â‘  John F Kennedy Steel Speech Analysis

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John F Kennedy Steel Speech Analysis

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John F. Kennedy, Inaugural Speech, Part 3 - The Art of Persuassive Writing \u0026 Public Speaking

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See Liberty Univ. Geithner , F. The majority therefore determined that the plaintiffs could not challenge the individual mandate until after they paid the penalty. The second provision of the Affordable Care Act directly challenged here is the Medicaid expansion. Enacted in , Medicaid offers federal funding to States to assist pregnant women, children, needy families, the blind, the elderly, and the disabled in obtaining medical care. See 42 U. In order to receive that funding, States must comply with federal criteria governing matters such as who receives care and what services are provided at what cost. By every State had chosen to participate in Medicaid. For example, the Act requires state programs to provide Medicaid coverage to adults with incomes up to percent of the federal poverty level, whereas many States now cover adults with children only if their income is considerably lower, and do not cover childless adults at all.

We granted certiorari to review the judgment of the Court of Appeals for the Eleventh Circuit with respect to both the individual mandate and the Medicaid expansion. And because there is a reasonable argument that the Anti-Injunction Act deprives us of jurisdiction to hear challenges to the individ-ual mandate, but no party supports that proposition, we appointed an amicus curiae to advance it. Before turning to the merits, we need to be sure we have the authority to do so.

Because of the Anti-Injunction Act, taxes can ordinarily be challenged only after they are paid, by suing for a refund. See Enochs v. Amicus contends that the Internal Revenue Code treats the penalty as a tax, and that the Anti-Injunction Act therefore bars this suit. The text of the pertinent statutes suggests otherwise. Where Congress uses certain language in one part of a statute and different language in another, it is generally presumed that Congress acts intentionally. See Russello v. Amicus argues that even though Congress did not label the shared responsibility payment a tax, we should treat it as such under the Anti-Injunction Act because it functions like a tax.

It is true that Congress cannot change whether an exaction is a tax or a penalty for constitutional pur-poses simply by describing it as one or the other. Kurth Ranch , U. See Bailey v. George , U. Congress can, of course, describe something as a penalty but direct that it nonetheless be treated as a tax for purposes of the Anti-Injunction Act. For example, 26 U. Penalties in subchapter 68B are thus treated as taxes under Title 26, which includes the Anti-Injunction Act.

The individual mandate, however, is not in subchapter 68B of the Code. Amicus attempts to show that Congress did render the Anti-Injunction Act applicable to the individual mandate, albeit by a more circuitous route. The Government disagrees. We think the Government has the better reading. The Anti-Injunction Act, by contrast, says nothing about the procedures to be used in assessing and collecting taxes. Amicus argues in the alternative that a different section of the Internal Revenue Code requires courts to treat the penalty as a tax under the Anti-Injunction Act. The Code contains many provisions treating taxes and assessable penalties as distinct terms.

The Affordable Care Act does not require that the penalty for failing to comply with the individual mandate be treated as a tax for purposes of the Anti-Injunction Act. The Anti-Injunction Act therefore does not apply to this suit, and we may proceed to the merits. The Government advances two theories for the proposition that Congress had constitutional authority to enact the individual mandate. First, the Government argues that Congress had the power to enact the mandate under the Commerce Clause. According to the Government, even if Congress lacks the power to direct individuals to buy insurance, the only effect of the individual mandate is to raise taxes on those who do not do so, and thus the law may be upheld as a tax.

According to the Government, the health care market is characterized by a significant cost-shifting problem. Everyone will eventually need health care at a time and to an extent they cannot predict, but if they do not have insurance, they often will not be able to pay for it. Because state and federal laws nonetheless require hospitals to provide a certain degree of care to individuals without regard to their ability to pay, see, e. To recoup the losses, hospitals pass on the cost to insurers through higher rates, and insurers, in turn, pass on the cost to policy holders in the form of higher premiums. In the Affordable Care Act, Congress addressed the problem of those who cannot obtain insurance coverage because of preexisting conditions or other health issues.

These provisions together prohibit insurance companies from denying coverage to those with such conditions or charging unhealthy individuals higher premiums than healthy individuals. The guaranteed-issue and community-rating reforms do not, however, address the issue of healthy individuals who choose not to purchase insurance to cover potential health care needs. In fact, the reforms sharply exacerbate that problem, by providing an incentive for individuals to delay purchasing health insurance until they become sick, relying on the promise of guaranteed and affordable coverage.

The reforms also threaten to impose massive new costs on insurers, who are required to accept unhealthy individuals but prohibited from charging them rates necessary to pay for their coverage. This will lead insurers to significantly increase premiums on everyone. By requiring that individuals purchase health insurance, the mandate prevents cost-shifting by those who would otherwise go without it. In addition, the mandate forces into the insurance risk pool more healthy individuals, whose premiums on average will be higher than their health care expenses. This allows insurers to subsidize the costs of covering the unhealthy individuals the reforms require them to accept.

The Government claims that Congress has power under the Commerce and Necessary and Proper Clauses to enact this solution. Brief for United States The path of our Commerce Clause decisions has not always run smooth, see United States v. Darby , U. See Wickard , U. Given its expansive scope, it is no surprise that Congress has employed the commerce power in a wide variety of ways to address the pressing needs of the time. But Congress has never attempted to rely on that power to compel individuals not engaged in commerce to purchase an unwanted product.

Free Enterprise Fund v. Public Com pany Accounting Oversight Bd. Lopez , supra , at If the power to regulate the armed forces or the value of money included the power to bring the subject of the regulation into existence, the specific grant of such powers would have been unnecessary. The language of the Constitution reflects the natural understanding that the power to regulate assumes there is already something to be regulated. See Gibbons , 9 Wheat. Our precedent also reflects this understanding. It instead compels individ-uals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce. Construing the Commerce Clause to permit Con-gress to regulate individuals precisely because they are doing nothing would open a new and potentially vast do-main to congressional authority.

Every day individuals do not do an infinite number of things. In some cases they decide not to do something; in others they simply fail to do it. Filburn shows how far that logic would carry us from the notion of a government of limited powers. In Wickard , the Court famously upheld a federal penalty im-posed on a farmer for growing wheat for consumption on his own farm. That amount of wheat caused the farmer to exceed his quota under a program designed to support the price of wheat by limiting supply. That decision, when considered in the aggregate along with sim-ilar decisions of others, would have had a substantial ef-fect on the interstate market for wheat.

But price can be supported by increasing demand as well as by decreasing supply. The aggregated decisions of some consumers not to purchase wheat have a substantial effect on the price of wheat, just as decisions not to purchase health insurance have on the price of insurance. Congress can therefore command that those not buying wheat do so, just as it argues here that it may command that those not buying health insurance do so.

The farmer in Wickard was at least actively engaged in the production of wheat, and the Government could regulate that activity because of its effect on commerce. See Seven-Sky , F. To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance. The failure of that group to have a healthy diet increases health care costs, to a greater extent than the failure of the uninsured to purchase insurance.

Those in-creased costs are borne in part by other Americans who must pay more, just as the uninsured shift costs to the insured. Congress addressed the insurance problem by ordering everyone to buy insurance. People, for reasons of their own, often fail to do things that would be good for them or good for society. Those failures—joined with the similar failures of others—can readily have a substantial effect on interstate commerce. That is not the country the Framers of our Constitution envisioned. Wirtz , U.

Congress already enjoys vast power to regulate much of what we do. To an economist, perhaps, there is no difference between activity and inactivity; both have measurable economic effects on commerce. Industrial Union Dept. American Petroleum Institute , U. There is no reason to depart from that understanding now. The Government sees things differently. Raich , U. The mandate primarily affects healthy, often young adults who are less likely to need significant health care and have other priorities for spending their money.

It is precisely because these individuals, as an actuarial class, incur relatively low health care costs that the mandate helps counter the effect of forcing insurance companies to cover others who impose greater costs than their premiums are allowed to reflect. If the individual mandate is targeted at a class, it is a class whose commercial inactivity rather than activity is its defining feature. The Government, however, claims that this does not matter.

The proposition that Congress may dictate the conduct of an individual today because of prophesied future ac-tivity finds no support in our precedent. We have said that Congress can anticipate the effects on commerce of an eco-nomic activity. NLRB , U. McClung , U. But we have never permitted Congress to anticipate that activity itself in order to regulate individuals not currently engaged in commerce. Each one of our cases, including those cited by Justice Ginsburg , post , at 20—21, involved preexisting economic activity. Everyone will likely participate in the markets for food, clothing, transportation, shelter, or energy; that does not authorize Congress to direct them to purchase particular products in those or other markets today.

The Commerce Clause is not a general license to regulate an individual from cradle to grave, simply because he will predictably engage in particular transactions. Any police power to regulate individuals as such, as opposed to their activities, remains vested in the States. The Government argues that the individual mandate can be sustained as a sort of exception to this rule, because health insurance is a unique product. They are purchased to cover the need for transportation and food. But that does not mean the compelled purchase of the first is properly regarded as a regulation of the second. And for most of those targeted by the mandate, significant health care needs will be years, or even decades, away.

The proximity and degree of connection between the mandate and the subsequent commercial activity is too lack-ing to justify an exception of the sort urged by the Gov- ernment. The individual mandate forces individuals into commerce precisely because they elected to refrain from commercial activity. United States ex rel. Singleton , U. Hunt ed. But we have also carried out our responsibility to declare unconstitutional those laws that undermine the structure of government established by the Constitution.

Hamilton ; see also New York , U. Applying these principles, the individual mandate cannot be sustained under the Necessary and Proper Clause as an essential component of the insurance reforms. Each of our prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power. Richland County , U. The individual mandate, by con-trast, vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power. Rather, such a conception of the Necessary and Proper Clause would work a substantial expansion of federal authority.

No longer would Congress be limited to regulating under the Commerce Clause those who by some preexisting activity bring themselves within the sphere of federal regulation. Instead, Congress could reach beyond the natural limit of its authority and draw within its regulatory scope those who otherwise would be outside of it. The Government relies primarily on our decision in Gonzales v.

Certain individuals sought an exemption from that regulation on the ground that they engaged in only intrastate possession and consumption. We denied any exemption, on the ground that marijuana is a fungible commodity, so that any marijuana could be readily diverted into the interstate market. The commerce power thus does not authorize the mandate. That is not the end of the matter. In making its Commerce Clause argument, the Government defended the mandate as a regulation requiring individuals to purchase health in-surance. The Government does not claim that the taxing power allows Congress to issue such a command. Instead, the Government asks us to read the mandate not as ordering individuals to buy insurance, but rather as imposing a tax on those who do not buy that product.

The text of a statute can sometimes have more than one possible meaning. And it is well established that if a statute has two possible meanings, one of which violates the Constitution, courts should adopt the meaning that does not do so. Bedford , 3 Pet. Holden , U. The most straightforward reading of the mandate is that it commands individuals to purchase insurance. Congress thought it could enact such a command under the Commerce Clause, and the Government primarily defended the law on that basis. But, for the reasons explained above, the Commerce Clause does not give Congress that power.

Under the mandate, if an individual does not maintain health insurance, the only consequence is that he must make an additional payment to the IRS when he pays his taxes. That, according to the Government, means the mandate can be regarded as establishing a condition—not owning health insurance—that triggers a tax—the required payment to the IRS. Under that theory, the mandate is not a legal command to buy insurance. Rather, it makes going without insurance just another thing the Government taxes, like buying gasoline or earning income. Crowell v.

The Government asks us to interpret the mandate as imposing a tax, if it would otherwise violate the Constitution. Granting the Act the full measure of deference owed to federal statutes, it can be so read, for the reasons set forth below. The exaction the Affordable Care Act imposes on those without health insurance looks like a tax in many respects. It does not apply to individuals who do not pay federal income taxes because their household income is less than the filing threshold in the Internal Revenue Code. For taxpayers who do owe the payment, its amount is determined by such familiar factors as taxable income, number of dependents, and joint filing status. This process yields the essential feature of any tax: it produces at least some revenue for the Government.

United States v. Kahriger , U. In the first, we held that a suit to enjoin collection of the so-called tax was barred by the Anti-Injunction Act. Congress knew that suits to obstruct taxes had to await payment under the Anti-Injunction Act; Congress called the child labor tax a tax; Congress therefore intended the Anti-Injunction Act to apply. Drexel Furniture , U. In the License Tax Cases , for example, we held that federal licenses to sell liquor and lottery tickets—for which the licensee had to pay a fee—could be sustained as exercises of the taxing power.

And in New York v. Quill Corp. North Dakota , U. Sotelo , U. Our cases confirm this functional approach. Second, it imposed that exaction only on those who knowingly employed underage laborers. Such scienter require-ments are typical of punitive statutes, because Congress often wishes to punish only those who intentionally break the law. The same analysis here suggests that the shared responsibility payment may for constitutional purposes be considered a tax, not a penalty: First, for most Americans the amount due will be far less than the price of insurance, and, by statute, it can never be more.

Second, the individual mandate contains no scienter requirement. Third, the payment is collected solely by the IRS through the normal means of taxation—except that the Service is not allowed to use those means most suggestive of a punitive sanction, such as criminal prosecution. None of this is to say that the payment is not intended to affect individual conduct. Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry. See W. Brownlee, Federal Taxation in America 22 2d ed.

Today, federal and state taxes can compose more than half the retail price of cigarettes, not just to raise more money, but to encourage people to quit smoking. And we have upheld such obviously regulatory measures as taxes on selling marijuana and sawed-off shotguns. Sanchez , U. To some extent it interposes an economic impediment to the activity taxed as compared with others not taxed. La Franca , U. While the individual mandate clearly aims to induce the purchase of health insurance, it need not be read to declare that failing to do so is unlawful. Neither the Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS.

The Government agrees with that reading, confirming that if someone chooses to pay rather than obtain health insurance, they have fully complied with the law. Brief for United States 60—61; Tr. Indeed, it is estimated that four million people each year will choose to pay the IRS rather than buy insurance. See Congressional Budget Office, supra, at We would expect Congress to be troubled by that prospect if such conduct were unlawful. That Congress apparently regards such extensive failure to comply with the mandate as tolerable suggests that Congress did not think it was creating four million outlaws.

It suggests instead that the shared responsibility payment merely imposes a tax citizens may lawfully choose to pay in lieu of buying health insurance. We have rejected a similar argument before. In New York v. A State that shipped its waste to another State was exposed to surcharges by the receiving State, a portion of which would be paid over to the Federal Government. New York urged us to read the statute as a federal command that the state legislature enact legislation to dispose of its waste, which would have violated the Constitution. We then sustained the charge paid to the Federal Government as an exercise of the taxing power. We see no insurmountable obstacle to a similar approach here. Post, at In effect, they contend that even if the Constitution permits Congress to do exactly what we interpret this statute to do, the law must be struck down because Congress used the wrong labels.

An example may help illustrate why labels should not control here. Those whose income is below the filing threshold need not pay. That is sufficient to sustain it. Cloyd W. Miller Co. Even if the taxing power enables Congress to impose a tax on not obtaining health insurance, any tax must still comply with other requirements in the Constitution. According to the plaintiffs, if the individual mandate imposes a tax, it is a direct tax, and it is unconstitutional because Congress made no effort to apportion it among the States.

See Springer v. This Court upheld the tax, in part reasoning that apportioning such a tax would make little sense, because it would have required taxing carriage owners at dramatically different rates depending on how many carriages were in their home State. See Hylton v. United States , 3 Dall. The Court was unanimous, and those Justices who wrote opinions either directly asserted or strongly suggested that only two forms of taxation were direct: capitations and land taxes.

See id. That narrow view of what a direct tax might be per-sisted for a century. In , we expanded our interpretation to include taxes on personal property and income from personal property, in the course of striking down aspects of the federal income tax. Pollock v. That result was overturned by the Sixteenth Amendment , although we continued to consider taxes on personal property to be direct taxes. See Eisner v. Macom-ber , U. A tax on going without health insurance does not fall within any recognized category of direct tax. It is not a capitation. The whole point of the shared responsibility payment is that it is triggered by specific cir-cumstances—earning a certain amount of income but not obtaining health insurance.

The payment is also plainly not a tax on the ownership of land or personal property. The shared responsibility payment is thus not a direct tax that must be apportioned among the several States. There may, however, be a more fundamental objection to a tax on those who lack health insurance. If it is troubling to interpret the Commerce Clause as authorizing Congress to regulate those who abstain from commerce, perhaps it should be similarly troubling to permit Congress to impose a tax for not doing something. Three considerations allay this concern. First, and most importantly, it is abundantly clear the Constitution does not guarantee that individuals may avoid taxation through inactivity.

A capitation, after all, is a tax that every- one must pay simply for existing, and capitations are expressly contemplated by the Constitution. The Court today holds that our Constitution protects us from federal regulation under the Commerce Clause so long as we ab-stain from the regulated activity. But from its creation, the Constitution has made no such promise with respect to taxes. See Letter from Benjamin Franklin to M. Le Roy Nov. Whether the mandate can be upheld under the Commerce Clause is a question about the scope of federal authority. Its answer depends on whether Congress can exercise what all acknowledge to be the novel course of directing individuals to purchase insurance.

Tax incentives already promote, for example, purchasing homes and professional educations. See 26 U. Sustaining the mandate as a tax depends only on whether Congress has properly exercised its taxing power to encourage purchasing health insurance, not whether it can. Upholding the individual mandate under the Taxing Clause thus does not recognize any new federal power. It determines that Congress has used an existing one. A few of our cases policed these limits aggressively, invalidating punitive exactions obviously designed to regulate behavior otherwise regarded at the time as beyond federal authority. Butler , U. More often and more recently we have declined to closely examine the regulatory motive or effect of revenue-raising measures.

See Kahriger , U. Supra, at 35— Because the tax at hand is within even those strict limits, we need not here decide the precise point at which an exaction becomes so punitive that the taxing power does not authorize it. Texas Co. Mississippi ex rel. Knox , U. Once we recognize that Congress may regulate a particular decision under the Commerce Clause, the Federal Government can bring its full weight to bear. Congress may simply command individ-uals to do as it directs. An individual who disobeys may be subjected to criminal sanctions.

Those sanctions can include not only fines and imprisonment, but all the attendant consequences of being branded a criminal: deprivation of otherwise protected civil rights, such as the right to bear arms or vote in elections; loss of employment opportunities; social stigma; and severe disabilities in other controversies, such as custody or immigration disputes. If a tax is properly paid, the Government has no power to compel or punish individuals subject to it. We do not make light of the se-vere burden that taxation—especially taxation motivated by a regulatory purpose—can impose.

But imposition of a tax nonetheless leaves an individual with a lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice. Be-cause the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness. But the statute reads more naturally as a command to buy insurance than as a tax, and I would uphold it as a command if the Constitution allowed it. It is only because the Commerce Clause does not authorize such a command that it is necessary to reach the taxing power question.

Without deciding the Commerce Clause question, I would find no basis to adopt such a saving construction. The Federal Government does not have the power to order people to buy health insurance. Section A would therefore be unconstitutional if read as a command. The Federal Government does have the power to impose a tax on those without health insurance. Section A is therefore constitutional, because it can reasonably be read as a tax. There is no doubt that the Act dramatically increases state obligations under Medicaid. The current Medicaid program requires States to cover only certain discrete categories of needy individuals—pregnant women, children, needy families, the blind, the elderly, and the dis-abled. There is no mandatory coverage for most childless adults, and the States typically do not offer any such coverage.

The States also enjoy considerable flexibility with respect to the coverage levels for parents of needy families. On average States cover only those unemployed parents who make less than 37 percent of the federal poverty level, and only those employed parents who make less than 63 percent of the poverty line. The Medicaid provisions of the Affordable Care Act, in contrast, require States to expand their Medicaid programs by to cover all individuals under the age of 65 with incomes below percent of the federal poverty line.

The Af-fordable Care Act provides that the Federal Government will pay percent of the costs of covering these newly eligible individuals through In the following years, the federal payment level gradually decreases, to a minimum of 90 percent. Statement of Douglas W. Gorman , U. Respecting this limitation is critical to ensuring that Spending Clause legislation does not undermine the status of the States as independent sovereigns in our fed-eral system.

Maine , U. Otherwise the two-government system established by the Framers would give way to a system that vests power in one central government, and individual liberty would suffer. Davis , U. Congress may use its spending power to create incentives for States to act in accordance with federal policies. That is true whether Congress directly commands a State to regulate or indirectly coerces a State to adopt a federal regulatory system as its own.

Permitting the Federal Government to force the States to implement a federal program would threaten the political accountability key to our federal system. Spending Clause programs do not pose this danger when a State has a legitimate choice whether to accept the federal conditions in exchange for federal funds. In such a situation, state officials can fairly be held politically accountable for choosing to accept or refuse the federal offer. But when the State has no choice, the Federal Government can achieve its objectives without accountability, just as in New York and Printz.

Indeed, this danger is heightened when Congress acts under the Spending Clause, because Congress can use that power to implement federal policy it could not impose directly under its enumerated powers. We addressed such concerns in Steward Machine. That case involved a federal tax on employers that was abated if the businesses paid into a state unemployment plan that met certain federally specified conditions. But we observed that Congress adopted the challenged tax and abatement program to channel money to the States that would otherwise have gone into the Federal Treasury for use in providing national unemployment services. Congress was willing to direct businesses to instead pay the money into state programs only on the condition that the money be used for the same purposes.

As our decision in Steward Machine confirms, Congress may attach appropriate conditions to federal taxing and spending programs to preserve its control over the use of federal funds. Massachusetts v. Mellon , U. The States are separate and independent sovereigns. Sometimes they have to act like it. The States, however, argue that the Medicaid expansion is far from the typical case. The States claim that this threat serves no purpose other than to force unwilling States to sign up for the dramatic expansion in health care coverage effected by the Act. Given the nature of the threat and the programs at issue here, we must agree. When, for example, such conditions take the form of threats to terminate other significant independent grants, the conditions are properly viewed as a means of pressuring the States to accept policy changes.

In South Dakota v. At the same time, the condition was not a restriction on how the highway funds—set aside for specific highway improvement and maintenance efforts—were to be used. See Nat. Dole , F. Dole , supra, at Brief for United States 10, n. In addition, the States have developed intricate statutory and administrative regimes over the course of many decades to implement their objectives under existing Medicaid. But that begs the question: The States contend that the expansion is in reality a new program and that Congress is forcing them to accept it by threatening the funds for the existing Medicaid program.

Here, the Government claims that the Medicaid expansion is properly viewed merely as a modification of the ex-isting program because the States agreed that Congress could change the terms of Medicaid when they signed on in the first place. So it does. Congress has in fact done so, sometimes conditioning only the new funding, other times both old and new. The Medicaid expansion, however, accomplishes a shift in kind, not merely degree. The original program was de-signed to cover medical services for four particular cat-egories of the needy: the disabled, the blind, the elderly, and needy families with dependent children. Previous amendments to Medicaid eligibility merely altered and expanded the boundaries of these categories.

It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide uni versal health insurance coverage. Indeed, the manner in which the expansion is structured indicates that while Congress may have styled the expansion a mere alteration of existing Medicaid, it recognized it was enlisting the States in a new health care program. Congress created a separate funding provision to cover the costs of providing services to any person made newly eligible by the expansion. The conditions on use of the different funds are also distinct. Congress mandated that newly eligible persons receive a level of coverage that is less comprehensive than the traditional Medicaid benefit package.

But the prior change she dis-cusses—presumably the most dramatic alteration she could find—does not come close to working the transformation the expansion accomplishes. She highlights an amendment requiring States to cover pregnant women and increasing the number of eligible children. We have no need to fix a line either. It is enough for today that wherever that line may be, this statute is surely beyond it. Mississippi , U. Nothing in our opinion precludes Congress from offering funds under the Affordable Care Act to expand the availability of health care, and requiring that States accepting such funds comply with the conditions on their use.

What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding. Section c gives the Secretary of Health and Human Services the authority to do just that. That fully remedies the constitutional violation we have identified. Booker , U. The question here is whether Congress would have wanted the rest of the Act to stand, had it known that States would have a genuine choice whether to participate in the new Medicaid expansion. Champlin Refining Co. We are confident that Congress would have wanted to preserve the rest of the Act. It is fair to say that Congress assumed that every State would participate in the Medicaid expansion, given that States had no real choice but to do so.

The States contend that Congress enacted the rest of the Act with such full participation in mind; they point out that Congress made Medicaid a means for satisfying the mandate, 26 U. According to the States, this means that the entire Act must fall. We disagree. The Court today limits the financial pressure the Secretary may apply to induce States to accept the terms of the Medicaid expansion.

As a practical matter, that means States may now choose to reject the expansion; that is the whole point. But that does not mean all or even any will. Some States may indeed decline to participate, either because they are unsure they will be able to afford their share of the new funding obligations, or because they are unwilling to commit the administra tive resources necessary to support the expansion. Other States, however, may voluntarily sign up, finding the idea of expanding Medicaid coverage attractive, particularly given the level of federal funding the Act offers at the outset.

We have no way of knowing how many States will accept the terms of the expansion, but we do not believe Congress would have wanted the whole Act to fall, simply because some may choose not to participate. Confident that Congress would not have intended anything different, we conclude that the rest of the Act need not fall in light of our constitutional holding. The Affordable Care Act is constitutional in part and unconstitutional in part. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to con-strue what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance.

As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer. The States are given no such choice in this case: They must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding.

The remedy for that constitutional violation is to preclude the Federal Government from imposing such a sanction. That remedy does not require striking down other portions of the Affordable Care Act. The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act.

Under the Constitution, that judgment is reserved to the people. The judgment of the Court of Appeals for the Eleventh Circuit is affirmed in part and reversed in part. The District Court had determined that it did not, and neither side challenged that holding on appeal. The same was true in the Fourth Circuit, but that court examined the question sua sponte because it viewed the Anti-Injunction Act as a limit on its subject matter jurisdiction. Circuit considered the question but determined that the Anti-Injunction Act did not apply. See Thomas More , F. Long to brief and argue the proposition that the Anti-Injunction Act bars the current challenges to the individual mandate.

Both amici have ably discharged their assigned responsibilities. Each of those mandates—to report for jury duty, to register for the draft, to purchase firearms in anticipation of militia service, to exchange gold currency for paper currency, and to file a tax return—are based on constitutional provisions other than the Commerce Clause. See Art. Johnson, Dictionary of the English Language 4th ed. Southern Kansas R. The fact that the Fifth Amendment requires the payment of just compensation when the Government exercises its power of eminent domain does not turn the taking into a commercial transaction between the landowner and the Government, let alone a government-compelled transaction between the landowner and a third party.

Post, at 17, n. The dissent itself treats the question here as one of statutory interpretation, and indeed also relies on a statutory interpretation case from the bankruptcy context. Post, at 23 citing United States v. See D. Congress could not, for example, expand its authority to impose criminal fines by creating strict liability offenses enforced by the IRS rather than the FBI. But the fact the exaction here is paid like a tax, to the agency that collects taxes—rather than, for example, exacted by Department of Labor inspectors after ferreting out willful malfeasance—suggests that this exaction may be viewed as a tax.

We did not rely on that reasoning in New York. See U. Nor could we have. But that does not show that the tax restricts the lawful choice whether to undertake or forgo the activity on which the tax is predicated. Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing they may not lawfully do is not buy health insurance and not pay the resulting tax. That not only ignores increased state administrative expenses, but also assumes that the Federal Government will continue to fund the expansion at the current statutorily specified levels.

It is not unheard of, however, for the Federal Government to increase requirements in such a manner as to impose unfunded mandates on the States. More importantly, the size of the new financial burden imposed on a State is irrelevant in analyzing whether the State has been coerced into accepting that burden. Yet it could hardly be argued that such an amendment was a permissible modification of Medicaid, rather than an attempt to foist an entirely new health care system upon the States. But it would certainly not be that easy. Practical constraints would plainly inhibit, if not preclude, the Federal Government from repealing the existing program and putting every feature of Medicaid on the table for political reconsideration.

Unlike The Chief Justice , however, I would hold, alterna tively, that the Commerce Clause authorizes Congress to enact the minimum coverage provision. I would also hold that the Spending Clause permits the Medicaid expansion exactly as Congress enacted it. In the Social Secu- rity Act, Congress installed a federal system to provide monthly benefits to retired wage earners and, eventually, to their survivors.

Beyond question, Congress could have adopted a similar scheme for health care. Congress chose, instead, to preserve a central role for private insurers and state governments. This rigid reading of the Clause makes scant sense and is stunningly retrogressive. Dagenhart , U. Alton R. It is a reading that should not have staying power. By any measure, that market is immense. Within the next decade, it is anticipated, spending on health care will nearly double. Unlike the market for almost any other product or service, the market for medical care is one in which all individuals inevitably participate. Virtually every person residing in the United States, sooner or later, will visit a doctor or other health-care professional. See Dept. Most people will do so repeatedly.

When individuals make those visits, they face another reality of the current market for medical care: its high cost. Over a lifetime, costs mount to hundreds of thousands of dollars. When a person requires nonroutine care, the cost will generally exceed what he or she can afford to pay. Treatments for many serious, though not uncommon, conditions similarly cost a substantial sum. Although every U. An accident, a heart attack, or a cancer diagnosis commonly occurs without warning. Times, Apr. A23 telling of an uninsured year-old woman who, healthy one day, became a quadriplegic the next due to an auto accident. To manage the risks associated with medical care— its high cost, its unpredictability, and its inevitability—most people in the United States obtain health insurance.

Many approximately million in are insured by private insurance companies. Others, including those over 65 and certain poor and disabled persons, rely on government-funded insurance programs, notably Medicare and Medicaid. Not all U. In , approximately 50 million people were uninsured, either by choice or, more likely, because they could not afford private insurance and did not qualify for government aid. DeNavas-Walt, B. The large number of individuals without health insurance, Congress found, heavily burdens the national health-care market.

As just noted, the cost of emergency care or treatment for a serious illness generally exceeds what an individual can afford to pay on her own. Unlike markets for most products, however, the inability to pay for care does not mean that an uninsured individual will receive no care. As a consequence, medical-care providers deliver sig- nificant amounts of care to the uninsured for which the providers receive no payment.

Health-care providers do not absorb these bad debts. Instead, they raise their prices, passing along the cost of uncompensated care to those who do pay reliably: the government and private insurance companies. In response, private insurers increase their premiums, shifting the cost of the elevated bills from providers onto those who carry insurance. The net result: Those with health insurance subsidize the medical care of those without it. The size of this subsidy is considerable. Higher premiums, in turn, render health insurance less affordable, forcing more people to go without insurance and leading to further cost-shifting.

And it is hardly just the currently sick or injured among the uninsured who prompt elevation of the price of health care and health insurance. Insurance companies and health-care providers know that some percentage of healthy, uninsured people will suffer sickness or injury each year and will receive medical care despite their inability to pay. In anticipation of this uncompensated care, health-care companies raise their prices, and insurers their premiums. In other words, because any uninsured person may need medical care at any moment and because health-care companies must account for that risk, every uninsured person impacts the market price of medical care and medical insurance.

The failure of individuals to acquire insurance has other deleterious effects on the health-care market. Because those without insurance generally lack access to preventative care, they do not receive treatment for conditions—like hypertension and diabetes—that can be successfully and affordably treated if diagnosed early on. When sickness finally drives the uninsured to seek care, once treatable conditions have escalated into grave health problems, requiring more costly and extensive intervention. States cannot resolve the problem of the uninsured on their own. An influx of unhealthy individuals into a State with universal health care would result in increased spending on medical services.

To cover the increased costs, a State would have to raise taxes, and private health-insurance companies would have to increase premiums. Higher taxes and increased insurance costs would, in turn, encourage businesses and healthy individuals to leave the State. Aware that a national solution was required, Congress could have taken over the health-insurance market by establishing a tax-and-spend federal program like Social Security. Such a program, commonly referred to as a single-payer system where the sole payer is the Federal Government , would have left little, if any, room for private enterprise or the States.

Instead of going this route, Congress enacted the ACA, a solution that retains a robust role for private insurers and state governments. To make its chosen approach work, however, Congress had to use some new tools, including a requirement that most individuals obtain private health insurance coverage. IV the minimum coverage provision. As explained below, by employing these tools, Congress was able to achieve a practical, alto- gether reasonable, solution.

A central aim of the ACA is to reduce the number of uninsured U. The minimum coverage provision advances this objective by giving potential recipients of health care a financial incentive to acquire insurance. Per the minimum coverage provision, an individual must either obtain insurance or pay a toll constructed as a tax penalty. Congress knew that encouraging individuals to purchase insurance would not suffice to solve the problem, because most of the uninsured are not uninsured by choice.

Because individuals with preexisting med- ical conditions cost insurance companies significantly more than those without such conditions, insurers routinely re- fused to insure these individuals, charged them substantially higher premiums, or offered only limited coverage that did not include the preexisting illness. To ensure that individuals with medical histories have access to affordable insurance, Congress devised a three-part solution. Community rating, in effect, bars insurance companies from charging higher premiums to those with preexisting conditions. But these two provisions, Congress comprehended, could not work effectively unless individuals were given a powerful incentive to obtain insurance.

The results were disastrous. Congress comprehended that guaranteed-issue and community-rating laws alone will not work. When insurance companies are required to insure the sick at affordable prices, individuals can wait until they become ill to buy insurance. Pretty soon, those in need of immediate medical care— i. In the seven States that tried guaranteed-issue and community-rating requirements without a minimum coverage provision, that is precisely what insurance companies did. Health Pol. Massachusetts, Congress was told, cracked the adverse selection problem. By requiring most residents to obtain insurance, see Mass.

Laws, ch. As a result, federal lawmakers observed, Massachusetts succeeded where other States had failed. In sum, Congress passed the minimum coverage provision as a key component of the ACA to address an economic and social problem that has plagued the Nation for decades: the large number of U. Reviewed with appropriate deference, the minimum coverage provision, allied to the guaranteed-issue and community-rating prescriptions, should survive measurement under the Commerce and Necessary and Proper Clauses. Wyoming , U. This scheme proved unworkable, because the individual States, understandably focused on their own economic interests, often failed to take actions critical to the success of the Nation as a whole. Rakove ed.

Rutland ed. If the former, let us, in all matters of general concern act as a nation, which ha[s] national objects to promote, and a national character to support. Farrand rev. See also North American Co. SEC , U. Trist Dec. There ought to be a capacity to provide for future contingencies[,] as they may happen; and as these are illimitable in their nature, it is impossible safely to limit that capacity. See also McCulloch , 4 Wheat. To deal with it effectively, Congress must be able to act in terms of economic and financial realities. This capacious power extends even to local activities that, viewed in the aggregate, have a substantial impact on interstate commerce.

See ibid. See also Wickard , U. Second, we owe a large measure of respect to Congress when it frames and enacts economic and social legislation. See Raich , U. See also Pension Benefit Guaranty Corporation v. Indiana , U. See also Raich , U. Carolene Products Co. Straightforward application of these principles would require the Court to hold that the minimum coverage provision is proper Commerce Clause legislation. Beyond dispute, Congress had a rational basis for concluding that the uninsured, as a class, substantially affect interstate commerce.

Those without insurance consume billions of dollars of health-care products and services each year. See supra, at 5. Those goods are produced, sold, and delivered largely by national and regional companies who routinely transact business across state lines. The uninsured also cross state lines to receive care. Some have medical emergencies while away from home. Others, when sick, go to a neighboring State that provides better care for those who have not prepaid for care. See supra, at 7—8. Not only do those without insurance consume a large amount of health care each year; critically, as earlier explained, their inability to pay for a significant portion of that consumption drives up market prices, foists costs on other consumers, and reduces market efficiency and stability.

See supra, at 5—7. See supra, at 14— By requiring those who do not carry insurance to pay a toll, the minimum coverage provision gives individuals a strong incentive to insure. This incentive, Congress had good reason to believe, would reduce the number of uninsured and, correspondingly, mitigate the adverse impact the uninsured have on the national health-care market. Congress also acted reasonably in requiring uninsured individuals, whether sick or healthy, either to obtain insurance or to pay the specified penalty.

As earlier observed, because every person is at risk of needing care at any moment, all those who lack insurance, regardless of their current health status, adversely affect the price of health care and health insurance. See supra, at 6—7. Moreover, an insurance-purchase requirement limited to those in need of immediate care simply could not work.

Another indication John F Kennedy Steel Speech Analysis progress is being made was found in the recent presidential election in the United States. Mutual News was among the Virtue In Meno And Platos Allegory Of The Cave to broadcast a report from the assassination location, because reporter Andrew West of John F Kennedy Steel Speech Analysisa Mutual Broadcasting System radio affiliate in John F Kennedy Steel Speech Analysis Angeles John F Kennedy Steel Speech Analysis, captured on audio tape the sounds of the immediate aftermath of Causes Of The Haitian Revolution John F Kennedy Steel Speech Analysis but not the actual shooting itself, using his reel-to-reel tape recorder and attached microphone. Sustaining John F Kennedy Steel Speech Analysis mandate as John F Kennedy Steel Speech Analysis tax John F Kennedy Steel Speech Analysis only on whether Congress has properly exercised its taxing power to encourage purchasing health insurance, not whether it can. T hereafter, Congress could have enacted Medicaid II, John F Kennedy Steel Speech Analysis new program combin- ing the pre coverage with the expanded coverage required by the John F Kennedy Steel Speech Analysis.

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