfod (nnd honco IImIfod) fodornI µowor.
Tho cnso uµon whIch fho Covornmonf µrIncIµnIIy roIIos
fo susfnIn fho IndIvIdunI Mnndnfo undor fho Þocossnry
nnd Iroµor 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 µossossIon of fhnf drug. 1J., nf l522. Ioicl
Is no µrocodonf for whnf Congross hns dono horo. Thnf
cnso`s µrohIbIfIon of growIng (cf. Wic/orJ, 3l? !. S. lll),
nnd of µossossIon (cf. InnumornbIo fodornI sfnfufos) dId nof
roµrosonf fho oxµnnsIon of fho fodornI µowor 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 sµIrIf of fho consfIfufIon.¨ McCullocl v. Mor,-
lonJ, 4 Whonf. 3l6, 42l (l8l9).
Moroovor, Ioicl Is fnr dIfforonf from fho IndIvIdunI
Mnndnfo In nnofhor rosµocf. Tho Courf`s oµInIon In Ioicl
µoInfod ouf fhnf fho growIng nnd µossossIon µrohIbIfIons
woro fho onIy µrncfIcnbIo wny of onnbIIng fho µrohIbIfIon
of Inforsfnfo frnffIc In mnrIjunnn fo bo offocfIvoIy onforcod.
545 !. S., nf 22. Soo nIso Slretepor/ Io/e Coeee, 234 !. S.
342 (l9l4) (Þocossnry nnd Iroµor 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 oxnmµIo, ondnngorod-sµocIos froµhIos obfnInod boforo


















l0 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fho sµocIos wns fodornIIy µrofocfod cnn bo dIsfInguIshod
from froµhIos obfnInod nfforwnrdswhIch mndo If nocos-
snry nnd µroµor fo µrohIbIf fho snIo of nII such froµhIos,
soo AnJrue v. AllorJ, 444 !. S. 5l (l9?9).
WIfh fho µrosonf sfnfufo, by confrnsf, fhoro nro mnny
wnys ofhor fhnn fhIs unµrocodonfod IndIvIdunI Mnndnfo
by whIch fho roguInfory schomo`s gonIs of roducIng Insur-
nnco µromIums nnd onsurIng fho µrofIfnbIIIfy of Insurors
couId bo nchIovod. Ior Insfnnco, fhoso who dId nof µur-
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
µurchnso fho Insurnnco.
Tho Covornmonf wns InvIfod, nf ornI nrgumonf, fo
suggosf whnf fodornI confroIs ovor µrIvnfo conducf (ofhor
fhnn fhoso oxµIIcIfIy µrohIbIfod by fho IIII of !Ighfs or
ofhor consfIfufIonnI confroIs) couId no/ bo jusfIfIod ns
nocossnry nnd µroµor 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 µrocIso scoµo of fho Commorco
CInuso nnd fho Þocossnry nnd Iroµor CInuso Is uncorfnIn,
fho µroµosIfIon fhnf fho IodornI Covornmonf cnnnof do
ovoryfhIng Is n fundnmonfnI µrocoµf. Soo Lopec, 5l4 !. S.,
nf 564 (¨|I]f wo woro fo nccoµf fho Covornmonf`s nrgu-
monfs, wo nro hnrd µrossod fo µosIf nny ncfIvIfy by nn In-
dIvIdunI fhnf Congross Is wIfhouf µowor fo roguInfo¨).
SocfIon 5000A Is dofonfod by fhnf µroµosIfIon.
I
Tho Covornmonf`s socond fhoory In suµµorf 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)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fnkos n fow dIfforonf forms, buf fho bnsIc Idon Is fhnf
§5000A roguInfos ¨fho wny In whIch IndIvIdunIs fInnnco
fhoIr µnrfIcIµnfIon In fho honIfh-core mnrkof.¨ IofIfIonors`
MInImum Covorngo IrIof 33 (omµhnsIs nddod). Thnf Is,
fho µrovIsIon dIrocfs fho mnnnor In whIch IndIvIdunIs
µurchnso honIfh cnro sorvIcos nnd roInfod goods (dIrocfIng
fhnf fhoy bo µurchnsod fhrough Insurnnco) nnd Is fhoro-
foro n sfrnIghfforwnrd oxorcIso of fho commorco µowor.
Tho µrImnry µrobIom wIfh fhIs nrgumonf Is fhnf §5000A
doos nof nµµIy onIy fo µorsons who µurchnso 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 µurchnsIng mosf or ovon nny of such goods or sorvIcos
nnd fhus no nood fo buy Insurnnco for fhoso µurchnsos.
Tho Covornmonf rosµonds fhnf fho honIfh-cnro mnrkof
InvoIvos ¨ossonfInIIy unIvorsnI µnrfIcIµnfIon,¨ iJ., nf 35.
Tho µrIncIµnI dIffIcuIfy wIfh fhIs rosµonso 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 µurchnso of n boffIo of nsµIrIn. Iuf fho honIfh
cnro ¨mnrkof¨ fhnf Is fho objocf of fho IndIvIdunI Mnndnfo
nof onIy IncIudos buf µrIncIµnIIy consIsfs of goods nnd
sorvIcos fhnf fho young µooµIo µrImnrIIy nffocfod by fho
Mnndnfo Jo no/ purcloee. Thoy nro quIfo sImµIy nof
µnrfIcIµnnfs In fhnf mnrkof, nnd cnnnof bo mndo so (nnd
fhoroby subjocfod fo roguInfIon) by fho sImµIo dovIco of
dofInIng µnrfIcIµnnfs fo IncIudo nII fhoso who wIII, Infor In
fhoIr IIfofImo, µrobnbIy µurchnso fho goods or sorvIcos
covorod by fho mnndnfod Insurnnco.
2
Such n dofInIfIon of

2
J!STICI CIÞSI!!C Is fhoroforo rIghf fo nofo fhnf Congross Is ¨nof
mnndnfIng fho µurchnso of n dIscrofo, unwnnfod µroducf.¨ An/e, nf 22
(oµInIon concurrIng In µnrf, concurrIng In judgmonf In µnrf, nnd dIs-




















l2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
mnrkof µnrfIcIµnnfs Is unµrocodonfod, nnd woro If fo bo n
µromIso for fho oxorcIso of nnfIonnI µowor, If wouId hnvo
no µrIncIµIod IImIfs.
In n vnrInfIon on fhIs nffomµfod oxorcIso of fodornI
µowor, fho Covornmonf µoInfs ouf fhnf Congross In fhIs
Acf hns µurµorfod fo roguInfo ¨oconomIc nnd fInnncInI
docIsIon|s] fo forogo [eic] honIfh Insurnnco covorngo nnd
|fo] nffomµf 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 µnrfIcIµnfIon In nn Inforsfnfo mnrkof Is
nof IfsoIf commorcInI ncfIvIfy (or Indood nny ncfIvIfy nf nII)
wIfhIn Congross` µowor fo roguInfo. If Is fruo fhnf, nf fho
ond of fho dny, If Is InovIfnbIo fhnf onch AmorIcnn wIII
nffocf commorco nnd bocomo n µnrf of If, ovon If nof by
choIco. Iuf If ovory µorson comos wIfhIn fho Commorco
CInuso µowor of Congross fo roguInfo by fho sImµIo ronson
fhnf ho wIII ono dny ongngo In commorco, fho Idon of n
IImIfod Covornmonf µowor Is nf nn ond.
Wic/orJ v. IilIurn hns boon rognrdod ns fho mosf ox-
µnnsIvo nssorfIon of fho commorco µowor In our hIsfory. A
cIoso socond Is Perec v. Ini/eJ S/o/ee, 402 !. S. l46 (l9?l),
whIch uµhoId n sfnfufo crImInnIIzIng fho omInonfIy IocnI
ncfIvIfy of Ionn-shnrkIng. Iofh of fhoso cnsos, howovor,

sonfIng In µnrf). Insfond, If Is mnndnfIng fho µurchnso of nn unwnnfod
suIfo of µroducfse.g., µhysIcInn offIco vIsIfs, omorgoncy room vIsIfs,
hosµIfnI room nnd bonrd, µhysIcnI fhornµy, durnbIo modIcnI oquIµmonf,
monfnI honIfh cnro, nnd subsfnnco nbuso dofoxIfIcnfIon. Soo SoIocfod
ModIcnI IonofIfs: A !oµorf from fho Ðoµf. of !nbor fo fho Ðoµf. of
HonIfh & Humnn SorvIcos (AµrII l5, 20ll) (roµorfIng fhnf ovor fwo-
fhIrds of µrIvnfo Indusfry honIfh µInns covor fhoso goods nnd sorvIcos),
onIIno nf hffµ://www.bIs.gov/ncs/obs/sµ/soImodbonsroµorf.µdf (nII Infor-
nof mnforInIs ns vIsIfod Juno 26, 20l2, nnd nvnIInbIo In CIork of Courf`s
cnso fIIo).























l3 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
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 comµoIIod, Is fo oxfond fodornI µowor fo vIrfu-
nIIy ovoryfhIng. AII of us consumo food, nnd whon wo do
so fho IodornI Covornmonf cnn µroscrIbo whnf Ifs qunIIfy
musf bo nnd ovon how much wo musf µny. Iuf fho moro
fncf fhnf wo nII consumo food nnd nro fhus, soonor or Infor,
µnrfIcIµnnfs In fho ¨mnrkof¨ for food, doos nof omµowor
fho Covornmonf fo sny whon nnd whnf wo wIII buy. Thnf
Is ossonfInIIy whnf fhIs Acf sooks fo do wIfh rosµocf fo fho
µurchnso of honIfh cnro. If oxcoods fodornI µowor.
C
A fow rosµocffuI rosµonsos fo J!STICI CIÞSI!!C`s dIs-
sonf on fho Issuo of fho Mnndnfo nro In ordor. Thnf dIs-
sonf duIy rocIfos fho fosf of Commorco CInuso µowor fhnf
our oµInIons hnvo nµµIIod, buf dIsrognrds fho µromIso 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-
µhnsIs 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 µurchnsIng
fho honIfh cnro covorod by fho Insurnnco mnndnfo sImµIy
bocnuso ono Is IIkoIy fo bo µurchnsIng If In fho fufuro. Our
fosf`s µromIso of roguInfod ncfIvIfy Is nof Invonfod ouf of
whoIo cIofh, buf rosfs uµon 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 µroµosIfIon fhnf hns novor rocommondod IfsoIf,
noIfhor fo fho Inw nor fo common sonso. To sny, for oxnm-
µIo, fhnf fho InncfIon horo consIsfs of ncfIvIfy In ¨fho soIf-
Insurnnco mnrkof,¨ iIiJ., sooms fo us wordµIny. Iy µnrIfy






















l4 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
of ronsonIng fho fnIIuro fo buy n cnr cnn bo cnIIod µnrfIcI-
µnfIon In fho non-µrIvnfo-cnr-frnnsµorfnfIon mnrkof. Com-
morco bocomos ovoryfhIng.
Tho dIssonf cInIms fhnf wo ¨fnI|I] fo oxµInIn 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 oxµnnsIvo monnIng fo fho Com-
morco CInuso fhnf oll µrIvnfo conducf (IncIudIng fnIIuro fo
ncf) bocomos subjocf fo fodornI confroI, offocfIvoIy dosfroy-
Ing fho ConsfIfufIon`s dIvIsIon of govornmonfnI µowors.
Thus fho dIssonf, on fho fhoorIos µroµosod for fho vnIIdIfy
of fho Mnndnfo, wouId nIfor fho nccoµfod consfIfufIonnI
roInfIon bofwoon fho IndIvIdunI nnd fho ÞnfIonnI Covorn-
monf. Tho dIssonf µrofosfs fhnf fho Þocossnry nnd Iroµor
CInuso hns boon hoId fo IncIudo ¨fho µowor fo onncf crImI-
nnI Inws, . . . fho µowor fo ImµrIson, . . . nnd fho µowor fo
cronfo n nnfIonnI bnnk,¨ on/e, nf 3435. Is nof fho µowor
fo comµoI µurchnso of honIfh Insurnnco much Iossor¨ Þo,
nof If (unIIko fhoso ofhor dIsµosIfIons) Ifs nµµIIcnfIon rosfs
uµon n fhoory fhnf ovoryfhIng Is wIfhIn fodornI confroI
sImµIy bocnuso If oxIsfs.
Tho dIssonf`s oxµosIfIon of fho wondorfuI fhIngs fho Iod-
ornI Covornmonf hns nchIovod fhrough oxorcIso of Ifs
nssIgnod µowors, such ns ¨fho µrovIsIon of oId-ngo nnd
survIvors` bonofIfs¨ In fho SocInI SocurIfy Acf, on/e, nf 2,
Is quIfo bosIdo fho µoInf. Tho Issuo horo Is whofhor fho
fodornI govornmonf cnn Imµoso fho IndIvIdunI Mnndnfo
fhrough fho Commorco CInuso. And fho roIovnnf hIsfory
Is nof fhnf Congross hns nchIovod wIdo nnd wondorfuI
rosuIfs fhrough fho µroµor oxorcIso of Ifs nssIgnod µowors
In fho µnsf, buf fhnf If hns novor boforo usod fho Com-
morco CInuso fo comµoI onfry Info commorco.
3
Tho dIssonf

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























l5 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fronfs fho ConsfIfufIon ns fhough If Is nn onumornfIon of
fhoso µrobIoms fhnf fho IodornI Covornmonf cnn nd-
drossnmong whIch, If fInds, Is ¨fho ÞnfIon`s courso In
fho oconomIc nnd socInI woIfnro ronIm,¨ iIiJ., nnd moro
sµocIfIcnIIy ¨fho µrobIom 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 µrobIoms If
wnnfs buf cnn brIng fo fhoIr soIufIon onIy fhoso µowors
fhnf fho ConsfIfufIon confors, nmong whIch Is fho µowor fo
roguInfo commorco. Þono of our cnsos sny nnyfhIng oIso.
ArfIcIo I confnIns no whnfovor-If-fnkos-fo-soIvo-n-nnfIonnI-
µrobIom µowor.
Tho dIssonf dIsmIssos fho concIusIon fhnf fho µowor fo
comµoI onfry Info fho honIfh-Insurnnco mnrkof wouId
IncIudo fho µowor fo comµoI onfry Info fho now-cnr or
broccoII mnrkofs. Tho Inffor µurchnsors, If snys, ¨wIII bo
obIIgod fo µny nf fho counfor boforo rocoIvIng fho vohIcIo

uµ wIfh nofhIng moro fhnn fwo condomnnfIon cnsos, whIch If snys
domonsfrnfo ¨Congross` nufhorIfy undor fho commorco µowor fo comµoI
nn 'InncfIvo` InndhoIdor fo submIf fo nn unwnnfod snIo.¨ An/e, nf 24.
Wrong on bofh scoros. As Ifs nnmo suggosfs, fho condomnnfIon µowor
doos nof ¨comµoI¨ nnyono fo do nnyfhIng. If ncfs in ren, ngnInsf fho
µroµorfy fhnf Is condomnod, nnd Is offocfIvo wIfh or wIfhouf n frnnsfor
of fIfIo from fho formor ownor. Moro Imµorfnnf, fho µowor fo condomn
for µubIIc uso Is n soµnrnfo sovoroIgn µowor, oxµIIcIfIy ncknowIodgod In
fho IIffh Amondmonf, whIch µrovIdos fhnf ¨µrIvnfo µroµorfy |shnII nof]
bo fnkon for µubIIc uso, wIfhouf jusf comµonsnfIon.¨
Thus, fho µowor fo condomn fonds fo rofufo rnfhor fhnn suµµorf
fho µowor fo comµoI µurchnso of unwnnfod goods nf n µroscrIbod µrIco:
Tho Inffor Is rnfhor IIko fho µowor fo condomn cnsh for µubIIc uso. If If
oxIsfod, why wouId If nof (IIko fho condomnnfIon µowor) bo nccomµn-
nIod by n roquIromonf of fnIr comµonsnfIon for fho µorfIon of fho
oxncfod µrIco fhnf oxcoods fho goods` fnIr mnrkof vnIuo (horo, fho
dIfforonco bofwoon whnf fho froo mnrkof wouId chnrgo for n honIfh-
Insurnnco µoIIcy on n young, honIfhy µorson wIfh no µro-oxIsfIng
condIfIons, nnd fho govornmonf-oxncfod communIfy-rnfod µromIum)¨
















l6 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
or nourIshmonf,¨ whorons fhoso rofusIng fo µurchnso
honIfh-Insurnnco wIII uIfImnfoIy gof fronfod nnywny, nf
ofhors` oxµonso. An/e, nf 2l. ¨|T]ho unIquo nffrIbufos of
fho honIfh-cnro mnrkof . . . gIvo rIso fo n sIgnIfIcnnf froo-
rIdIng µrobIom fhnf doos nof occur In ofhor mnrkofs.¨
An/e, nf 28. And ¨n vogofnbIo-µurchnso mnndnfo¨ (or n
cnr-µurchnso 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 µurchnso honIfh Insurnnco, unIIko fho fnIIuro fo
µurchnso cnrs or broccoII, cronfos n nnfIonnI, socInI-woIfnro
µrobIom fhnf Is (In fho dIssonf`s vIow) IncIudod nmong fho
unonumornfod ¨µrobIoms¨ 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 µubIIc fo µurchnso Amor-
Icnn cnrs mny ondnngor fho oxIsfonco of domosfIc nufomo-
bIIo mnnufncfurors; or fho fnIIuro of somo fo onf broccoII
mny bo found fo doµrIvo fhom of n nowIy dIscovorod cnncor-
fIghfIng chomIcnI whIch onIy fhnf food confnIns, µroducIng
honIfh-cnro cosfs fhnf nro n burdon on fho rosf of usIn
whIch cnso, undor fho fhoory of J!STICI CIÞSI!!C`s dIs-
sonf, movIng ngnInsf fhoso InncfIvIfIos wIII nIso como
wIfhIn fho IodornI Covornmonf`s unonumornfod µrobIom-
soIvIng µowors.)
II
!"# !+/(&0 123#4
As fnr ns §5000A Is concornod, wo wouId sfoµ fhoro.
Congross hns nffomµfod fo roguInfo boyond fho scoµo of Ifs




















l? CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
Commorco CInuso nufhorIfy,
4
nnd §5000A Is fhoroforo
InvnIId. Tho Covornmonf confonds, howovor, ns oxµrossod
In fho cnµfIon fo Inrf II of Ifs brIof, fhnf ¨THI MIÞIM!M
COVI!ACI I!OVISIOÞ IS IÞÐIIIÞÐIÞT!Y A!THO!IZIÐ IY
COÞC!ISS`S TAXIÞC IOWI!.¨ IofIfIonors` MInImum Cov-
orngo IrIof 52. Tho µhrnso ¨IndoµondonfIy nufhorIzod¨
suggosfs fho oxIsfonco of n cronfuro novor hIfhorfo soon
In fho !nIfod Sfnfos !oµorfs: A µonnIfy for consfIfufIonnI
µurµosos fhnf Is oleo n fnx for consfIfufIonnI µurµosos. In
nII our cnsos fho fwo nro mufunIIy oxcIusIvo. Tho µrovI-
sIon chnIIongod undor fho ConsfIfufIon Is oIfhor n µonnIfy
or oIso n fnx. Of courso In mnny cnsos whnf wns n rogu-
Infory mnndnfo onforcod by n µonnIfy coulJ lote Ieen
Imµosod ns n fnx uµon µormIssIbIo ncfIon; or whnf wns Im-
µosod ns n fnx uµon µormIssIbIo ncfIon coulJ lote Ieen n
roguInfory mnndnfo onforcod by n µonnIfy. Iuf wo know
of no cnso, nnd fho Covornmonf cIfos nono, In whIch fho
ImµosIfIon wns, for consfIfufIonnI µurµosos, bofh.
5
Tho
fwo nro mufunIIy oxcIusIvo. Thus, whnf fho Covornmonf`s
cnµfIon shouId hnvo rond wns ¨A!TI!ÞATIVI!Y, THI
MIÞIM!M COVI!ACI I!OVISIOÞ IS ÞOT A MAÞÐATI-WITH-
IIÞA!TY I!T A TAX.¨ If Is Imµorfnnf fo bonr fhIs In mInd
In ovnIunfIng fho fnx nrgumonf of fho Covornmonf nnd of
fhoso who suµµorf If: Tho Issuo Is nof whofhor Congross

4
Þo ono sorIousIy confonds fhnf nny of Congross` ofhor onumornfod
µowors gIvos If fho nufhorIfy fo onncf §5000A oe o regulo/ion.
5
Of courso If cnn bo bofh for sfnfufory µurµosos, sInco Congross cnn
dofIno ¨fnx¨ nnd ¨µonnIfy¨ 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 dIsµrovo our
sfnfomonf. Thnf cnso hoId fhnf n ¨µonnIfy¨ for wIIIfuI fnIIuro fo µny
ono`s fnxos wns IncIudod nmong fho ¨fnxos¨ mndo non-dIschnrgonbIo
undor fho Innkruµfcy Codo. 436 !. S., nf 2?32?5. Whofhor fho
¨µonnIfy¨ wns n ¨fnx¨ wIfhIn fho monnIng of fho Innkruµfcy Codo hnd
nbsoIufoIy no bonrIng on whofhor If oscnµod fho consfIfufIonnI IImIfn-
fIons on µonnIfIos.




















l8 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
hnd fho pouer fo frnmo fho mInImum-covorngo µrovIsIon
ns n fnx, buf whofhor If JiJ so.
In nnsworIng fhnf quosfIon wo musf, If ¨fnIrIy µossIbIo,¨
Crouell v. Beneon, 285 !. S. 22, 62 (l932), consfruo fho
µrovIsIon fo bo n fnx rnfhor fhnn n mnndnfo-wIfh-µonnIfy,
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 µoInf of µorvorfIng
fho µurµoso 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
sImµIy 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 oscnµo whnf Congross
onncfod: n mnndnfo fhnf IndIvIdunIs mnInfnIn mInImum
ossonfInI covorngo, onforcod by n µonnIfy.
Our cnsos osfnbIIsh n cIonr IIno bofwoon n fnx nnd n
µonnIfy: ¨ '|A] fnx Is nn onforcod confrIbufIon fo µrovIdo for
fho suµµorf of govornmonf; n µonnIfy . . . Is nn oxncfIon
Imµosod by sfnfufo ns µunIshmonf 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¨ Imµosod uµon µrIvnfo conducf
wns so onorous ns fo bo In offocf n µonnIfy. Iuf wo hnvo
novor hoIdneterfhnf n µonnIfy Imµosod for vIoInfIon of
fho Inw wns so frIvInI ns fo bo In offocf n fnx. Wo hnvo
novor hoId fhnf on, oxncfIon Imµosod for vIoInfIon of
fho Inw Is nn oxorcIso of Congross` fnxIng µoworovon
whon fho sfnfufo colle If n fnx, much Ioss whon (ns horo)
fho sfnfufo roµonfodIy cnIIs If n µonnIfy. Whon nn ncf
















l9 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
¨ndoµf|s] fho crIforIn of wrongdoIng¨ nnd fhon Imµosos n
monofnry µonnIfy ns fho ¨µrIncIµnI consoquonco on fhoso
who frnnsgross Ifs sfnndnrd,¨ If cronfos n roguInfory µon-
nIfy, nof n fnx. ClilJ LoIor Tox Coee, 259 !. S. 20, 38
(l922).
So fho quosfIon Is, quIfo sImµIy, whofhor fho oxncfIon
horo Is Imµosod for vIoInfIon of fho Inw. If unquosfIon-
nbIy Is. Tho mInImum-covorngo µrovIsIon Is found In 26
!. S. C. §5000A, onfIfIod ¨Iequirenen/ fo mnInfnIn mInI-
mum ossonfInI covorngo.¨ (ImµhnsIs nddod.) If commnnds
fhnf ovory ¨nµµIIcnbIo IndIvIdunI eloll . . . onsuro fhnf fho
IndIvIdunI . . . Is covorod undor mInImum ossonfInI covor-
ngo.¨ 1IiJ. (omµhnsIs nddod). And fho ImmodInfoIy foI-
IowIng µrovIsIon sfnfos fhnf, ¨|I]f . . . nn nµµIIcnbIo
IndIvIdunI . . . fnIIs fo moof fho requirenen/ of subsocfIon
(n) . . . fhoro Is horoby Imµosod . . . n penol/,.¨ §5000A(b)
(omµhnsIs 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 µowor, nof moro fnxIng µowor. 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)(Ð) (¨Tho roquIromonf nchIovos nonr-unIvorsnI
covorngo¨); §l809l(2)(H) (¨Tho roquIromonf Is nn ossonfInI
µnrf 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
Suµromo Courf of fho !nIfod Sfnfos ruIod fhnf Insurnnco
Is Inforsfnfo commorco subjocf fo IodornI roguInfIon¨).
Tho Covornmonf nnd fhoso who suµµorf Ifs vIow on fho
fnx µoInf 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 µrovIsIonn
rocIfnI fhnf µrovIdod for no IognI consoquoncoswhIch
snId fhnf ¨|o]nch Sfnfo shnII bo rosµonsIbIo for µrovIdIng

















20 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
. . . for fho dIsµosnI 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 µroIImInnry µrovIsIon couId nof Imµoso uµon fho oµor-
nfIvo µrovIsIons of fho Acf n mnndnfo fhnf fhoy dId nof
confnIn: ¨Wo . . . docIIno µofIfIonors` InvIfnfIon fo con-
sfruo §202lc(n)(l)(A), nIono nnd In IsoInfIon, ns n com-
mnnd fo fho Sfnfos Indoµondonf of fho romnIndor of fho
Acf.¨ Aeu Yor/, 505 !. S., nf l?0. Our oµInIon fhon
µrocoodod fo ¨consIdor onch |of fho fhroo oµornfIvo µrovI-
sIons] In furn.¨ 1IiJ. Horo fho mnndnfofho ¨shnII¨Is
confnInod nof In nn InoµornfIvo µroIImInnry rocIfnI, buf In
fho dIsµosIfIvo oµornfIvo µrovIsIon IfsoIf. Aeu Yor/ µro-
vIdos no suµµorf for rondIng If fo bo µormIssIvo.
QuIfo soµnrnfoIy, fho fncf fhnf Congross (In Ifs own
words) ¨Imµosod . . . n µonnIfy,¨ 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 Inforµrofn-
fIon fhnf n sfnfufo fhnf µonnIIzos nn ncf mnkos If unInw-
fuI: ¨|W]horo fho sfnfufo InfIIcfs n µonnIfy for doIng nn ncf,
nIfhough fho ncf IfsoIf Is nof oxµrossIy µrohIbIfod, yof fo do
fho ncf Is unInwfuI, bocnuso If cnnnof bo suµµosod fhnf fho
!ogIsInfuro Infondod fhnf n µonnIfy 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 µonnIfy for doIng nn ncf,
fho µonnIfy ImµIIos n µrohIbIfIon, nnd fho fhIng Is unInw-
fuI, fhough fhoro bo no µrohIbIfory words In fho sfnfufo.¨
l J. Konf, CommonfnrIos on AmorIcnn !nw 436 (l826).
Wo novor hnvo cInssIfIod ns n fnx nn oxncfIon Imµosod
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 µonnIfy. To bo suro, wo hnvo somofImos fronfod ns n
fnx n sfnfufory oxncfIon (Imµosod 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)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
of n µonnIfysuch 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 uµ fo fho crIfIcnI dIfforonco bofwoon
n fnx nnd n µonnIfy, nnd oxµIIcIfIy donomInnfos fho oxnc-
fIon n ¨µonnIfy.¨ IIghfoon fImos In §5000A IfsoIf nnd oIso-
whoro fhroughouf fho Acf, Congross cnIIod fho oxncfIon In
§5000A(b) n ¨µonnIfy.¨
Thnf §5000A Imµosos nof n sImµIo fnx buf n mnndnfo fo
whIch n µonnIfy Is nffnchod Is domonsfrnfod by fho fncf
fhnf somo nro oxomµf from fho fnx who nro nof ox-
omµf from fho mnndnfon dIsfIncfIon fhnf wouId mnko
no sonso If fho mnndnfo woro nof n mnndnfo. SocfIon
5000A(d) oxomµfs fhroo cInssos of µooµIo from fho dofInI-
fIon of ¨nµµIIcnbIo IndIvIdunI¨ subjocf fo fho mInImum
covorngo roquIromonf: Thoso wIfh roIIgIous objocfIons or
who µnrfIcIµnfo In n ¨honIfh cnro shnrIng mInIsfry,¨
§5000A(d)(2); fhoso who nro ¨nof InwfuIIy µrosonf¨ In fho
!nIfod Sfnfos, §5000A(d)(3); nnd fhoso who nro Incnrcor-
nfod, §5000A(d)(4). SocfIon 5000A(o) fhon cronfos n soµn-
rnfo sof of oxomµfIons, oxcusIng from IInbIIIfy for fho
µonnIfy 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 oxµorIonco onIy shorf
gnµs In covorngo, §5000A(o)(4); nnd who, In fho judgmonf
of fho Socrofnry of HonIfh nnd Humnn SorvIcos, ¨hnvo
sufforod n hnrdshIµ wIfh rosµocf fo fho cnµnbIIIfy fo obfnIn
covorngo,¨ §5000A(o)(5). If §5000A woro n fnx, fhoso fwo
cInssos of oxomµfIon wouId mnko no sonso; fhoro boIng no
roquIromonf, oll fho oxomµfIons wouId nffnch fo fho µon-
nIfy (ronnmod fnx) nIono.
In fho fnco of nII fhoso IndIcnfIons of n roguInfory ro-
quIromonf nccomµnnIod by n µonnIfy, fho SoIIcIfor ConornI
nssuros us fhnf ¨noIfhor fho Tronsury Ðoµnrfmonf nor fho













22 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
Ðoµnrfmonf of HonIfh nnd Humnn SorvIcos Inforµrofs
SocfIon 5000A ns ImµosIng n IognI obIIgnfIon,¨ IofIfIonors`
MInImum Covorngo IrIof 6l, nnd fhnf ¨|I]f |fhoso subjocf
fo fho Acf] µny fho fnx µonnIfy, fhoy`ro In comµIInnco wIfh
fho Inw,¨ Tr. of OrnI Arg. 50 (Mnr. 26, 20l2). Thoso soIf-
sorvIng IIfIgnfIng µosIfIons 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 µosIfIon In roInfod IIfIgnfIon.
ShorfIy boforo fho AffordnbIo Cnro Acf wns µnssod, fho
CommonwonIfh of VIrgInIn onncfod Vn. Codo Ann. §38.2
3430.l:l (!oxIs Suµµ. 20ll), whIch sfnfos, ¨Þo rosIdonf of
|fho] CommonwonIfh . . . shnII bo roquIrod fo obfnIn or
mnInfnIn n µoIIcy of IndIvIdunI Insurnnco covorngo oxcoµf
ns roquIrod by n courf or fho Ðoµnrfmonf of SocInI Sor-
vIcos . . . .¨ In oµµosIng VIrgInIn`s nssorfIon of sfnndIng fo
chnIIongo §5000A bnsod on fhIs sfnfufo, fho Covornmonf
snId fhnf ¨If fho mInImum covorngo µrovIsIon Is unconsfI-
fufIonnI, fho |VIrgInIn] sfnfufo Is unnocossnry, nnd If fho
mInImum covorngo µrovIsIon Is uµhoId, fho sfnfo sfnfufo Is
voId undor fho Suµromncy CInuso.¨ IrIof for AµµoIInnf
In Þo. lll05? ofc. (CA4), µ. 29. Iuf If wouId bo voId
undor fho Suµromncy CInuso onIy If If wns confrndIcfod by
n fodornI ¨roquIro|monf] fo obfnIn or mnInfnIn n µoIIcy of
IndIvIdunI Insurnnco covorngo.¨
AgnInsf fho mounfnIn of ovIdonco fhnf fho mInImum
covorngo roquIromonf Is whnf fho sfnfufo cnIIs Ifn ro-
quIromonfnnd fhnf fho µonnIfy for Ifs vIoInfIon Is whnf
fho sfnfufo cnIIs Ifn µonnIfyfho Covornmonf brIngs
forwnrd fho fIImsIosf of IndIcnfIons fo fho confrnry. If
nofos fhnf ¨|f]ho mInImum covorngo µrovIsIon nmonds fho
InfornnI !ovonuo Codo fo µrovIdo fhnf n non-oxomµfod
IndIvIdunI . . . wIII owo n monofnry µonnIfy, In nddIfIon fo
fho Incomo fnx IfsoIf,¨ nnd fhnf ¨|f]ho |InfornnI !ovonuo
SorvIco (I!S)] wIII nssoss nnd coIIocf fho µonnIfy In fho
snmo mnnnor ns nssossnbIo µonnIfIos undor fho InfornnI




















23 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
!ovonuo Codo.¨ IofIfIonors` MInImum Covorngo IrIof 53.
Tho mnnnor of coIIocfIon couId µorhnµs suggosf n fnx If
I!S µonnIfy-coIIocfIon woro unhonrd-of or rnro. If Is nof.
Soo, e.g., 26 !. S. C. §52?(j) (2006 od.) (I!S-coIIocfIbIo µon-
nIfy for fnIIuro fo mnko cnmµnIgn-fInnnco dIscIosuros);
§5?6l(c) (I!S-coIIocfIbIo µonnIfy for domosfIc snIos of fo-
bncco µroducfs InboIod for oxµorf); §9?0? (I!S-coIIocfIbIo
µonnIfy for fnIIuro fo mnko roquIrod honIfh-Insurnnco
µromIum µnymonfs on bohnIf of mInIng omµIoyoos). 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 µonnIfy. ¨|I]f fho concoµf of µonnIfy monns
nnyfhIng,¨ wo snId, ¨If monns µunIshmonf for nn unInwfuI
ncf or omIssIon.¨ 1J., nf 224. Soo nIso Lip/e v. LeJerer,
259 !. S. 55? (l922) (snmo). Moroovor, whIIo fho µonnIfy
Is nssossod nnd coIIocfod by fho I!S, §5000A Is ndmInIs-
forod bofh by fhnf ngoncy nnd by fho Ðoµnrfmonf of
HonIfh nnd Humnn SorvIcos (nnd nIso fho Socrofnry of
Vofornn AffnIrs), soo §5000A(o)(l)(Ð), (o)(5), (f)(l)(A)(v),
(f)(l)(I) (2006 od., Suµµ. IV), whIch Is rosµonsIbIo for
dofInIng Ifs subsfnnfIvo scoµon fonfuro fhnf wouId bo
quIfo oxfrnordInnry for fnxos.
Tho Covornmonf µoInfs ouf fhnf ¨|f]ho nmounf of fho
µonnIfy wIII bo cnIcuInfod ns n µorconfngo of housohoId
Incomo for fodornI Incomo fnx µurµosos, subjocf fo n fIoor
nnd |n] cn|µ],¨ 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 µonnIfy¨
(fhough fhoy nro, ns wo dIscussod onrIIor, subjocf fo fho
mnndnfo). IofIfIonors` MInImum Covorngo IrIof l2, 53.
Iuf vnryIng n µonnIfy nccordIng fo nbIIIfy fo µny Is nn
ufforIy fnmIIInr µrncfIco. Soo, e.g., 33 !. S. C. §l3l9(d)
(2006 od., Suµµ. IV) (¨In doformInIng fho nmounf of n cIvII
µonnIfy fho courf shnII consIdor . . . fho oconomIc Imµncf of
fho µonnIfy on fho vIoInfor¨); soo nIso 6 !. S. C. §488o(c); ?






















24 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
!. 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 µofIfIon-
ors fhnf wo wIII nddross Is fho confonfIon fhnf whnf fhIs
sfnfufo roµonfodIy cnIIs n µonnIfy Is In fncf n fnx bocnuso If
confnIns no scIonfor roquIromonf. Tho preeence of such n
roquIromonf suggosfs n µonnIfyfhough ono cnn ImngIno
n fnx Imµosod onIy on wIIIfuI ncfIon; buf fho oIeence of
such n roquIromonf doos nof suggosf n fnx. IonnIfIos for
nbsoIufo-IInbIIIfy offonsos nro commonµInco. And whoro n
sfnfufo Is sIIonf ns fo scIonfor, wo frndIfIonnIIy µrosumo
n nene reo roquIromonf If fho sfnfufo Imµosos n ¨sovoro
µonnIfy.¨ S/oplee v. Ini/eJ S/o/ee, 5ll !. S. 600, 6l8
(l994). SInco wo hnvo nn onfIro jurIsµrudonco nddrossIng
whon If Is fhnf n scIonfor roquIromonf shouId bo Inforrod
from n µonnIfy, If Is quIfo IIIogIcnI fo suggosf fhnf n
µonnIfy Is nof n µonnIfy for wnnf of nn oxµross scIonfor
roquIromonf.
And fho nnII In fho coffIn Is fhnf fho mnndnfo nnd µon-
nIfy nro Iocnfod In TIfIo I of fho Acf, Ifs oµornfIvo 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 Imµosod n
roguInfory µonnIfy, nof n fnx.
Ior nII fhoso ronsons, fo sny fhnf fho IndIvIdunI Mnn-
dnfo moroIy Imµosos n fnx Is nof fo Inforµrof fho sfnfufo
buf fo rowrIfo If. JudIcInI fnx-wrIfIng Is µnrfIcuInrIy froubI-
Ing. Tnxos hnvo novor boon µoµuInr, soo, e.g., Sfnmµ Acf
of l?65, nnd In µnrf for fhnf ronson, fho ConsfIfufIon
roquIros fnx Incronsos fo orIgInnfo In fho Houso of !oµro-
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)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
µooµIo, whoro IogIsInfors musf woIgh fho nood for fho fnx
ngnInsf fho forrIbIo µrIco fhoy mIghf µny nf fhoIr noxf
oIocfIon, whIch Is novor moro fhnn fwo yonrs off. Tho
IodornIIsf Þo. 58 ¨dofond|od] fho docIsIon fo gIvo fho
orIgInnfIon µowor fo fho Houso on fho ground fhnf fho
Chnmbor fhnf Is moro nccounfnbIo fo fho µooµIo shouId
hnvo fho µrImnry roIo In rnIsIng rovonuo.¨ Ini/eJ S/o/ee
v. Munoc-Iloree, 495 !. S. 385, 395 (l990). Wo hnvo no
doubf fhnf Congross know µrocIsoIy whnf If wns doIng
whon If rojocfod nn onrIIor vorsIon of fhIs IogIsInfIon fhnf
Imµosod n fnx Insfond of n roquIromonf-wIfh-µonnIfy. 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. Imµos-
Ing n fnx fhrough judIcInI IogIsInfIon Invorfs fho consfIfu-
fIonnI schomo, nnd µIncos fho µowor 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 nµµorfIonod nmong fho Sfnfos
nccordIng fo fhoIr µoµuInfIon. Arf. I, §9, cI. 4. Iorhnµs If
Is nof (wo hnvo no nood fo nddross fho µoInf); buf fho
monnIng of fho ÐIrocf Tnx CInuso Is fnmousIy uncIonr, nnd
Ifs nµµIIcnfIon horo Is n quosfIon of fIrsf ImµrossIon fhnf
dosorvos moro fhoughffuI consIdornfIon fhnn fho IIck-nnd-
n-µromIso nccordod by fho Covornmonf nnd Ifs suµµorfors.
Tho Covornmonf`s oµonIng brIof dId nof ovon nddross fho
quosfIonµorhnµs bocnuso, unfII fodny, no fodornI courf
hns nccoµfod fho ImµInusIbIo nrgumonf fhnf §5000A Is
nn oxorcIso of fho fnx µowor. And onco rosµondonfs rnIsod
fho Issuo, fho Covornmonf dovofod n moro 2l IInos of Ifs
roµIy brIof fo fho Issuo. IofIfIonors` MInImum Covorngo
!oµIy IrIof 25. Af ornI nrgumonf, fho mosf µroIongod
sfnfomonf nbouf fho Issuo wns jusf ovor 50 words. Tr. of
OrnI Arg. ?9 (Mnr. 2?, 20l2). Ono wouId oxµocf fhIs Courf
























26 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fo domnnd moro fhnn fIy-by-nIghf brIofIng nnd nrgumonf
boforo docIdIng n dIffIcuIf consfIfufIonnI quosfIon of fIrsf
ImµrossIon.
III
!"# 5&.(6%&7*&8.(2& 58.
Thoro Is nnofhor µoInf roInfod fo fho IndIvIdunI Mnn-
dnfo fhnf wo musf dIscussn µoInf fhnf IogIcnIIy shouId
hnvo boon dIscussod fIrsf: Whofhor jurIsdIcfIon ovor fho
chnIIongos fo fho mInImum-covorngo µrovIsIon Is µrocIudod
by fho AnfI-InjuncfIon Acf, whIch µrovIdos fhnf ¨no suIf
for fho µurµoso of rosfrnInIng fho nssossmonf or coIIocfIon
of nny fnx shnII bo mnInfnInod In nny courf by nny µor-
son,¨ 26 !. S. C. §?42l(n) (2006 od.).
Wo hnvo Ioff fho quosfIon fo fhIs µoInf bocnuso If
soomod fo us fhnf fho dIsµosIfIvo quosfIon whofhor fho
mInImum-covorngo µrovIsIon Is n fnx Is moro nµµroµrInfoIy
nddrossod In fho sIgnIfIcnnf consfIfufIonnI confoxf of
whofhor If Is nn oxorcIso of Congross` fnxIng µowor. Hnv-
Ing found fhnf If Is nof, wo hnvo no dIffIcuIfy In docIdIng
fhnf fhoso suIfs do nof hnvo ¨fho µurµoso of rosfrnInIng
fho nssossmonf or coIIocfIon of nny fnx.¨
6

6
Tho onicue nµµoInfod fo dofond fho µroµosIfIon fhnf fho AnfI-
InjuncfIon Acf doµrIvos us of jurIsdIcfIon sfrossos fhnf fho µonnIfy for
fnIIIng fo comµIy wIfh fho mnndnfo ¨shnII bo nssossod nnd coIIocfod
In fho snmo mnnnor ns nn nssossnbIo µonnIfy undor subchnµfor I of
chnµfor 68,¨ 26 !. S. C. §5000A(g)(l) (2006 od., Suµµ. IV), nnd fhnf
such µonnIfIos ¨shnII bo nssossod nnd coIIocfod In fho snmo mnnnor
ns fnxos,¨ §66?l(n) (2006 od.). Iuf fhnf µoInf sooms fo us fo confIrm
fho inopplicoIili/, of fho AnfI-InjuncfIon Acf. Thnf fho µonnIfy Is fo
bo ¨nssossod nnd coIIocfod in /le eone nonner oe fnxos¨ rofufos fho
µroµosIfIon fhnf If ie n fnx for nII sfnfufory µurµosos, IncIudIng wIfh
rosµocf fo fho AnfI-InjuncfIon Acf. Moroovor, oIsowhoro In fho InfornnI
!ovonuo Codo, Congross hns µrovIdod Io/l fhnf n µnrfIcuInr µnymonf
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 µnymonf. Soo, e.g., §§?42l(b)(l), §690l(n); §6305(n), (b). Tho
























2? CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
Tho Covornmonf nnd fhoso who suµµorf Ifs µosIfIon on
fhIs µoInf mnko fho romnrknbIo nrgumonf fhnf §5000A Is
nof n fnx for µurµosos of fho AnfI-InjuncfIon Acf, soo IrIof
for IofIfIonors In Þo. ll398 (AnfI-InjuncfIon Acf), buf
Is n fnx for consfIfufIonnI µurµosos, soo IofIfIonors` MInI-
mum Covorngo IrIof 5262. Tho rhoforIcnI dovIco fhnf
frIos fo cIonk fhIs nrgumonf In suµorfIcInI µInusIbIIIfy Is
fho snmo dovIco omµIoyod In nrguIng fhnf for consfIfu-
fIonnI µurµosos fho mInImum-covorngo µrovIsIon 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 µurµosos of fho AnfI-InjuncfIon Acf, unIIko
whnf qunIIfIos ns n fnx for µurµosos of fho ConsfIfufIon, Is
onfIroIy wIfhIn fho confroI of Congross. Comµnro 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 µowor). Congross couId hnvo dofInod ¨fnx¨
for µurµosos of fhnf sfnfufo In such fnshIon ns fo oxcIudo
somo oxncfIons fhnf In fncf nro ¨fnxos.¨ If mIghf hnvo
µroscrIbod, for oxnmµIo, fhnf n µnrfIcuInr oxorcIso of fho
fnxIng µowor ¨shnII nof bo rognrdod ns n fnx for µurµosos
of fho AnfI-InjuncfIon Acf.¨ Iuf fhoro Is no such µroscrIµ-
fIon horo. Whnf fho Covornmonf wouId hnvo us boIIovo In

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



















28 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
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, dooµ Info fho forbIddon Innd of fho
soµhIsfs.
IV
!"# -#'(8+(' 9/:+&;(2&
Wo now consIdor rosµondonfs` socond chnIIongo fo fho
consfIfufIonnIIfy of fho ACA, nnmoIy, fhnf fho Acf`s drn-
mnfIc oxµnnsIon of fho ModIcnId µrogrnm oxcoods Con-
gross` µowor fo nffnch condIfIons fo fodornI grnnfs fo fho
Sfnfos.
Tho ACA doos nof IognIIy comµoI fho Sfnfos fo µnrfIcI-
µnfo In fho oxµnndod ModIcnId µrogrnm, 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 oxµondIfuros.
?
A Sfnfo forcod ouf of fho µrogrnm wouId nof onIy Ioso fhIs
hugo sum buf wouId nImosf corfnInIy fInd If nocossnry fo
Incronso Ifs own honIfh-cnro oxµondIfuros subsfnnfInIIy,
roquIrIng oIfhor n drnsfIc roducfIon In fundIng for ofhor
µrogrnms or n Inrgo Incronso In sfnfo fnxos. And fhoso
now fnxos wouId como on foµ of fho fodornI fnxos nIrondy
µnId by fho Sfnfo`s cIfIzons fo fund fho ModIcnId µrogrnm
In ofhor Sfnfos.
Tho Sfnfos chnIIongIng fho consfIfufIonnIIfy of fho ACA`s
ModIcnId IxµnnsIon confond fhnf, for fhoso µrncfIcnI
ronsons, fho Acf ronIIy doos nof gIvo fhom nny choIco nf
nII. As µroof of fhIs, fhoy µoInf fo fho gonI nnd fho sfruc-

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

















29 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
furo of fho ACA. Tho gonI of fho Acf Is fo µrovIdo nonr-
unIvorsnI modIcnI covorngo, 42 !. S. C. §l809l(2)(Ð), nnd
wIfhouf l00° Sfnfo µnrfIcIµnfIon In fho ModIcnId µro-
grnm, nffnInmonf of fhIs gonI wouId bo fhwnrfod. Ivon If
Sfnfos couId oIocf fo romnIn In fho oId ModIcnId µrogrnm,
whIIo docIInIng fo µnrfIcIµnfo In fho IxµnnsIon, fhoro
wouId bo n gnµIng hoIo In covorngo. And If n subsfnnfInI
numbor of Sfnfos woro onfIroIy oxµoIIod from fho µrogrnm,
fho numbor of µorsons wIfhouf covorngo wouId bo ovon
hIghor.
In IIghf of fho ACA`s gonI of nonr-unIvorsnI covorngo,
µofIfIonors nrguo, If Congross hnd fhoughf fhnf nnyfhIng
Ioss fhnn l00° sfnfo µnrfIcIµnfIon wns n ronIIsfIc µossIbII-
Ify, Congross wouId hnvo µrovIdod n bnckuµ schomo. Iuf
no such schomo Is fo bo found nnywhoro In fho moro fhnn
900 µngos 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 rosµonso fo fhIs nrgumonf, fho Covornmonf confonds
fhnf nny congrossIonnI nssumµfIon nbouf unIform sfnfo
µnrfIcIµnfIon wns bnsod on fho sImµIo fncf fhnf fho offor
of fodornI funds nssocInfod wIfh fho oxµnndod 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 µowor fo sµond monoy nnd fo
nffnch condIfIons fo monoy grnnfod fo fho Sfnfos.
A
Þo ono hns ovor doubfod fhnf fho ConsfIfufIon nufhor-
Izos fho IodornI Covornmonf fo sµond monoy, buf for
mnny yonrs fho scoµo of fhIs µowor wns unsoffIod. Tho
ConsfIfufIon grnnfs Congross fho µowor fo coIIocf fnxos ¨fo
. . . µrovIdo for fho . . . gonornI WoIfnro of fho !nIfod
Sfnfos,¨ Arf. I, §8, cI. l, nnd from ¨fho foundnfIon of fho
ÞnfIon shnrµ dIfforoncos of oµInIon hnvo µorsIsfod ns fo



















30 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fho fruo InforµrofnfIon of fho µhrnso¨ ¨fho gonornI woI-
fnro.¨ Bu/ler, 29? !. S., nf 65. MndIson, If hns boon snId,
fhoughf fhnf fho µhrnso ¨nmounfod fo no moro fhnn n
roforonco fo fho ofhor µowors onumornfod In fho subso-
quonf cInusos of fho snmo socfIon,¨ whIIo HnmIIfon ¨mnIn-
fnInod fho cInuso confors n µowor soµnrnfo nnd dIsfIncf
from fhoso Infor onumornfod |nnd] Is nof rosfrIcfod In
monnIng by fho grnnf of fhom.¨ 1IiJ.
Tho Courf rosoIvod fhIs dIsµufo In Bu/ler. WrIfIng for
fho Courf, JusfIco !oborfs oµInod fhnf fho MndIsonInn
vIow wouId mnko ArfIcIo I`s grnnf of fho sµondIng µowor n
¨moro fnufoIogy.¨ 1IiJ. To nvoId fhnf, ho ndoµfod HnmII-
fon`s nµµronch nnd found fhnf ¨fho µowor of Congross fo
nufhorIzo oxµondIfuro of µubIIc monoys for µubIIc µur-
µosos Is nof IImIfod by fho dIrocf grnnfs of IogIsInfIvo
µowor found In fho ConsfIfufIon.¨ 1J., nf 66. Insfond, ho
wrofo, fho sµondIng µowor`s ¨confInos nro sof In fho cInuso
whIch confors If, nnd nof In fhoso of socfIon 8 whIch bo-
sfow nnd dofIno fho IogIsInfIvo µowors 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 µowor fo mnko nny oxµondIfuro 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 oxµondIfuro qunIIfIos. Soo Heltering,
30l !. S., nf 64064l. ¨Tho dIscrofIon boIongs fo Con-
gross,¨ fho Courf wrofo, ¨unIoss fho choIco Is cIonrIy
wrong, n dIsµIny of nrbIfrnry µowor, nof nn oxorcIso of
judgmonf.¨ 1J., nf 640. SInco fhnf fImo, fho Courf hns
novor hoId fhnf n fodornI oxµondIfuro wns nof for ¨fho
gonornI woIfnro.¨
I
Ono wny In whIch Congross mny sµond fo µromofo fho
gonornI woIfnro Is by mnkIng grnnfs fo fho Sfnfos. Mono-























3l CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fnry grnnfs, so-cnIIod grnnfs-In-nId, bocnmo moro froquonf
durIng fho l930`s, C. Sfoµhons & Þ. 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 oxµondIfuros from
fhoIr own sourcos.
9
Iy l9?0 fhIs numbor hnd grown fo
$l23.? bIIIIon
l0
or 29.l° of sfnfo nnd IocnI govornmonf
oxµondIfuros 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
oxµondIfuros.
l2
Whon Congross mnkos grnnfs fo fho Sfnfos, If cusfomnr-
IIy nffnchos condIfIons, nnd fhIs Courf hns Iong hoId fhnf
fho ConsfIfufIon gonornIIy µormIfs 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) (oµInIon of Iurgor, C. J.); S/euorJ Mocline, eupro,
nf 593.
C
ThIs µrncfIco of nffnchIng condIfIons fo fodornI funds

8
ThIs numbor Is oxµrossod 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-
µnrIson of TofnI OufInys for Crnnfs fo Sfnfo nnd !ocnI Covornmonfs:
l94020l? (horoInnffor TnbIo l2.l), hffµ://www.whIfohouso.gov/omb/
budgof/HIsforIcnIs; iJ., TnbIo l5.2TofnI Covornmonf IxµondIfuros:
l94820ll (horoInnffor TnbIo l5.2).
l0
ThIs numbor Is oxµrossod In bIIIIons of IIscnI Yonr 2005 doIInrs.
ll
Soo TnbIo l2.l; Ðoµf. of Commorco, Iuronu of Consus, SfnfIsfIcnI
Absfrncf of fho !nIfod Sfnfos: 200l, µ. 262 (TnbIo 4l9, IodornI Crnnfs-
In-AId Summnry: l9?0 fo 200l).
l2
Soo SfnfIsfIcnI Absfrncf of fho !nIfod Sfnfos: 20l2, µ. 268 (TnbIo
43l, IodornI Crnnfs-In-AId fo Sfnfo nnd !ocnI Covornmonfs: l990 fo
20ll).

















32 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
gronfIy Incronsos fodornI µowor. ¨|O]bjocfIvos nof fhoughf
fo bo wIfhIn ArfIcIo I`s onumornfod IogIsInfIvo fIoIds, mny
novorfhoIoss bo nffnInod fhrough fho uso of fho sµondIng
µowor 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 µowor, If nof chockod In nny wny, wouId
µrosonf n grnvo fhronf fo fho sysfom of fodornIIsm cronfod
by our ConsfIfufIon. If Congross` ¨SµondIng CInuso µowor
fo µursuo objocfIvos oufsIdo of ArfIcIo I`s onumornfod
IogIsInfIvo fIoIds,¨ Dotie v. Monroe Coun/, BJ. of 1J., 526
!. S. 629, 654 (l999) (KIÞÞIÐY, 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 SµondIng CInuso gIvos 'µowor fo fho Congross fo fonr
down fho bnrrIors, fo Invndo fho sfnfos` jurIsdIcfIon, nnd fo
bocomo n µnrIInmonf of fho whoIo µooµIo, subjocf fo no
rosfrIcfIons snvo such ns nro soIf-Imµosod,` ¨ Dole, eupro, nf
2l? (O`Connor, J., dIssonfIng) (quofIng Bu/ler, 29? !. S.,
nf ?8). ¨|T]ho SµondIng CInuso µowor, If wIoIdod wIfhouf
concorn for fho fodornI bnInnco, hns fho µofonfInI fo obIIfo-
rnfo dIsfIncfIons bofwoon nnfIonnI nnd IocnI sµhoros of
Inforosf nnd µowor by µormIffIng fho IodornI Covornmonf
fo sof µoIIcy In fho mosf sonsIfIvo nrons of frndIfIonnI
sfnfo concorn, nrons whIch ofhorwIso wouId IIo oufsIdo
Ifs ronch.¨ Dotie, eupro, nf 654655 (KIÞÞIÐY, J.,
dIssonfIng).
!ocognIzIng fhIs µofonfInI for nbuso, our cnsos hnvo Iong
hoId fhnf fho µowor fo nffnch condIfIons fo grnnfs fo fho
Sfnfos hns IImIfs. Soo, e.g., Dole, eupro, nf 20?208; iJ.,
nf 20? (sµondIng µowor Is ¨subjocf fo sovornI gonornI ro-






















33 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
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 µnrfIcuInr nnfIonnI µrojocfs or µrogrnms,¨
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 nccoµf condIfIonnI grnnfs, Congross mny
nof cross fho ¨µoInf nf whIch µrossuro furns Info comµuI-
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 nccoµf or docIIno n fodornI nId µnckngo, fho
fodornI-sfnfo roInfIonshIµ Is In fho nnfuro of n confrncfunI
roInfIonshIµ. 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` µowor
fo IogIsInfo undor fho sµondIng µowor . . . rosfs on whofhor
fho Sfnfo tolun/oril, nnd knowIngIy nccoµfs fho forms
of fho 'confrncf.` ¨ 1IiJ. (omµhnsIs nddod). If n fodornI
sµondIng µrogrnm coorcos µnrfIcIµnfIon fho Sfnfos hnvo
nof ¨oxorcIso|d] fhoIr choIco¨Iof nIono mndo nn ¨Informod
choIco.¨ 1J., nf l?, 25.
CoorcIng Sfnfos fo nccoµf condIfIons rIsks fho dosfruc-
fIon of fho ¨unIquo roIo of fho Sfnfos In our sysfom.¨
Dotie, eupro, nf 685 (KIÞÞIÐY, J., dIssonfIng). ¨|T]ho
ConsfIfufIon hns novor boon undorsfood fo confor uµon
Congross fho nbIIIfy fo roquIro fho Sfnfos fo govorn nccord-
Ing fo Congross` InsfrucfIons.¨ Aeu Yor/, 505 !. S., nf



















34 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
l62. Congross mny nof ¨sImµIy commnndoor fho IogIsIn-
fIvo µrocossos of fho Sfnfos by dIrocfIy comµoIIIng fhom fo
onncf nnd onforco n fodornI roguInfory µrogrnm.¨ 1J.,
nf l6l (InfornnI quofnfIon mnrks nnd brnckofs omIffod).
Congross offocfIvoIy ongngos In fhIs ImµormIssIbIo com-
µuIsIon whon sfnfo µnrfIcIµnfIon In n fodornI sµondIng
µrogrnm Is coorcod, so fhnf fho Sfnfos` choIco whofhor fo
onncf or ndmInIsfor n fodornI roguInfory µrogrnm Is ron-
dorod IIIusory.
Whoro nII Congross hns dono Is fo ¨oncourng|o] sfnfo
roguInfIon rnfhor fhnn comµo|I] If, sfnfo govornmonfs
romnIn rosµonsIvo fo fho IocnI oIocfornfo`s µroforoncos;
sfnfo offIcInIs romnIn nccounfnbIo fo fho µooµIo. |Iuf]
whoro fho IodornI Covornmonf comµoIs Sfnfos fo roguInfo,
fho nccounfnbIIIfy of bofh sfnfo nnd fodornI offIcInIs Is
dImInIshod.¨ Aeu Yor/, eupro, nf l68.
Anici who suµµorf fho Covornmonf nrguo fhnf forcIng
sfnfo omµIoyoos fo ImµIomonf n fodornI µrogrnm Is moro
rosµocffuI of fodornIIsm fhnn usIng fodornI workors fo
ImµIomonf fhnf µrogrnm. Soo, e.g., IrIof for SorvIco Im-
µIoyoos InfornnfIonnI !nIon of nI. ns Anici Curioe In Þo.
ll398, µµ. 2526. Thoy nofo fhnf Congross, Insfond of
oxµnndIng ModIcnId, couId hnvo osfnbIIshod nn onfIroIy
fodornI µrogrnm fo µrovIdo covorngo for fho snmo grouµ of
µooµIo. Iy choosIng fo sfrucfuro ModIcnId ns n cooµornfIvo
fodornI-sfnfo µrogrnm, 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 comµoIs fho Sfnfos fo do Ifs bIddIng, If bIurs fho
IInos of µoIIfIcnI 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 µubIIc, nnd If wIII bo fodornI offI-
cInIs fhnf suffor fho consoquoncos If fho docIsIon furns ouf
fo bo dofrImonfnI or unµoµuInr.¨ Aeu Yor/, 505 !. S., nf























35 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
l68. Iuf whon fho IodornI Covornmonf comµoIs fho
Sfnfos fo fnko unµoµuInr ncfIons, ¨If mny bo sfnfo offIcInIs
who wIII bonr fho brunf of µubIIc dIsnµµrovnI, whIIo fho
fodornI offIcInIs who dovIsod fho roguInfory µrogrnm 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 ¨doµnrfur|o]
from fho fodornI sfrucfuro fo bo In fhoIr µorsonnI Inforosfs
. . . ns n monns of shIffIng rosµonsIbIIIfy for fho ovonfunI
docIsIon.¨ Aeu Yor/, 505 !. S., nf l82l83. And ovon sfnfo
offIcInIs mny fnvor such n ¨doµnrfuro from fho consfIfu-
fIonnI µInn,¨ sInco uncorfnInfy concornIng rosµonsIbIIIfy
mny nIso µormIf fhom fo oscnµo nccounfnbIIIfy. 1J., nf
l82. If n µrogrnm Is µoµuInr, sfnfo offIcInIs mny cInIm
crodIf; If If Is unµoµuInr, fhoy mny µrofosf fhnf fhoy woro
moroIy rosµondIng fo n fodornI dIrocfIvo.
Onco If Is rocognIzod fhnf sµondIng-µowor IogIsInfIon
cnnnof coorco sfnfo µnrfIcIµnfIon, fwo quosfIons romnIn:
(l) Whnf Is fho monnIng of coorcIon In fhIs confoxf¨ (2) Is
fho ACA`s oxµnndod ModIcnId covorngo coorcIvo¨ Wo now
furn fo fhoso quosfIons.
Ð
l
Tho nnswor fo fho fIrsf of fhoso quosfIonsfho monnIng
of coorcIon In fho µrosonf confoxfIs sfrnIghfforwnrd. As
wo hnvo oxµInInod, fho IogIfImncy of nffnchIng condIfIons
fo fodornI grnnfs fo fho Sfnfos doµonds on fho voIunfnrI-
noss of fho Sfnfos` choIco fo nccoµf or docIIno fho offorod
µnckngo. Thoroforo, If Sfnfos ronIIy hnvo no choIco ofhor
fhnn fo nccoµf fho µnckngo, fho offor Is coorcIvo, nnd fho
condIfIons cnnnof bo susfnInod undor fho sµondIng µowor.
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
sµondIng µowor µormIffod Congross fo condIfIon 5° of fho
















36 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
Sfnfo`s fodornI hIghwny funds on fho Sfnfo`s ndoµfIon of
n mInImum drInkIng ngo of 2l yonrs. Soufh Ðnkofn nr-
guod fhnf fho µrogrnm wns ImµormIssIbIy 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 µorconfngo of corfnIn
fodornI hIghwny funds.¨ 483 !. S., nf 2ll. Iocnuso ¨nII
Soufh Ðnkofn 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 sµocIfIod hIgh-
wny grnnf µrogrnms,¨ 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 comµIy wIfh
fho fodornI condIfIon ¨romnIn|od] fho µrorognfIvo of fho
Sfnfos no/ nerel, in /leor, Iu/ in foc/,¨ nnd so fho µro-
grnm nf Issuo dId nof oxcood Congross` µowor. 1J., nf 2ll
2l2 (omµhnsIs nddod).
Tho quosfIon whofhor n Inw onncfod undor fho sµondIng
µowor Is coorcIvo In fncf wIII somofImos bo dIffIcuIf, buf
whoro Congross hns µInInIy ¨crossod fho IIno dIsfInguIsh-
Ing oncourngomonf from coorcIon,¨ Aeu Yor/, eupro, nf
l?5, n fodornI µrogrnm fhnf cooµfs fho Sfnfos` µoIIfIcnI
µrocossos musf bo docInrod unconsfIfufIonnI. ¨|T]ho fod-
ornI bnInnco Is foo ossonfInI n µnrf of our consfIfufIonnI
sfrucfuro nnd µInys foo vIfnI n roIo In socurIng froodom for
us fo ndmIf InnbIIIfy fo Inforvono.¨ Lopec, 5l4 !. S., nf
5?8 (KIÞÞIÐY, J., concurrIng).
2
Tho IodornI Covornmonf`s nrgumonf In fhIs cnso nf bosf
µnys IIµ sorvIco fo fho nnfIcoorcIon µrIncIµIo. 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 !osµondonfs In Þo. ll400, µ. l? (omµhnsIs
nddod); soo nIso iJ., nf 25. AccordIng fo fho IodornI Cov-


















3? CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
ornmonf, noIfhor fho nmounf of fho offorod fodornI funds
nor fho nmounf of fho fodornI fnxos oxfrncfod from fho
fnxµnyors of n Sfnfo fo µny for fho µrogrnm In quosfIon Is
roIovnnf In doformInIng whofhor fhoro Is ImµormIssIbIo
coorcIon. 1J., nf 4l46.
ThIs nrgumonf Ignoros ronIIfy. Whon n honvy fodornI
fnx Is IovIod fo suµµorf n fodornI µrogrnm fhnf offors Inrgo
grnnfs fo fho Sfnfos, Sfnfos mny, ns n µrncfIcnI mnffor, bo
unnbIo fo rofuso fo µnrfIcIµnfo In fho fodornI µrogrnm nnd
fo subsfIfufo n sfnfo nIfornnfIvo. Ivon If n Sfnfo boIIovos
fhnf fho fodornI µrogrnm Is InoffocfIvo nnd InoffIcIonf,
wIfhdrnwnI wouId IIkoIy forco fho Sfnfo fo Imµoso n hugo
fnx Incronso on Ifs rosIdonfs, nnd fhIs now sfnfo fnx wouId
como on foµ of fho fodornI fnxos nIrondy µnId by rosIdonfs
fo suµµorf subsIdIos fo µnrfIcIµnfIng Sfnfos.
l3
Accoµfnnco of fho IodornI Covornmonf`s Inforµrofn-
fIon of fho nnfIcoorcIon ruIo wouId µormIf Congross fo dIc-
fnfo µoIIcy In nrons frndIfIonnIIy govornod µrImnrIIy nf fho
sfnfo or IocnI IovoI. Suµµoso, for oxnmµIo, fhnf Congross
onncfod IogIsInfIon offorIng onch Sfnfo n grnnf oqunI fo fho
Sfnfo`s onfIro nnnunI oxµondIfuros for µrImnry nnd soc-
ondnry oducnfIon. Suµµoso 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 CIÞSI!!C nrguos fhnf ¨|n] Sfnfo . . . hns no cInIm on fho
monoy Ifs rosIdonfs µny 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 cnµncIfIos` ns
'fho µooµIo of AmorIcn`nof ns rosIdonfs of n µnrfIcuInr Sfnfo.¨ An/e, nf
58, n. 26 (quofIng I. S. Tern Lini/e, 1nc. v. Tlorn/on, 5l4 !. S. ??9,
839 (l995) (KIÞÞIÐY, J., concurrIng)). Iuf unIoss J!STICI CIÞSI!!C
fhInks fhnf fhoro Is no IImIf fo fho nmounf of monoy fhnf cnn bo
squoozod ouf of fnxµnyors, honvy fodornI fnxnfIon dImInIshos fho
µrncfIcnI nbIIIfy of Sfnfos fo coIIocf fhoIr own fnxos.
















38 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
schooI cnIondnr, n dross codo for sfudonfs, nnd ruIos for
sfudonf dIscIµIIno. 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 µny fho fodornI fnxos noodod fo suµµorf
fhIs oxµonsIvo now µrogrnm, buf fhoy wouId nIso bo forcod
fo µny 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 sµondIng µowor, fho
SoIIcIfor ConornI rosµondod fhnf If wouId. Tr. of OrnI Arg.
4445 (Mnr. 28, 20l2).
I
Whofhor fodornI sµondIng 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 Ixµnn-
sIon. If fho nnfIcoorcIon ruIo doos nof nµµIy In fhIs cnso,
fhon fhoro Is no such ruIo.
l
Tho dImonsIons of fho ModIcnId µrogrnm Iond sfrong
suµµorf fo fho µofIfIonor Sfnfos` nrgumonf fhnf rofusIng fo
nccodo fo fho condIfIons sof ouf In fho ACA Is nof n ronIIs-
fIc oµfIon. Ioforo fho ACA`s onncfmonf, ModIcnId fundod
modIcnI cnro for µrognnnf womon, fnmIIIos wIfh doµond-
onfs, chIIdron, fho bIInd, fho oIdorIy, nnd fho dIsnbIod. Soo
42 !. S. C. §l396n(n)(l0) (2006 od., Suµµ. IV). Tho ACA
gronfIy oxµnnds fho µrogrnm`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)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
l33° of fho fodornI µovorfy IIno. Soo §l396n(n)
(l0)(A)(I)(VIII). Any Sfnfo fhnf rofusos fo oxµnnd
Ifs ModIcnId µrogrnms 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 µrogrnm of
grnnfs fo fho Sfnfos. Soo IrIof for !osµondonfs In Þo. ll
400, nf 3?. In 20l0, fho IodornI Covornmonf dIrocfod
moro fhnn $552 bIIIIon In fodornI funds fo fho Sfnfos. Soo
Þnf. Assn. of Sfnfo Iudgof OffIcors, 20l0 Sfnfo IxµondI-
furo !oµorf: IxnmInIng IIscnI 200920ll Sfnfo SµondIng,
µ. ? (20ll) (ÞASIO !oµorf). Of fhIs, moro fhnn $233
bIIIIon wonf fo µro-oxµnnsIon 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 µorconfngo 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 oxµondIfuros, soo §l396d(b) (2006 od.,
Suµµ. 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 sµondIng
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, hffµ://
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
oxµondIfuros 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 oxµondIfuros from fhoIr own sourcos.























40 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
$5 bIIIIon, ÞASIO !oµorf 4?. Thoso fodornI doIInrs fofnI
nonrIy fwo fhIrds64.6°of nII ModIcnId oxµondIfuros
nnfIonwIdo.
l5
1J., nf 46.
Tho Courf of AµµonIs concIudod fhnf fho Sfnfos fnIIod fo
osfnbIIsh coorcIon In fhIs cnso In µnrf bocnuso fho ¨sfnfos
hnvo fho µowor fo fnx nnd rnIso rovonuo, nnd fhoroforo cnn
cronfo nnd fund µrogrnms 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 Þo. ll
400, µ. 2l (¨Sfnfos mny nIwnys chooso fo docronso oxµondI-
furos on ofhor µrogrnms or fo rnIso rovonuos¨). Iuf fho
shoor sIzo of fhIs fodornI sµondIng µrogrnm In roInfIon fo
sfnfo oxµondIfuros monns fhnf n Sfnfo wouId bo vory hnrd
µrossod fo comµonsnfo for fho Ioss of fodornI funds by
cuffIng ofhor sµondIng or rnIsIng nddIfIonnI rovonuo.
ArIzonn, for oxnmµIo, commIfs l2° of Ifs sfnfo oxµondI-
furos fo ModIcnId, nnd roIIos on fho IodornI Covornmonf
fo µrovIdo fho rosf: $5.6 bIIIIon, oqunIIng roughIy ono-fhIrd
of ArIzonn`s nnnunI sfnfo oxµondIfuros of $l? bIIIIon. Soo
ÞASIO !oµorf ?, 4?. Thoroforo, If ArIzonn Iosf fodornI
ModIcnId fundIng, fho Sfnfo wouId hnvo fo commIf nn
nddIfIonnI 33° of nII Ifs sfnfo oxµondIfuros fo fund nn
oquIvnIonf sfnfo µrogrnm nIong fho IInos of µro-oxµnnsIon
ModIcnId. ThIs monns fhnf fho Sfnfo wouId hnvo fo nIIo-
cnfo 45° of Ifs nnnunI oxµondIfuros for fhnf ono µurµoso.
Soo iIiJ.
Tho Sfnfos nro fnr Ioss roIInnf on fodornI fundIng for nny
ofhor µrogrnm. Affor ModIcnId, fho noxf bIggosf fodornI

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


















4l CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fundIng Ifom Is nId fo suµµorf 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 oxµondIfuros combInod. Soo iIiJ. In ArIzonn,
for oxnmµIo, nIfhough fodornI ModIcnId oxµondIfuros nro
oqunI fo 33° of nII sfnfo oxµondIfuros, fodornI oducnfIon
funds nmounf fo onIy 9.8° of nII sfnfo oxµondIfuros. 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 µorconfngo of sfnfo oxµond-
Ifuros. 1J., nf ?, l6, 4?.
A Sfnfo forcod ouf of fho ModIcnId µrogrnm wouId fnco
burdons In nddIfIon fo fho Ioss of fodornI ModIcnId fund-
Ing. Ior oxnmµIo, n nonµnrfIcIµnfIng Sfnfo mIghf bo found
fo bo InoIIgIbIo for ofhor mnjor fodornI fundIng sourcos,
such ns Tomµornry AssIsfnnco for Þoody InmIIIos (TAÞI),
whIch Is µromIsod on fho oxµocfnfIon fhnf Sfnfos wIII
µnrfIcIµnfo In ModIcnId. Soo 42 !. S. C. §602(n)(3) (2006
od.) (roquIrIng fhnf corfnIn bonofIcInrIos of TAÞI funds bo
¨oIIgIbIo for modIcnI nssIsfnnco undor fho Sfnfo|`s ModI-
cnId] µInn¨). And wIfhdrnwnI or oxµuIsIon from fho ModI-
cnId µrogrnm wouId nof roIIovo n Sfnfo`s hosµIfnIs of fhoIr
obIIgnfIon undor fodornI Inw fo µrovIdo cnro for µnfIonfs
who nro unnbIo fo µny for modIcnI sorvIcos. Tho Imor-
goncy ModIcnI Tronfmonf nnd AcfIvo !nbor Acf, §l395dd,
roquIros hosµIfnIs fhnf rocoIvo nny fodornI fundIng fo
µrovIdo sfnbIIIznfIon cnro for IndIgonf µnfIonfs buf doos
nof offor fodornI fundIng fo nssIsf fncIIIfIos In cnrryIng ouf
Ifs mnndnfo. Mnny of fhoso µnfIonfs nro now covorod by
ModIcnId. If µrovIdors couId nof Iook fo fho ModIcnId
µrogrnm fo µny for fhIs cnro, fhoy wouId fInd If oxcood-
IngIy dIffIcuIf fo comµIy wIfh fodornI Inw unIoss fhoy woro
gIvon subsfnnfInI sfnfo suµµorf. Soo, e.g., IrIof for Icon-
omIsfs ns Anici Curioe In Þo ll400, µ. ll.
Ior fhoso ronsons, fho offor fhnf fho ACA mnkos fo fho
Sfnfosgo nIong wIfh n drnmnfIc oxµnnsIon of ModIcnId or


















42 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
µofonfInIIy Ioso nII fodornI ModIcnId fundIngIs quIfo
unIIko nnyfhIng fhnf wo hnvo soon In n µrIor sµondIng-
µowor 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 comµIy wIfh fho 2l-yonr-oId drInkIng
ngo wns nµµroxImnfoIy $6l4.? mIIIIonor nbouf 0.l9°
of nII sfnfo oxµondIfuros combInod. Soo Þnf. Assn.
of Sfnfo Iudgof OffIcors, l989 (IIscnI Yonrs l98?
l989 Ðnfn) Sfnfo IxµondIfuro !oµorf l0, 84 (l989),
hffµ://www.nnsbo.org/µubIIcnfIons-dnfn/sfnfo-oxµondIfuro-
roµorf/nrchIvos. Soufh Ðnkofn sfood fo Ioso, nf mosf,
fundIng fhnf nmounfod fo Ioss fhnn l° of Ifs nnnunI sfnfo
oxµondIfuros. Soo iIiJ. !ndor fho ACA, by confrnsf, fho
IodornI Covornmonf hns fhronfonod fo wIfhhoId 42.3° of
nII fodornI oufInys fo fho sfnfos, or nµµroxImnfoIy $233
bIIIIon. Soo ÞASIO !oµorf ?, l0, 4?. Soufh Ðnkofn
sfnnds fo Ioso fodornI fundIng oqunIIng 28.9° of Ifs nnnunI
sfnfo oxµondIfuros. Soo iJ., nf ?, 4?. WIfhhoIdIng $6l4.?
mIIIIon, oqunIIng onIy 0.l9° of nII sfnfo oxµondIfuros
combInod, Is nµfIy chnrncforIzod ns ¨roInfIvoIy mIId on-
courngomonf,¨ buf fhronfonIng fo wIfhhoId $233 bIIIIon,
oqunIIng 2l.86° of nII sfnfo oxµondIfuros 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 oxµrossod Ifs Informod vIow fhnf no Sfnfo couId
µossIbIy 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 µorson obfnIn n mInImum IovoI of covorngo. If nf-
fomµfs fo ronch fhIs gonI In sovornI dIfforonf wnys. Tho
gunrnnfood Issuo nnd communIfy-rnfIng µrovIsIons nro
dosIgnod fo mnko qunIIfyIng Insurnnco nvnIInbIo nnd
nffordnbIo for µorsons wIfh modIcnI condIfIons fhnf mny














43 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
roquIro oxµonsIvo cnro. Ofhor ACA µrovIsIons sook fo
mnko such µoIIcIos moro nffordnbIo for µooµIo of modosf
monns. IInnIIy, for Iow-Incomo IndIvIdunIs who nro
sImµIy nof nbIo fo obfnIn Insurnnco, Congross oxµnndod
ModIcnId, frnnsformIng If from n µrogrnm covorIng onIy
mombors of n IImIfod IIsf of vuInornbIo grouµs Info n µro-
grnm fhnf µrovIdos nf Ionsf fho roquIsIfo mInImum IovoI
of covorngo for fho µoor. Soo 42 !. S. C. §§l396n(n)
(l0)(A)(I)(VIII) (2006 od., Suµµ. IV), l396u?(n), (b)(5),
l8022(n). ThIs dosIgn wns Infondod fo µrovIdo nf Ionsf
n sµocIfIod mInImum IovoI of covorngo for nII AmorIcnns,
buf fho nchIovomonf of fhnf gonI obvIousIy doµonds on
µnrfIcIµnfIon 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 gnµIng
hoIo In fho ACA`s covorngo.
If Is fruo fhnf somo µorsons who nro oIIgIbIo for ModI-
cnId covorngo undor fho ACA mny bo nbIo fo socuro µrIvnfo
Insurnnco, oIfhor fhrough fhoIr omµIoyors or by obfnIn-
Ing subsIdIzod Insurnnco fhrough nn oxchnngo. Soo 26
!. S. C. §36I(n) (2006 od., Suµµ. IV); IrIof for !osµond-
onfs In Þo. ll400, nf l2. Iuf fho now fodornI subsIdIos
nro nof nvnIInbIo fo fhoso whoso Incomo Is boIow fho fod-
ornI µovorfy IovoI, nnd fho ACA µrovIdos no monns, ofhor
fhnn ModIcnId, for fhoso IndIvIdunIs fo obfnIn covorngo
nnd comµIy wIfh fho Mnndnfo. Tho Covornmonf counfors
fhnf fhoso µooµIo wIII nof hnvo fo µny fho µonnIfy, soo, e.g.,
Tr. of OrnI Arg. 68 (Mnr. 28, 20l2); IrIof for !osµondonfs
In Þo. ll400, nf 4950, buf fhnf nrgumonf mIssos fho
µoInf: 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 oxµnnsIon of ModIcnId, Con-
gross wouId suroIy hnvo dovIsod n bnckuµ schomo so fhnf
fho mosf vuInornbIo grouµs In our socIofy, fhoso µrovIousIy














44 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
oIIgIbIo for ModIcnId, wouId nof bo Ioff ouf In fho coId. Iuf
nowhoro In fho ovor 900-µngo Acf Is such n schomo fo bo
found. Iy confrnsf, bocnuso Congross fhoughf fhnf somo
Sfnfos mIghf docIIno fodornI fundIng for fho oµornfIon of
n ¨honIfh bonofIf oxchnngo,¨ Congross µrovIdod n bnckuµ
schomo; If n Sfnfo docIInos fo µnrfIcIµnfo In fho oµornfIon
of nn oxchnngo, fho IodornI Covornmonf wIII sfoµ In
nnd oµornfo nn oxchnngo In fhnf Sfnfo. Soo 42 !. S. C.
§l804l(c)(l). !IkowIso, knowIng fhnf Sfnfos wouId nof
nocossnrIIy µrovIdo nffordnbIo honIfh Insurnnco for nIIons
InwfuIIy µrosonf In fho !nIfod Sfnfosbocnuso ModIcnId
doos nof roquIro Sfnfos fo µrovIdo 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) (oxcoµfIng from fho Incomo IImIf IndIvIdunIs
who nro ¨nof oIIgIbIo for fho modIcnId µrogrnm . . . by
ronson of |fhoIr] nIIon sfnfus¨). Congross dId nof mnko
fhoso subsIdIos nvnIInbIo for cIfIzons wIfh Incomos boIow
fho µovorfy IovoI bocnuso Congross obvIousIy nssumod
fhnf fhoy wouId bo covorod by ModIcnId. If Congross hnd
confomµInfod fhnf somo of fhoso cIfIzons wouId bo Ioff
wIfhouf ModIcnId covorngo ns n rosuIf of n Sfnfo`s wIfh-
drnwnI or oxµuIsIon from fho µrogrnm, Congross suroIy
wouId hnvo mndo fhom oIIgIbIo for fho fnx subsIdIos µro-
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 oxµnnsIon of ModIcnId. Con-
gross woII undorsfood fhnf rofusnI wns nof n µrncfIcnI
oµfIon.
Tho IodornI Covornmonf doos nof dIsµufo fho Inforonco
fhnf Congross nnfIcIµnfod l00° sfnfo µnrfIcIµnfIon, buf If
nrguos fhnf fhIs nssumµfIon wns bnsod on fho fncf fhnf
ACA`s offor wns nn ¨oxcoodIngIy gonorous¨ gIff. IrIof for
!osµondonfs In Þo. ll400, nf 50. As fho IodornI Cov-
ornmonf soos fhIngs, Congross Is IIko fho gonorous bono-
















45 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
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 snnµ
uµ hIs offor, so Congross nssumod fhnf ovory Sfnfo wouId
grnfofuIIy nccoµf fho fodornI funds (nnd condIfIons) fo go
wIfh fho oxµnnsIon 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 nccoµf fhIs ¨oxcood-
IngIy gonorous¨ gIff wouId rIsk IosIng nII ModIcnId funds¨
Congross couId hnvo mndo jusf fho neu fundIng µrovIdod
undor fho ACA confIngonf on nccoµfnnco of fho forms of
fho ModIcnId IxµnnsIon. Congross fook such nn nµµronch
In somo onrIIor nmondmonfs fo ModIcnId, soµnrnfIng now
covorngo roquIromonfs nnd fundIng from fho rosf of fho
µrogrnm 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, nccoµfnnco of fho offor wIII Imµoso vory
subsfnnfInI cosfs on µnrfIcIµnfIng Sfnfos. If Is fruo fhnf
fho IodornI Covornmonf wIII bonr mosf of fho InIfInI cosfs
nssocInfod wIfh fho ModIcnId IxµnnsIon, fIrsf µnyIng
l00° of fho cosfs of covorIng nowIy oIIgIbIo IndIvIdunIs
bofwoon 20l4 nnd 20l6. 42 !. S. C. §l396d(y). Iuf fhnf
Is jusf µnrf of fho µIcfuro. InrfIcIµnfIng 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 IxµnnsIon, soo iIiJ., wIfh sfnfo
sµondIng µrojocfod fo Incronso by nf Ionsf $20 bIIIIon by
2020 ns n consoquonco. Sfnfomonf of ÐougIns W. IImon-










46 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
dorf, CIO`s AnnIysIs of fho Mnjor HonIfh Cnro !ogIsInfIon
Inncfod In Mnrch 20l0, µ. 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 Imµncfs 4, n. 2? (Iob. 20ll) (osfImnfIng now
sfnfo sµondIng nf $43.2 bIIIIon fhrough 20l9). Affor 20l9,
sfnfo sµondIng Is oxµocfod fo Incronso nf n fnsfor rnfo; fho
CIO osfImnfos now sfnfo sµondIng nf $60 bIIIIon fhrough
202l. Sfnfomonf of ÐougIns W. IImondorf, eupro, nf 24.
And fhoso cosfs mny Incronso In fho fufuro bocnuso of
fho vory ronI µossIbIIIfy fhnf fho IodornI Covornmonf wIII
chnngo fundIng forms nnd roduco fho µorconfngo of funds
If wIII covor. ThIs wouId Ionvo fho Sfnfos fo bonr nn In-
cronsIngIy Inrgo µorconfngo of fho bIII. Soo Tr. of OrnI
Arg. ?4?6 (Mnr. 28, 20l2). IInnIIy, nffor 20l5, fho Sfnfos
wIII hnvo fo µIck uµ fho fnb for 50° of nII ndmInIsfrnfIvo
cosfs nssocInfod wIfh ImµIomonfIng fho now µrogrnm, soo
§§l396b(n)(2)(5), (?) (2006 od., Suµµ. IV), cosfs fhnf couId
nµµronch $l2 bIIIIon bofwoon fIscnI yonrs 20l4 nnd 2020,
soo Ðoµf. of HonIfh nnd Humnn SorvIcos, Confor for ModI-
cnId nnd ModIcnro SorvIcos, 20l0 AcfunrInI !oµorf on fho
IInnncInI OufIook for ModIcnId 30.
In sum, If Is µorfocfIy cIonr from fho gonI nnd sfrucfuro
of fho ACA fhnf fho offor of fho ModIcnId IxµnnsIon wns
ono fhnf Congross undorsfood no Sfnfo couId rofuso. Tho
ModIcnId IxµnnsIon fhoroforo oxcoods Congross` sµondIng
µowor nnd cnnnof bo ImµIomonfod.
I
Sovon Mombors of fho Courf ngroo fhnf fho ModIcnId
IxµnnsIon, ns onncfod by Congross, Is unconsfIfufIonnI.
Soo Inrf IVA fo IVI, eupro; Inrf IVA, on/e, nf 4555
(oµInIon of !OII!TS, C. J., joInod by I!IYI! nnd KACAÞ,
JJ.). Iocnuso fho ModIcnId IxµnnsIon Is unconsfIfufIonnI,
fho quosfIon of romody nrIsos. Tho mosf nnfurnI romody



















4? CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
wouId bo fo InvnIIdnfo fho ModIcnId IxµnnsIon. Howovor,
fho Covornmonf µroµososIn fwo cursory sonfoncos nf
fho vory ond of Ifs brIofµrosorvIng fho IxµnnsIon. !ndor
Ifs µroµosnI, Sfnfos wouId rocoIvo fho nddIfIonnI ModI-
cnId funds If fhoy oxµnnd oIIgIbIIIfy, buf Sfnfos wouId
kooµ fhoIr µro-oxIsfIng ModIcnId funds If fhoy do nof
oxµnnd oIIgIbIIIfy. Wo cnnnof nccoµf fho Covornmonf`s
suggosfIon.
Tho ronIIfy fhnf Sfnfos woro gIvon no ronI choIco buf fo
oxµnnd ModIcnId wns nof nn nccIdonf. Congross nssumod
Sfnfos wouId hnvo no choIco, nnd fho ACA doµonds on
Sfnfos` hnvIng no choIco, bocnuso Ifs Mnndnfo roquIros
Iow-Incomo IndIvIdunIs fo obfnIn Insurnnco mnny of fhom
cnn nfford onIy fhrough fho ModIcnId IxµnnsIon. Iur-
fhormoro, n Sfnfo`s wIfhdrnwnI mIghf subjocf ovoryono In
fho Sfnfo fo much hIghor Insurnnco µromIums. Thnf Is
bocnuso fho ModIcnId IxµnnsIon wIII no Iongor offsof fho
cosf fo fho Insurnnco Indusfry Imµosod by fho ACA`s In-
surnnco roguInfIons nnd fnxos, n µoInf fhnf Is oxµInInod In
moro dofnII In fho sovornbIIIfy socfIon boIow. To mnko fho
ModIcnId IxµnnsIon oµfIonnI dosµIfo fho ACA`s sfrucfuro
nnd dosIgn ¨ 'wouId bo fo mnko n now Inw, nof fo onforco
nn oId ono. ThIs Is no µnrf of our dufy.` ¨ TroJe-Mor/
Coeee, l00 !. S. 82, 99 (l8?9).
Worso, fho Covornmonf`s µroµosod romody Infroducos n
now dynnmIc: Sfnfos musf chooso bofwoon oxµnndIng
ModIcnId or µnyIng hugo fnx sums fo fho fodornI fIsc for
fho soIo bonofIf of oxµnndIng 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 InforµrofnfIon. Wo do nof
doubf fhnf Sfnfos nro cnµnbIo of mnkIng docIsIons whon
µuf In n fIghf sµof. Wo do doubf fho nufhorIfy of fhIs
Courf fo µuf fhom fhoro.
Tho Covornmonf cIfos n sovornbIIIfy cInuso codIfIod wIfh
ModIcnId In Chnµfor ? of fho !nIfod Sfnfos Codo sfnfIng















48 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fhnf If ¨nny µrovIsIon of fhIs chnµfor, or fho nµµIIcnfIon
fhoroof fo nny µorson or cIrcumsfnnco, Is hoId InvnIId, fho
romnIndor of fho chnµfor, nnd fho nµµIIcnfIon of such
µrovIsIon fo ofhor µorsons or cIrcumsfnncos shnII nof bo
nffocfod fhoroby.¨ 42 !. S. C. §l303 (2006 od.). Iuf fhnf
cInuso foIIs us onIy fhnf ofhor µrovIsIons In Chnµfor ?
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 µowor wouId
nof bo cnIIod fho docfrIno of sovornbIIIfy buf µorhnµs
fho docfrIno of nmondnfory InvnIIdnfIonsImIInr fo fho
nmondnfory vofo fhnf µormIfs fho Covornors of somo
Sfnfos fo roduco fho nmounfs nµµroµrInfod In IogIsInfIon.
Tho µroof fhnf such n µowor doos nof oxIsf Is fho fncf fhnf
If wouId nof µrosorvo ofhor congrossIonnI dIsµosIfIons, buf
wouId Ionvo If uµ fo fho Courf whnf fho ¨vnIIdnfod¨ IogIs-
InfIon wIII confnIn. Tho Courf fodny oµfs for µormIffIng
fho cuf-off of onIy IncromonfnI ModIcnId fundIng, buf If
mIghf jusf ns woII hnvo µormIffod, sny, fho cuf-off of funds
fhnf roµrosonf no moro fhnn x µorconf of fho Sfnfo`s bud-
gof. Tho Courf sovors nofhIng, buf sImµIy rovIsos §l396c fo
rond ns fho Courf wouId dosIro.
Wo shouId nof nccoµf fho Covornmonf`s InvIfnfIon fo
nffomµf fo soIvo n consfIfufIonnI µrobIom by rowrIfIng fho
ModIcnId IxµnnsIon so ns fo nIIow Sfnfos fhnf rojocf If
fo rofnIn fhoIr µro-oxIsfIng ModIcnId funds. Worso, fho
Covornmonf`s romody, now ndoµfod by fho Courf, fnkos
fho ACA nnd fhIs ÞnfIon In n now dIrocfIon nnd chnrfs n
courso for fodornIIsm fhnf fho Courf, nof fho Congross, hns
choson; buf undor fho ConsfIfufIon, fhnf µowor 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)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
unIvorsnI¨ honIfh Insurnnco covorngo. §l809l(2)(Ð) (2006
od., Suµµ. IV). Tho fwo µIIInrs of fho Acf nro fho IndIvId-
unI Mnndnfo nnd fho oxµnnsIon of covorngo undor ModIcnId.
In our vIow, bofh fhoso confrnI µrovIsIons of fho Acffho
IndIvIdunI Mnndnfo nnd ModIcnId IxµnnsIonnro InvnIId.
If foIIows, ns somo of fho µnrfIos urgo, fhnf nII ofhor µrovI-
sIons of fho Acf musf fnII ns woII. Tho foIIowIng socfIon
oxµInIns fho sovornbIIIfy µrIncIµIos 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
usurµnfIon fo Imµoso nn onfIroIy now mochnnIsm for
wIfhdrnwnI of ModIcnId fundIng, soo Inrf IVI, eupro,
whIch Is ono of mnny oxnmµIos of how rowrIfIng fho Acf
nIfors Ifs dynnmIcs.
A
Whon nn unconsfIfufIonnI µrovIsIon Is buf n µnrf of n
moro comµrohonsIvo sfnfufo, fho quosfIon nrIsos ns fo fho
vnIIdIfy of fho romnInIng µrovIsIons. Tho Courf`s nufhor-
Ify fo docInro n sfnfufo µnrfInIIy unconsfIfufIonnI hns boon
woII osfnbIIshod sInco MorIur, v. MoJieon, l Crnnch l3?
(l803), whon fho Courf sovorod nn unconsfIfufIonnI µrovI-
sIon from fho JudIcInry Acf of l?89. And whIIo fho Courf
hns somofImos nµµIIod ¨nf Ionsf n modosf µrosumµfIon In
fnvor of . . . sovornbIIIfy,¨ C. ÞoIson, Sfnfufory Inforµrofn-
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
µrovIsIons 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 Imµosos on fho ÞnfIon, by fho Courf`s
docroo, Ifs own now sfnfufory rogImo, consIsfIng of µoII-


















50 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
cIos, rIsks, nnd dufIos fhnf Congross dId nof onncf. Thnf
cnn bo n moro oxfromo oxorcIso of fho judIcInI µowor fhnn
sfrIkIng fho whoIo sfnfufo nnd nIIowIng Congross fo nd-
dross fho condIfIons fhnf µorfnInod whon fho sfnfufo wns
consIdorod nf fho oufsof.
Tho Courf hns nµµIIod n fwo-µnrf 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
µrovIsIon unconsfIfufIonnI, If fhon doformInos whofhor
fho now fruncnfod sfnfufo wIII oµornfo In fho mnnnor Con-
gross Infondod. If nof, fho romnInIng µrovIsIons 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 IncnµnbIo of
funcfIonIng IndoµondonfIy.¨ 1J., nf 684. Ivon If fho ro-
mnInIng µrovIsIons wIII oµornfo In somo cohoronf wny,
fhnf nIono doos nof snvo fho sfnfufo. Tho quosfIon Is
whofhor fho µrovIsIons 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 (omµhnsIs In orIgInnI).
Soo nIso Iree 1n/erpriee IunJ v. PuIlic Conpon, Accoun/-
ing Otereigl/ BJ., 56l !. S. ___, ___ (20l0) (sIIµ oµ., nf
28) (fho Acf ¨romnIns fuIIy oµornfIvo 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 µrovIsIons . . . musf bo InvnIIdnfod In ordor
fo nIIow fho sfnfufo fo oµornfo In n mnnnor consIsfonf
wIfh congrossIonnI Infonf¨); Mille Loce, eupro, nf l94 (¨|I]m-
bodyIng ns If dId ono cohoronf µoIIcy, |fho onfIro ordor]
Is InsovornbIo¨).
Socond, ovon If fho romnInIng µrovIsIons cnn oµornfo ns
Congross dosIgnod fhom fo oµornfo, fho Courf musf do-
formIno If Congross wouId hnvo onncfod fhom sfnndIng
nIono nnd wIfhouf fho unconsfIfufIonnI µorfIon. If Con-















5l CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
gross wouId nof, fhoso µrovIsIons, foo, musf bo InvnIIdnfod.
Soo Aloe/o Airlinee, eupro, nf 685 (¨|T]ho unconsfIfu-
fIonnI µrovIsIon 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
___ (sIIµ oµ., nf 29) (¨|Þ]ofhIng In fho sfnfufo`s foxf or
hIsforIcnI confoxf mnkos If 'ovIdonf` fhnf Congross, fncod
wIfh fho IImIfnfIons Imµosod by fho ConsfIfufIon, wouId
hnvo µroforrod 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 µroforrod 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) (µIurnI-
Ify oµInIon) (¨WouId Congross sfIII hnvo µnssod §l0(n) hnd
If known fhnf fho romnInIng µrovIsIons woro InvnIId¨
(InfornnI quofnfIon mnrks nnd brnckofs omIffod)).
Tho fwo InquIrIoswhofhor fho romnInIng µrovIsIons
wIII oµornfo ns Congross dosIgnod fhom, nnd whofhor
Congross wouId hnvo onncfod fho romnInIng µrovIsIons
sfnndIng nIonooffon nro InforroInfod. In fho ordInnry
courso, If fho romnInIng µrovIsIons cnnnof oµornfo 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
oxµInIn why fho Courf hns nof nIwnys boon µrocIso In
dIsfInguIshIng bofwoon fho fwo. Thoro nro, howovor,
occnsIons In whIch fho sovornbIIIfy sfnndnrd`s fIrsf InquIry
(sfnfufory funcfIonnIIfy) Is nof n µroxy for fho socond
InquIry (whofhor fho !ogIsInfuro Infondod fho romnInIng
µrovIsIons fo sfnnd nIono).
I
Tho Acf wns µnssod fo onnbIo nffordnbIo, ¨nonr-unIvorsnI¨
honIfh Insurnnco covorngo. 42 !. S. C. §l809l(2)(Ð).
Tho rosuIfIng, comµIox sfnfufo consIsfs of mnndnfos nnd

















52 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
ofhor roquIromonfs; comµrohonsIvo roguInfIon nnd µonnI-
fIos; somo undoubfod fnxos; nnd Incronsos In somo gov-
ornmonfnI oxµondIfuros, docronsos In ofhors. !ndor fho
sovornbIIIfy fosf sof ouf nbovo, If musf bo doformInod If
fhoso µrovIsIons funcfIon In n cohoronf wny nnd ns Con-
gross wouId hnvo Infondod, ovon whon fho mnjor µrovI-
sIons osfnbIIshIng fho IndIvIdunI Mnndnfo nnd ModIcnId
IxµnnsIon 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 Imµoso fho InovIfnbIo cosfs on nny ono Indus-
fry or grouµ of IndIvIdunIs. Tho whoIo dosIgn of fho Acf
Is fo bnInnco fho cosfs nnd bonofIfs nffocfIng onch sof
of roguInfod µnrfIos. Thus, IndIvIdunIs nro roquIrod fo
obfnIn honIfh Insurnnco. Soo 26 !. S. C. §5000A(n). Insur-
nnco comµnnIos nro roquIrod fo soII fhom Insurnnco ro-
gnrdIoss of µnfIonfs` µro-oxIsfIng condIfIons nnd fo comµIy
wIfh n hosf of ofhor roguInfIons. And fho comµnnIos musf
µny now fnxos. Soo §4980I (hIgh-cosf Insurnnco µInns);
42 !. S. C. §§300gg(n)(l), 300gg4(b) (communIfy rnfIng);
§§300ggl, 300gg3, 300gg4(n) (gunrnnfood Issuo);
§300ggll (oIImInnfIon of covorngo IImIfs); §300ggl4(n)
(doµondonf chIIdron uµ 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 oxµocfod fo oxµnnd ModIcnId
oIIgIbIIIfy nnd fo cronfo roguInfod mnrkofµIncos cnIIod ox-
chnngos whoro IndIvIdunIs cnn µurchnso Insurnnco. Soo
42 !. S. C. §§l396n(n)(l0)(A)(I)(VIII) (2006 od., Suµµ. IV)
(ModIcnId IxµnnsIon), l803l (oxchnngos). Somo µorsons
who cnnnof nfford Insurnnco nro µrovIdod If fhrough fho
ModIcnId IxµnnsIon, nnd ofhors nro nIdod In fhoIr µur-
chnso of Insurnnco fhrough fodornI subsIdIos nvnIInbIo on
honIfh-Insurnnco oxchnngos. Soo 26 !. S. C. §36I (2006


















53 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
od., Suµµ. IV), 42 !. S. C. §l80?l (2006 od., Suµµ. IV)
(fodornI subsIdIos). Tho IodornI Covornmonf`s Incronsod
sµondIng Is offsof by now fnxos nnd cufs In ofhor fodornI
oxµondIfuros, IncIudIng roducfIons In ModIcnro nnd In
fodornI µnymonfs fo hosµIfnIs. Soo, e.g., §l395ww(r) (Mod-
Icnro cufs); ACA TIfIo IX, SubfIfIo A, l24 Sfnf. 84? (¨!ov-
onuo Offsof IrovIsIons¨). ImµIoyors wIfh nf Ionsf 50
omµIoyoos musf oIfhor µrovIdo omµIoyoos wIfh ndoqunfo
honIfh bonofIfs or µny n fInnncInI oxncfIon If nn omµIoyoo
who qunIIfIos for fodornI subsIdIos µurchnsos Insurnnco
fhrough nn oxchnngo. Soo 26 !. S. C. §4980H (2006 od.,
Suµµ. IV).
In shorf, fho Acf nffomµfs fo nchIovo nonr-unIvorsnI
honIfh Insurnnco covorngo by sµrondIng Ifs cosfs fo IndI-
vIdunIs, Insurors, govornmonfs, hosµIfnIs, nnd omµIoyors
whIIo, nf fho snmo fImo, offsoffIng sIgnIfIcnnf µorfIons
of fhoso cosfs wIfh now bonofIfs fo onch grouµ. Ior ox-
nmµIo, fho IodornI Covornmonf bonrs fho burdon of µny-
Ing bIIIIons for fho now onfIfIomonfs mnndnfod by fho
ModIcnId IxµnnsIon nnd fodornI subsIdIos for Insurnnco
µurchnsos on fho oxchnngos; buf If bonofIfs from roduc-
fIons In fho roImbursomonfs If µnys fo hosµIfnIs. HosµI-
fnIs Ioso fhoso roImbursomonfs; buf fhoy bonofIf from fho
docronso In uncomµonsnfod cnro, for undor fho Insurnnco
roguInfIons If Is onsIor for IndIvIdunIs wIfh µro-oxIsfIng
condIfIons fo µurchnso covorngo fhnf Incronsos µnymonfs
fo hosµIfnIs. Insurnnco comµnnIos bonr now cosfs Imµosod
by n coIIocfIon of Insurnnco roguInfIons nnd fnxos, IncIudIng
¨gunrnnfood Issuo¨ nnd ¨communIfy rnfIng¨ roquIromonfs
fo gIvo covorngo rognrdIoss of fho Insurod`s µro-oxIsfIng
condIfIons; buf fho Insurors bonofIf from fho now, honIfhy
µurchnsors who nro forcod by fho IndIvIdunI Mnndnfo
fo buy fho Insurors` µroducf nnd from fho now Iow-
Incomo ModIcnId rocIµIonfs who wIII onroII In Insurnnco
comµnnIos` ModIcnId-fundod mnnngod cnro µrogrnms. In
summnry, fho IndIvIdunI Mnndnfo nnd ModIcnId Ixµnn-















54 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
sIon offsof Insurnnco roguInfIons nnd fnxos, whIch offsof
roducod roImbursomonfs fo hosµIfnIs, whIch offsof In-
cronsos In fodornI sµondIng. So, fho Acf`s mnjor µrovIsIons
nro Infordoµondonf.
Tho Acf fhon rofors fo fhoso InfordoµondoncIos ns
¨shnrod rosµonsIbIIIfy.¨ Soo ACA SubfIfIo I, TIfIo I, l24
Sfnf. 242 (¨Shnrod !osµonsIbIIIfy¨); ACA §l50l, iIiJ.
(snmo); ACA §l5l3, iJ., nf 253 (snmo); ACA §4980H, iIiJ.
(snmo). In nf Ionsf sIx µIncos, fho Acf doscrIbos fho IndI-
vIdunI Mnndnfo ns workIng ¨fogofhor wIfh fho ofhor µro-
vIsIons of fhIs Acf.¨ 42 !. S. C. §l809l(2)(C) (2006 od.,
Suµµ. 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 µooror honIfh nnd shorfor IIfosµnn of fho unIn-
surod); §l809l(2)(I) (workIng ¨fogofhor¨ fo ¨Iowor honIfh
Insurnnco µromIums¨); §l809l(2)(C) (workIng ¨fogofhor¨ fo
¨Imµrovo fInnncInI socurIfy for fnmIIIos¨); §l809l(2)(I)
(workIng ¨fogofhor¨ fo mInImIzo ¨ndvorso soIocfIon nnd
brondon fho honIfh Insurnnco rIsk µooI fo IncIudo honIfhy
IndIvIdunIs¨); §l809l(2)(J) (workIng ¨fogofhor¨ fo ¨sIgnIf-
IcnnfIy roduco ndmInIsfrnfIvo cosfs nnd Iowor honIfh
Insurnnco µromIums¨). Tho Acf cnIIs fho IndIvIdunI Mnn-
dnfo ¨nn ossonfInI µnrf¨ 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 µroIImInnry µoInf shouId bo nofod boforo nµµIyIng
sovornbIIIfy µrIncIµIos fo fho Acf. To bo suro, nn nrgumonf
cnn bo mndo fhnf fhoso µorfIons of fho Acf fhnf nono of fho
µnrfIos hns sfnndIng fo chnIIongo cnnnof bo hoId nonso-
vornbIo. Tho rosµonso fo fhIs nrgumonf Is fhnf our cnsos
do nof suµµorf 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)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
nbIo sfnfufory µrovIsIons fhnf dId nof burdon fho µnrfIos).
If wouId bo µnrfIcuInrIy dosfrucfIvo of sound govornmonf
fo nµµIy such n ruIo wIfh rognrd fo n muIfIfncofod µIoco of
IogIsInfIon IIko fho ACA. If wouId fnko yonrs, µorhnµs
docndos, for onch of Ifs µrovIsIons fo bo ndjudIcnfod soµn-
rnfoIynnd for somo of fhom (fhoso sImµIy oxµondIng
fodornI funds) no ono mny hnvo soµnrnfo sfnndIng. Tho
IodornI Covornmonf, fho Sfnfos, nnd µrIvnfo µnrfIos oughf
fo know nf onco whofhor fho onfIro IogIsInfIon fnIIs.
Tho oµInIon now oxµInIns In Inrf VCl, infro, why fho
Acf`s mnjor µrovIsIons nro nof sovornbIo from fho Mnndnfo
nnd ModIcnId IxµnnsIon. If µrocoods from fho Insurnnco
roguInfIons nnd fnxos (Cln), fo fho roducfIons In roIm-
bursomonfs fo hosµIfnIs nnd ofhor ModIcnro roducfIons
(Clb), fho oxchnngos nnd fhoIr fodornI subsIdIos (Clc),
nnd fho omµIoyor rosµonsIbIIIfy nssossmonf (Cld).
Inrf VC2, infro, oxµInIns why fho Acf`s mInor µrovI-
sIons nIso nro nof sovornbIo.
l
!"# 58.?; -+724 142)(;(2&;
Mnjor µrovIsIons of fho AffordnbIo Cnro Acfi.e., fho
Insurnnco roguInfIons nnd fnxos, fho roducfIons In fodornI
roImbursomonfs fo hosµIfnIs nnd ofhor ModIcnro sµond-
Ing roducfIons, fho oxchnngos nnd fhoIr fodornI subsIdIos,
nnd fho omµIoyor rosµonsIbIIIfy nssossmonfcnnnof romnIn
onco fho IndIvIdunI Mnndnfo nnd ModIcnId IxµnnsIon nro
InvnIId. Thnf rosuIf foIIows from fho undoubfod InnbIIIfy
of fho ofhor mnjor µrovIsIons fo oµornfo ns Congross In-
fondod wIfhouf fho IndIvIdunI Mnndnfo nnd ModIcnId
IxµnnsIon. Absonf fho InvnIId µorfIons, fho ofhor mnjor
µrovIsIons couId Imµoso onormous rIsks of unoxµocfod bur-
dons on µnfIonfs, fho honIfh-cnro communIfy, nnd fho
fodornI budgof. Thnf consoquonco wouId bo In nbsoIufo
confIIcf wIfh fho ACA`s dosIgn of ¨shnrod rosµonsIbIIIfy,¨
nnd wouId µoso n fhronf fo fho ÞnfIon fhnf Congross dId


















56 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
nof Infond.
n
"#$%&'#() *)+%,'-./#$ '#0 1'2)$
WIfhouf fho IndIvIdunI Mnndnfo nnd ModIcnId Ixµnn-
sIon, fho AffordnbIo Cnro Acf`s Insurnnco roguInfIons nnd
Insurnnco fnxos Imµoso rIsks on Insurnnco comµnnIos nnd
fhoIr cusfomors fhnf fhIs Courf cnnnof monsuro. Thoso
rIsks wouId undormIno Congross` schomo of ¨shnrod ro-
sµonsIbIIIfy.¨ Soo 26 !. S. C. §4980I (2006 od., Suµµ.
IV) (hIgh-cosf Insurnnco µInns); 42 !. S. C. §§300gg(n)(l)
(2006 od., Suµµ. IV), 300gg4(b) (communIfy rnfIng);
§§300ggl, 300gg3, 300gg4(n) (gunrnnfood Issuo);
§300ggll (oIImInnfIon of covorngo IImIfs); §300ggl4(n)
(doµondonf chIIdron uµ 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
IxµnnsIon 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
nµµroxImnfoIy $?00 bIIIIon In now cosfs fo fho Insurnnco
Indusfry Imµosod by fho Acf`s Insurnnco roguInfIons nnd
fnxos; nnd fhnf fho now $?00-bIIIIon burdon wouId ofhor-
wIso dwnrf fho Indusfry`s curronf µrofIf mnrgIn. Soo IrIof
for IconomIsfs ns Anici Curioe In Þo. ll393 ofc. (Sovor-
nbIIIfy), µµ. 9l6, l0n.
If fhnf nnnIysIs Is corrocf, fho roguInfIons nnd fnxos wIII
monn hIghor cosfs for Insurnnco comµnnIos. HIghor cosfs
mny monn hIghor µromIums for consumors, dosµIfo fho
Acf`s gonI of ¨Iowor|Ing] honIfh Insurnnco µromIums.¨ 42
!. S. C. §l809l(2)(I) (2006 od., Suµµ. IV). HIghor cosfs
nIso couId fhronfon fho survIvnI of honIfh-Insurnnco com-
µnnIos, dosµIfo fho Acf`s gonI of ¨offocfIvo honIfh Insurnnco
mnrkofs.¨ §l809l(2)(J).















5? CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
Tho ncfunI cosf of fho roguInfIons nnd fnxos mny bo
moro or Ioss fhnn µrodIcfod. Whnf Is known, howovor, Is
fhnf sovorIng ofhor µrovIsIons from fho IndIvIdunI Mnn-
dnfo nnd ModIcnId IxµnnsIon nocossnrIIy wouId Imµoso
sIgnIfIcnnf rIsks nnd ronI uncorfnInfIos on Insurnnco com-
µnnIos, 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 µrogross nnd fIscnI sfnbIIIfy
nnd fhus fo fho snfofy nnd woIfnro of fho ÞnfIon nnd fho
ÞnfIon`s froodom. If fhoso rIsks nnd uncorfnInfIos nro fo
bo Imµosod, 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 µnymonfs by fho Iod-
ornI Covornmonf fo hosµIfnIs by moro fhnn $200 bIIIIon
ovor l0 yonrs. Soo 42 !. S. C. §l395ww(b)(3)(I)(xI)(xII)
(2006 od., Suµµ. IV); §l395ww(q); §l395ww(r); §l396r
4(f)(?).
Tho concoµf Is sfrnIghfforwnrd: Þonr-unIvorsnI covorngo
wIII roduco uncomµonsnfod cnro, whIch wIII Incronso hos-
µIfnIs` rovonuos, whIch wIII offsof fho govornmonf`s ro-
ducfIons In ModIcnro nnd ModIcnId roImbursomonfs fo
hosµIfnIs. !osµonsIbIIIfy wIII bo shnrod, ns burdons nnd
bonofIfs bnInnco onch ofhor. ThIs Is fyµIcnI of fho whoIo
dynnmIc of fho Acf.
InvnIIdnfIng fho koy mochnnIsms for oxµnndIng Insur-
nnco covorngo, such ns communIfy rnfIng nnd fho ModI-
cnId IxµnnsIon, wIfhouf InvnIIdnfIng fho roducfIons In
ModIcnro nnd ModIcnId, dIsforfs fho ACA`s dosIgn of
¨shnrod rosµonsIbIIIfy.¨ Somo hosµIfnIs mny bo forcod fo
rnIso fho cosf of cnro In ordor fo offsof fho roducfIons In
roImbursomonfs, whIch couId rnIso fho cosf of Insurnnco
µromIums, In confrnvonfIon of fho Acf`s gonI of ¨Iowor|Ing]
















58 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
honIfh Insurnnco µromIums.¨ 42 !. S. C. §l809l(2)(I)
(2006 od., Suµµ. IV). Soo nIso §l809l(2)(I) (gonI of
¨Iowor|Ing] honIfh Insurnnco µromIums¨); §l809l(2)(J)
(snmo). Ofhor hosµIfnIs, µnrfIcuInrIy snfofy-nof hosµIfnIs fhnf
sorvo n Inrgo numbor of unInsurod µnfIonfs, mny bo forcod
fo shuf down. Cf. ÞnfIonnI Assn. of IubIIc HosµIfnIs, 2009
AnnunI Survoy: Snfofy Þof HosµIfnIs nnd HonIfh Sysfoms
IuIfIII MIssIon In !ncorfnIn TImos 56 (Iob. 20ll). !Iko
fho offocf of µrosorvIng fho Insurnnco roguInfIons nnd
fnxos, fho µrocIso dogroo of rIsk fo hosµIfnIs Is unknow-
nbIo. If Is nof fho µroµor roIo of fho Courf, by sovorIng
µnrf of n sfnfufo nnd nIIowIng fho rosf fo sfnnd, fo Imµoso
unknownbIo rIsks fhnf Congross couId noIfhor monsuro
nor µrodIcf. And Congross couId nof hnvo Infondod fhnf
rosuIf In nny ovonf.
Thoro Is n socond, Indoµondonf ronson why fho roduc-
fIons In roImbursomonfs fo hosµIfnIs 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 IxµnnsIon. 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
rosµonsIbIIIfy¨ concoµf oxfonds fo fho fodornI budgof.
Congross choso fo offsof now fodornI oxµondIfuros wIfh
budgof cufs nnd fnx Incronsos. Thnf Is why fho !nIfod
Sfnfos hns oxµInInod In fho courso of fhIs IIfIgnfIon fhnf
¨|w]hon Congross µnssod fho ACA, If wns cnrofuI fo onsuro
fhnf nny Incronsod sµondIng, IncIudIng on ModIcnId, wns
offsof by ofhor rovonuo-rnIsIng nnd cosf-snvIng µrovI-
sIons.¨ Momornndum In Suµµorf of Covornmonf`s MofIon
for Summnry Judgmonf In Þo. 3l0cv9l, µ. 4l.
If fho ModIcnro nnd ModIcnId roducfIons wouId no Iongor
















59 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
bo noodod fo offsof fho cosfs of fho ModIcnId IxµnnsIon,
fho roducfIons wouId no Iongor oµornfo In fho mnnnor
Congross Infondod. Thoy wouId Ioso fhoIr jusfIfIcnfIon nnd
foundnfIon. In nddIfIon, fo µrosorvo fhom wouId bo ¨fo
oIImInnfo n sIgnIfIcnnf quiJ pro quo of fho IogIsInfIvo com-
µromIso¨ 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 unµoµuInr; nnd If Is mosf ImµrobnbIo
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-sfoµ mnr-
kofµInco for IndIvIdunIs nnd smnII busInossos fo comµnro
communIfy-rnfod honIfh Insurnnco nnd µurchnso fho
µoIIcy of fhoIr choIco. Tho oxchnngos cnnnof oµornfo In fho
mnnnor Congross Infondod If fho IndIvIdunI Mnndnfo,
ModIcnId IxµnnsIon, nnd Insurnnco roguInfIons cnnnof
romnIn In forco.
Tho Acf`s dosIgn Is fo nIIocnfo bIIIIons of fodornI doIInrs
fo subsIdIzo IndIvIdunIs` µurchnsos on fho oxchnngos. In-
dIvIdunIs wIfh Incomos bofwoon l00 nnd 400 µorconf of
fho µovorfy IovoI rocoIvo fnx crodIfs fo offsof fho cosf of
Insurnnco fo fho IndIvIdunI µurchnsor. 26 !. S. C. §36I
(2006 od., Suµµ. IV); 42 !. S. C. §l80?l (2006 od., Suµµ.
IV). Iy 20l9, 20 mIIIIon of fho 24 mIIIIon µooµIo who wIII
obfnIn Insurnnco fhrough nn oxchnngo nro oxµocfod fo
rocoIvo nn nvorngo fodornI subsIdy of $6,460 µor µorson.
Soo CIO, AnnIysIs of fho Mnjor HonIfh Cnro !ogIsInfIon
Inncfod In Mnrch 20l0, µµ. l8l9 (Mnr. 30, 20ll). WIfh-
ouf fho communIfy-rnfIng Insurnnco roguInfIon, howovor,


















60 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fho nvorngo fodornI subsIdy couId bo much hIghor; for
communIfy rnfIng gronfIy Iowors fho onormous µromIums
unhonIfhy IndIvIdunIs wouId ofhorwIso µny. IodornI
subsIdIos wouId mnko uµ much of fho dIfforonco.
Tho rosuIf wouId bo nn unInfondod boon fo Insurnnco
comµnnIos, nn unInfondod hnrm fo fho fodornI fIsc, nnd
n corrosµondIng bronkdown of fho ¨shnrod rosµonsIbII-
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 µurchnsors, Insur-
nnco comµnnIos 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 µoII-
cIos oufsIdo of nn oxchnngo, bocnuso fodornI subsIdIos
wouId bo unnvnIInbIo oufsIdo of nn oxchnngo. ÐIffIcuIfy In
nffrncfIng IndIvIdunIs oufsIdo of fho oxchnngo wouId In
furn mofIvnfo Insurors fo onfor oxchnngos, dosµIfo fho
oxchnngos` onorous roguInfIons. Soo 42 !. S. C. §l803l.
Thnf sysfom of InconfIvos coIInµsos If fho fodornI subsIdIos
nro InvnIIdnfod. WIfhouf fho fodornI subsIdIos, IndIvId-
unIs wouId Ioso fho mnIn InconfIvo fo µurchnso 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 oµornfo
ns Congross Infondod nnd mny nof oµornfo nf nII.
Thoro Is n socond ronson why, If communIfy rnfIng Is
InvnIIdnfod by fho Mnndnfo nnd ModIcnId IxµnnsIon`s
InvnIIdIfy, oxchnngos cnnnof bo ImµIomonfod In n mnnnor
consIsfonf wIfh fho Acf`s dosIgn. A koy µurµoso of nn
oxchnngo Is fo µrovIdo n mnrkofµInco of Insurnnco oµfIons
whoro µrIcos nro sfnndnrdIzod rognrdIoss of fho buy-
or`s µro-oxIsfIng condIfIons. Soo iIiJ. An IndIvIdunI who
shoµs for Insurnnco fhrough nn oxchnngo wIII ovnIunfo
dIfforonf Insurnnco µroducfs. Tho µroducfs wIII offor
dIfforonf bonofIfs nnd µrIcos. Congross dosIgnod fho ox-



















6l CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
chnngos so fho shoµµor cnn comµnro bonofIfs nnd µrIcos.
Iuf fho comµnrIson cnnnof bo mndo In fho wny Congross
dosIgnod If fho µrIcos doµond on fho shoµµor`s µro-oxIsfIng
honIfh condIfIons. Tho µrIcos wouId vnry from µorson fo
µorson. So wIfhouf communIfy rnfIngwhIch µrohIbIfs
Insurors from bnsIng fho µrIco of Insurnnco on µro-oxIsfIng
condIfIonsfho oxchnngos cnnnof oµornfo In fho mnnnor
Congross Infondod.
d
:36,/=)&>*)$6/#$.4.,.-= ?$$)$$3)#-
Tho omµIoyor rosµonsIbIIIfy nssossmonf µrovIdos nn
InconfIvo for omµIoyors wIfh nf Ionsf 50 omµIoyoos fo
µrovIdo fhoIr omµIoyoos wIfh honIfh Insurnnco oµfIons
fhnf moof mInImum crIforIn. Soo 26 !. S. C. §4980H
(2006 od., Suµµ. IV). !nIIko fho IndIvIdunI Mnndnfo,
fho omµIoyor-rosµonsIbIIIfy nssossmonf doos nof roquIro
omµIoyors fo µrovIdo nn Insurnnco oµfIon. Insfond, If ro-
quIros fhom fo mnko n µnymonf fo fho IodornI Covorn-
monf If fhoy do nof offor Insurnnco fo omµIoyoos nnd If
Insurnnco Is boughf on nn oxchnngo by nn omµIoyoo who
qunIIfIos for fho oxchnngo`s fodornI subsIdIos. Soo iIiJ.
Ior fwo ronsons, fho omµIoyor-rosµonsIbIIIfy nssossmonf
musf bo InvnIIdnfod. IIrsf, fho ACA mnkos n dIrocf IInk
bofwoon fho omµIoyor-rosµonsIbIIIfy nssossmonf nnd fho
oxchnngos. Tho fInnncInI nssossmonf ngnInsf omµIoyors
occurs onIy undor corfnIn condIfIons. Ono of fhom Is fho
µurchnso of Insurnnco by nn omµIoyoo on nn oxchnngo.
WIfh no oxchnngos, fhoro nro no µurchnsos on fho ox-
chnngos; nnd wIfh no µurchnsos on fho oxchnngos, fhoro Is
nofhIng fo frIggor fho omµIoyor-rosµonsIbIIIfy nssossmonf.
Socond, nffor fho InvnIIdnfIon of burdons on IndIvIdunIs
(fho IndIvIdunI Mnndnfo), Insurors (fho Insurnnco rogu-
InfIons nnd fnxos), Sfnfos (fho ModIcnId IxµnnsIon), fho
IodornI Covornmonf (fho fodornI subsIdIos for oxchnngos
nnd for fho ModIcnId IxµnnsIon), nnd hosµIfnIs (fho roduc-




















62 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
fIons In roImbursomonfs), fho µrosorvnfIon of fho omµIoyor-
rosµonsIbIIIfy nssossmonf wouId uµsof fho ACA`s dosIgn
of ¨shnrod rosµonsIbIIIfy.¨ If wouId Ionvo omµIoyors ns fho
onIy µnrfIos bonrIng nny sIgnIfIcnnf rosµonsIbIIIfy. Thnf
wns nof fho congrossIonnI Infonf.
2
!"# 58.?; -(&24 142)(;(2&;
Tho noxf quosfIon Is whofhor fho InvnIIdnfIon of fho
ACA`s mnjor µrovIsIons roquIros fho Courf fo InvnIIdnfo
fho ACA`s ofhor µrovIsIons. If doos.
Tho ACA Is ovor 900 µngos Iong. Ifs roguInfIons IncIudo
roquIromonfs rnngIng from n bronk fImo nnd socIudod
µInco nf work for nursIng mofhors, soo 29 !. S. C. §20?(r)(l)
(2006 od., Suµµ. IV), fo dIsµInys 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 Imµosod on hIgh-Incomo fnxµnyors, soo ACA
§§90l5, l0906; HCI!A §l402, modIcnI dovIcos, soo 26
!. S. C. §4l9l (2006 od., Suµµ. IV), nnd fnnnIng boofhs,
soo §5000I. If sµonds govornmonf monoy on, nmong ofhor
fhIngs, fho sfudy of how fo sµond Ioss govornmonf monoy.
42 !. S. C. §l3l5n. And If IncIudos n numbor of µrovIsIons
fhnf µrovIdo bonofIfs fo fho Sfnfo of n µnrfIcuInr IogIsInfor.
Ior oxnmµIo, §l0323, l24 Sfnf. 954, oxfonds ModIcnro
covorngo fo IndIvIdunIs oxµosod fo nsbosfos from n mIno In
!Ibby, Monfnnn. Anofhor µrovIsIon, §2006, iJ., nf 284,
Incronsos ModIcnId µnymonfs onIy In !ouIsInnn.
Such µrovIsIons 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 Imµorfnnf fo fhom.
. . . |And] If fhoy don`f hnvo somofhIng In If Imµorfnnf fo
fhom, fhon If doosn`f sµonk woII of fhom. Thnf`s whnf fhIs
IogIsInfIon Is nII nbouf: If`s fho nrf of comµromIso.` ¨ Ionr,
In HonIfh IIII for Ivoryono, IrovIsIons for n Iow, Þ. Y.
TImos, Jnn. 4, 20l0, µ. Al0 (quofIng Son. !oId). Offon, n














63 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
mInor µrovIsIon wIII bo fho µrIco µnId for suµµorf of n
mnjor µrovIsIon. So, If fho mnjor µrovIsIon woro unconsfI-
fufIonnI, Congross wouId nof hnvo µnssod fho mInor ono.
WIfhouf fho ACA`s mnjor µrovIsIons, mnny of fhoso
mInor µrovIsIons wIII nof oµornfo In fho mnnnor Congross
Infondod. Ior oxnmµIo, fho fnx Incronsos nro ¨!ovonuo
Offsof IrovIsIons¨ dosIgnod fo hoIµ offsof fho cosf fo fho
IodornI Covornmonf of µrogrnms IIko fho ModIcnId Ix-
µnnsIon nnd fho oxchnngos` fodornI subsIdIos. Soo TIfIo
IX, SubfIfIo A!ovonuo Offsof IrovIsIons, l24 Sfnf. 84?.
WIfh fho ModIcnId IxµnnsIon nnd fho oxchnngos InvnII-
dnfod, fho fnx Incronsos no Iongor oµornfo fo offsof cosfs,
nnd fhoy no Iongor sorvo fho µurµoso In fho Acf`s schomo
of ¨shnrod rosµonsIbIIIfy¨ fhnf Congross Infondod.
Somo µrovIsIons, such ns roquIrIng chnIn rosfnurnnfs fo
dIsµIny nufrIfIonnI confonf, nµµonr IIkoIy fo oµornfo ns
Congross Infondod, buf fhoy fnII fho socond fosf for sovor-
nbIIIfy. Thoro Is no ronson fo boIIovo fhnf Congross wouId
hnvo onncfod fhom IndoµondonfIy. Tho Courf hns nof
µrovIousIy hnd occnsIon fo consIdor sovornbIIIfy In fho con-
foxf of nn omnIbus onncfmonf IIko fho ACA, whIch In-
cIudos nof onIy mnny µrovIsIons fhnf nro nncIIInry fo Ifs
confrnI µrovIsIons buf nIso mnny fhnf nro onfIroIy unro-
InfodhIfchod on bocnuso If wns n quIck wny fo gof fhom
µnssod dosµIfo oµµosIfIon, or bocnuso fhoIr µroµononfs
couId oxncf fhoIr onncfmonf ns fho quiJ pro quo for fhoIr
noodod suµµorf. Whon wo nro confronfod wIfh such n so-
cnIIod ¨ChrIsfmns froo,¨ n Inw fo whIch mnny nongormnno
ornnmonfs hnvo boon nffnchod, wo fhInk fho µroµor ruIo
musf bo fhnf whon fho froo no Iongor oxIsfs fho ornnmonfs
nro suµorfIuous. Wo hnvo no roIInbIo bnsIs for knowIng
whIch µIocos of fho Acf wouId hnvo µnssod on fhoIr own. If
Is corfnIn fhnf mnny of fhom wouId nof hnvo, nnd If Is nof
n µroµor 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 µnrf of our dufy.` ¨














64 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
TroJe-Mor/ Coeee, l00 !. S., nf 99.
ThIs Courf musf nof Imµoso rIsks unInfondod by Con-
gross or µroduco IogIsInfIon Congross mny hnvo Inckod fho
suµµorf fo onncf. Ior fhoso ronsons, fho unconsfIfufIon-
nIIfy of bofh fho IndIvIdunI Mnndnfo nnd fho ModIcnId
IxµnnsIon roquIros fho InvnIIdnfIon of fho AffordnbIo Cnro
Acf`s ofhor µrovIsIons.
* * *
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 µonnIfy Is Insfond nn oµfIon subjocf
fo n fnx. And If chnngos fho InfonfIonnIIy coorcIvo snnc-
fIon of n fofnI cuf-off of ModIcnId funds fo n suµµosodIy
noncoorcIvo cuf-off of onIy fho IncromonfnI funds fhnf fho
Acf mnkos nvnIInbIo.
Tho Courf rognrds Ifs sfrnInod sfnfufory InforµrofnfIon
ns judIcInI modosfy. If Is nof. If nmounfs Insfond fo n vnsf
judIcInI ovorronchIng. If cronfos n dobIIIfnfod, InoµornbIo
vorsIon of honIfh-cnro roguInfIon fhnf Congross dId nof
onncf nnd fho µubIIc doos nof oxµocf. If mnkos onncfmonf
of sonsIbIo honIfh-cnro roguInfIon moro dIffIcuIf, sInco
Congross cnnnof sfnrf nfrosh buf musf fnko ns Ifs µoInf of
doµnrfuro n jumbIo of now sonsoIoss µrovIsIons, µrovIsIons
fhnf corfnIn Inforosfs fnvorod undor fho Courf`s now do-
sIgn wIII sfruggIo fo rofnIn. And If Ionvos fho µubIIc nnd
fho Sfnfos fo oxµond vnsf sums of monoy on roquIromonfs
fhnf mny or mny nof survIvo fho nocossnry congrossIonnI
rovIsIon.
Tho Courf`s dIsµosIfIon, 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 IxµnnsIon Issuo ushors In now fodornIIsm con-






















65 CIfo ns: 56? !. S. ____ (20l2)
SCA!IA, KIÞÞIÐY, THOMAS, nnd A!ITO, JJ., dIssonfIng
corns nnd µIncos nn unnccusfomod sfrnIn uµon fho !nIon.
Thoso Sfnfos fhnf docIIno fho ModIcnId IxµnnsIon musf
subsIdIzo, by fho fodornI fnx doIInrs fnkon from fhoIr
cIfIzons, vnsf grnnfs fo fho Sfnfos fhnf nccoµf fho ModIcnId
IxµnnsIon. If fhnf dosfnbIIIzIng µoIIfIcnI 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 µowors. 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 cooµornfIvo fodornIIsm, If un-
dormInos sfnfo sovoroIgnfy.
Tho ConsfIfufIon, fhough If dnfos from fho foundIng of
fho !oµubIIc, hns µoworfuI monnIng nnd vIfnI roIovnnco
fo our own fImos. Tho consfIfufIonnI µrofocfIons fhnf fhIs
cnso InvoIvos nro µrofocfIons of sfrucfuro. SfrucfurnI
µrofocfIonsnofnbIy, fho rosfrnInfs Imµosod by fodornIIsm
nnd soµnrnfIon of µoworsnro Ioss romnnfIc nnd hnvo Ioss
obvIous n connocfIon fo µorsonnI froodom fhnn fho µrovI-
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 rosµonsIbIIIfy of fho Courf fo
fonch ofhorwIso, fo romInd our µooµIo fhnf fho Irnmors
consIdorod sfrucfurnI µrofocfIons of froodom fho mosf Im-
µorfnnf onos, for whIch ronson fhoy nIono woro ombod-
Iod In fho orIgInnI ConsfIfufIon nnd nof Ioff fo Infor
nmondmonf. Tho frngmonfnfIon of µowor µroducod by fho
sfrucfuro of our Covornmonf Is confrnI fo IIborfy, nnd
whon wo dosfroy If, wo µInco IIborfy nf µorII. 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 rosµocffuIIy dIssonf.



_________________

_________________























l CIfo ns: 56? !. S. ____ (20l2)
THOMAS, J., dIssonfIng
SUPREME COURT OF THE UNITED STATES
Þos. ll393, ll398 nnd ll400
ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS, IT A!., IITITIOÞI!S
ll393 t.
KATH!IIÞ SIII!I!S, SIC!ITA!Y OI HIA!TH
AÞÐ H!MAÞ SI!VICIS, IT A!.
ÐIIA!TMIÞT OI HIA!TH AÞÐ H!MAÞ
SI!VICIS, IT A!., IITITIOÞI!S
ll398 t.
I!O!IÐA IT A!.
ll400
I!O!IÐA, IT A!., IITITIOÞI!S
t.
ÐIIA!TMIÞT OI HIA!TH AÞÐ
H!MAÞ SI!VICIS IT A!.
OÞ W!ITS OI CI!TIO!A!I TO THI !ÞITIÐ STATIS CO!!T OI
AIIIA!S IO! THI I!IVIÞTH CI!C!IT
|Juno 28, 20l2]
J!STICI THOMAS, dIssonfIng.
I dIssonf for fho ronsons sfnfod In our joInf oµInIon, buf
I wrIfo soµnrnfoIy fo sny n word nbouf fho Commorco
CInuso. Tho joInf dIssonf nnd THI CHIII J!STICI cor-
rocfIy nµµIy our µrocodonfs fo concIudo fhnf fho IndIvIdunI
Mnndnfo Is boyond fho µowor grnnfod fo Congross un-
dor fho Commorco CInuso nnd fho Þocossnry nnd Iroµor
CInuso. !ndor fhoso µrocodonfs, 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








2 ÞATIOÞA! IIÐI!ATIOÞ OI IÞÐIIIÞÐIÞT
I!SIÞISS t. SIII!I!S
THOMAS, J., dIssonfIng
'subsfnnfInI offocfs` fosf undor fho Commorco CInuso Is
InconsIsfonf wIfh fho orIgInnI undorsfnndIng of Congross`
µowors 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
oxµInInod, fho Courf`s confInuod uso of fhnf fosf ¨hns
oncourngod fho IodornI Covornmonf fo µorsIsf In Ifs vIow
fhnf fho Commorco CInuso hns vIrfunIIy no IImIfs.¨ Morri-
eon, eupro, nf 62?. Tho Covornmonf`s unµrocodonfod
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 µoInf.

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