National Federation of Independent Business v. Sebelius

Syllabus
In 2010, Congress enacted the Patient Protection and Affordable Care Act in order to increase the number of Americans covered by health insurance and decrease the cost of health care. One key provision is the individual mandate, which requires most Americans to maintain "minimum essential" health insurance coverage. 26 U.S.C. § 5000A. For individuals who are not exempt, and who do not receive health insurance through an employer or government program, the means of satisfying the requirement is to purchase insurance from a private company. Beginning in 2014, those who do not comply with the mandate must make a "[s]hared responsibility payment" to the Federal Government. § 5000A(b)(1). The Act provides that this "penalty" will be paid to the Internal Revenue Service (IRS) with an individual's taxes, and "shall be assessed and collected in the same manner" as tax penalties. §§ 5000A(c), (g)(1).

Another key provision of the Act is the Medicaid expansion. The current Medicaid program offers federal funding to States to assist pregnant women, children, needy families, the blind, the elderly, and the disabled in obtaining medical care. 42 U.S.C. § 1396d(a). The Affordable Care Act expands the scope of the Medicaid program and increases the number of individuals the States must cover. For example, the Act requires state programs to provide Medicaid coverage by 2014 to adults with incomes up to 133 percent of the federal poverty level, whereas many States now cover adults with children only if their income is considerably lower, and do not cover childless adults at all. § 1396a(a)(10) (A)(i)(VIII). The Act increases federal funding to cover the States' costs in expanding Medicaid coverage. § 1396d(y)(1). But if a State does not comply with the Act's new coverage requirements, it may lose [p517] not only the federal funding for those requirements, but all of its federal Medicaid funds. § 1396c.

Twenty-six States, several individuals, and the National Federation of Independent Business brought suit in Federal District Court, challenging the constitutionality of the individual mandate and the Medicaid expansion. The Court of Appeals for the Eleventh Circuit upheld the Medicaid expansion as a valid exercise of Congress's spending power, but concluded that Congress lacked authority to enact the individual mandate. Finding the mandate severable from the Act's other provisions, the Eleventh Circuit left the rest of the Act intact.

Held: The judgment is affirmed in part and reversed in part.

648 F.3d 1235, affirmed in part and reversed in part.

 C J R delivered the opinion of the Court with respect to Part II, concluding that the Anti-Injunction Act does not bar this suit. The Anti-Injunction Act provides that "no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person," 26 U.S.C. § 7421(a), so that those subject to a tax must first pay it and then sue for a refund. The present challenge seeks to restrain the collection of the shared responsibility payment from those who do not comply with the individual mandate. But Congress did not intend the payment to be treated as a "tax" for purposes of the Anti-Injunction Act. The Affordable Care Act describes the payment as a "penalty," not a "tax." That label cannot control whether the payment is a tax for purposes of the Constitution, but it does determine the application of the Anti-Injunction Act. The Anti-Injunction Act therefore does not bar this suit. Pp. 543–546.  C J R concluded in Part III–A that the individual mandate is not a valid exercise of Congress's power under the Commerce Clause and the Necessary and Proper Clause. Pp. 547–561.  The Constitution grants Congress the power to "regulate Commerce." Art. I, § 8, cl. 3 (emphasis added). The power to regulate commerce presupposes the existence of commercial activity to be regulated. This Court's precedent reflects this understanding: As expansive as this Court's cases construing the scope of the commerce power have been, they uniformly describe the power as reaching "activity." E.g., United States v. Lopez, 514 U.S. 549, 560. The individual mandate, however, does not regulate existing commercial activity. It instead compels individuals 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 Congress to regulate individuals precisely because they are doing nothing would open a new and [p517] potentially vast domain to congressional authority. Congress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle that the Federal Government is a government of limited and enumerated powers. The individual mandate thus cannot be sustained under Congress's power to "regulate Commerce." Pp. 547–558.  Nor can the individual mandate be sustained under the Necessary and Proper Clause as an integral part of the Affordable Care Act's other reforms. Each of this Court's prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power. E.g., United States v. Comstock, 560 U.S. 126. The individual mandate, by contrast, vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power and draw within its regulatory scope those who would otherwise be outside of it. Even if the individual mandate is "necessary" to the Affordable Care Act's other reforms, such an expansion of federal power is not a "proper" means for making those reforms effective. Pp. 558–561. C J R concluded in Part III–B that the individual mandate must be construed as imposing a tax on those who do not have health insurance, if such a construction is reasonable. The most straightforward reading of the individual mandate is that it commands individuals to purchase insurance. But, for the reasons explained, the Commerce Clause does not give Congress that power. It is therefore necessary to turn to the Government's alternative argument: that the mandate may be upheld as within Congress's power to "lay and collect Taxes." Art. I, § 8, cl. 1. In pressing its taxing power argument, the Government asks the Court to view the mandate as imposing a tax on those who do not buy that product. Because "every reasonable construction must be resorted to, in order to save a statute from unconstitutionality," Hooper v. California, 155 U.S. 648, 657, the question is whether it is "fairly possible" to interpret the mandate as imposing such a tax, Crowell v. Benson, 285 U.S. 22, 62. Pp. 561–563.  C J R delivered the opinion of the Court with respect to Part III–C, concluding that the individual mandate may be upheld as within Congress's power under the Taxing Clause. Pp. 563–574.  The Affordable Care Act describes the "[s]hared responsibility payment" as a "penalty," not a "tax." That label is fatal to the applica- [p522] tion of the Anti-Injunction Act. It does not, however, control whether an exaction is within Congress's power to tax. In answering that constitutional question, this Court follows a functional approach, "[d]isregarding the designation of the exaction, and viewing its substance and application." United States v. Constantine, 296 U.S. 287, 294. Pp. 563–565. <li>Such an analysis suggests that the shared responsibility payment may for constitutional purposes be considered a tax. The payment is not so high that there is really no choice but to buy health insurance; the payment is not limited to willful violations, as penalties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation. Cf. Child Labor Tax Case (Bailey v. Drexel Furniture Co.), 259 U.S. 20, 36–37. None of this is to say that payment is not intended to induce the purchase of health insurance. But the mandate need not be read to declare that failing to do so is unlawful. Neither the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS. And Congress's choice of language—stating that individuals "shall" obtain insurance or pay a "pen-alty"—does not require reading § 5000A as punishing unlawful conduct. It may also be read as imposing a tax on those who go without insurance. See New York v. United States, 505 U.S. 144, 169–174. Pp. 565–570.</li> <li>Even if the mandate may reasonably be characterized as a tax, it must still comply with the Direct Tax Clause, which provides: "No Capitation, or other direct, Tax shall be laid, unless in Proportion to the Census or Enumeration herein before directed to be taken." Art. I, § 9, cl. 4. A tax on going without health insurance is not like a capitation or other direct tax under this Court's precedents. It therefore need not be apportioned so that each State pays in proportion to its population. Pp. 570–571.</li></ol> <li>C J R, joined by J B and J K, concluded in Part IV that the Medicaid expansion violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion. Pp. 575–588.</li> <ol style="list-style-type:lower-alpha;margin-left:2em"> <li>The Spending Clause grants Congress the power "to pay the Debts and provide for the general Welfare of the United States." Art. I, § 8, cl. 1. Congress may use this power to establish cooperative state-federal Spending Clause programs. The legitimacy of Spending Clause legislation, however, depends on whether a State voluntarily and knowingly accepts the terms of such programs. Pennhurst State School and Hospital v. Halderman, 451 U.S. 1, 17. "[T]he Constitution simply does not give Congress the authority to require the States to [p523] regulate." New York, supra, at 178. When Congress threatens to terminate other grants as a means of pressuring the States to accept a Spending Clause program, the legislation runs counter to this Nation's system of federalism. Cf. South Dakota v. Dole, 483 U.S. 203, 211. Pp. 575–581.</li> <li>Section 1396c gives the Secretary of Health and Human Services the authority to penalize States that choose not to participate in the Medicaid expansion by taking away their existing Medicaid funding. 42 U.S.C. § 1396c. The threatened loss of over 10 percent of a State's overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion. The Government claims that the expansion is properly viewed as only a modification of the existing program, and that this modification is permissible because Congress reserved the "right to alter, amend, or repeal any provision" of Medicaid. § 1304. But the expansion accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for particular categories of vulnerable individuals. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. A State could hardly anticipate that Congress's reservation of the right to "alter" or "amend" the Medicaid program included the power to transform it so dramatically. The Medicaid expansion thus violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion. Pp. 581–585.</li> <li>The constitutional violation is fully remedied by precluding the Secretary from applying § 1396c to withdraw existing Medicaid funds for failure to comply with the requirements set out in the expansion. See § 1303. The other provisions of the Affordable Care Act are not affected. 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 Medicaid expansion. Pp. 585–588.</li></ol> <li>J G, joined by J S, is of the view that the Spending Clause does not preclude the Secretary from withholding Medicaid funds based on a State's refusal to comply with the expanded Medicaid program. But given the majority view, she agrees with T C J's conclusion in Part IV–B that the Medicaid Act's severability clause, 42 U.S.C. § 1303, determines the appropriate remedy. Because T C J finds the withholding—not the granting—of federal funds incompatible with the Spending Clause, Congress' extension of Medicaid remains available to any State that affirms its willingness to participate. Even absent § 1303's command, the Court would have no warrant to invalidate the funding offered by the [p524] Medicaid expansion, and surely no basis to tear down the Affordable Care Act in its entirety. When a court confronts an unconstitutional statute, its endeavor must be to conserve, not destroy, the legislation. See, e.g., Ayotte v. Planned Parenthood of Northern New Eng.,  546 U.S. 320, 328–330. Pp. 645–646.</li></ol>

R, C.J., announced the judgment of the Court and delivered the opinion of the Court with respect to Parts I, II, and III–C, in which G, B, S, and K, JJ., joined; an opinion with respect to Part IV, in which B and K, JJ., joined; and an opinion with respect to Parts III–A, III–B, and III–D. G, J., filed an opinion concurring in part, concurring in the judgment in part, and dissenting in part, in which S, J., joined, and in which B and K, JJ., joined as to Parts I, II, III, and IV, post, p. 589. S, K, T, and A, JJ., filed a dissenting opinion, post, p. 646. T, J., filed a dissenting opinion, post, p. 707.

Robert A. Long, Jr., by invitation of the Court, 565 U.S. 1048, argued the cause in No. 11–398 (Anti-Injunction Act) as amicus curiae  in support of vacatur. With him on the briefs were Emin Toro, Mark W. Mosier, and Henry B. Liu.

Solicitor General Verrilli argued the cause for petitioners in No. 11–398 (Anti-Injunction Act). With him on the briefs were Assistant Attorney General West, Deputy Solicitor General Kneedler, Principal Deputy Assistant Attorney General DiCicco, Deputy Assistant Attorney General Brinkmann, Leondra R. Kruger, Mark B. Stern, Alisa B. Klein, Joel McElvain, M. Patricia Smith, William B. Schultz, and Kenneth Y. Choe.

Gregory G. Katsas argued the cause for respondents in No. 11–398 (Anti-Injunction Act). With him on the briefs for private respondents were Michael A. Carvin, C. Kevin Marshall, Hashim M. Mooppan, Karen R. Harned, and Randy E. Barnett. On the briefs for state respondents were Paul D. Clement, Erin E. Murphy, Conor B. Dugan, Erin M. Hawley, Pamela Jo Bondi, Attorney General of Florida, Scott D. Makar, Solicitor General, and Louis F. Hubener, Timothy D. Osterhaus, and Blaine H. Winship, Luther Strange, Attorney General of Alabama, Michael C. Geraghty, [p525] Attorney General of Alaska, Janice K. Brewer, Governor of Arizona, and Tom Horne, Attorney General, John W. Suthers, Attorney General of Colorado, Samuel S. Olens, Attorney General of Georgia, Lawrence G. Wasden, Attorney General of Idaho, Gregory F. Zoeller, Attorney General of Indiana, Terry Branstad, Governor of Iowa, Derek Schmidt, Attorney General of Kansas, James D. "Buddy" Caldwell, Attorney General of Louisiana, William J. Schneider, Attorney General of Maine, Bill Schuette, Attorney General of Michigan, Michael B. Wallace, by and through Phil Bryant, Governor of Mississippi, Jon Bruning, Attorney General of Nebraska, and Katherine J. Spohn, Brian Sandoval, Governor of Nevada, Wayne Stenehjem, Attorney General of North Dakota, Michael DeWine, Attorney General of Ohio, and David B. Rivkin and Lee A. Casey, Thomas W. Corbett, Jr., Governor of Pennsylvania, and Linda L. Kelly, Attorney General, Alan Wilson, Attorney General of South Carolina, Marty J. Jackley, Attorney General of South Dakota, Greg Abbott, Attorney General of Texas, and Bill Cobb, Deputy Attorney General, Mark L. Shurtleff, Attorney General of Utah, Robert M. McKenna, Attorney General of Washington, J. B. Van Hollen, Attorney General of Wisconsin, and Matthew Mead, Governor of Wyoming.

Solicitor General Verrilli argued the cause for petitioners in No. 11–398 (Minimum Coverage Provision). With him on the briefs were Assistant Attorney General West, Deputy Solicitor General Kneedler, Deputy Assistant Attorney General Brinkmann, Joseph R. Palmore, Mr. Stern, Ms. Klein, Ms. Smith, Mr. Schultz, and Mr. Choe.

Mr. Clement argued the cause for state respondents in No. 11–398 (Minimum Coverage Provision). With him on the brief for respondents Florida et al. were Ms. Murphy, Ms. Bondi, Attorney General of Florida, Mr. Makar, Solicitor General, and Mr. Hubener, Mr. Osterhaus, and Mr. Winship, Mr. Strange, Attorney General of Alabama, Mr. Geraghty, Attorney General of Alaska, Ms. Brewer, Governor of Ari- [p526] zona, and Mr. Horne, Attorney General, Mr. Suthers, Attorney General of Colorado, Mr. Olens, Attorney General of Georgia, Mr. Wasden, Attorney General of Idaho, Mr. Zoeller, Attorney General of Indiana, Mr. Branstad, Governor of Iowa, Mr. Schmidt, Attorney General of Kansas, Mr. Caldwell, Attorney General of Louisiana, Mr. Schneider, Attorney General of Maine, Mr. Schuette, Attorney General of Michigan, Mr. Wallace, by and through Mr. Bryant, Governor of Mississippi, Mr. Bruning, Attorney General of Nebraska, and Ms. Spohn, Mr. Sandoval, Governor of Nevada, Mr. Stenehjem, Attorney General of North Dakota, Mr. De-Wine,  Attorney General of Ohio, and Mr. Rivkin  and Mr. Casey, Mr. Corbett, Governor of Pennsylvania, and Ms. Kelly, Attorney General, Mr. Wilson, Attorney General of South Carolina, Mr. Jackley, Attorney General of South Dakota, Mr. Abbott, Attorney General of Texas, and Mr. Cobb, Deputy Attorney General, Mr. Shurtleff, Attorney General of Utah, Mr. McKenna, Attorney General of Washington, Mr. Van Hollen,  Attorney General of Wisconsin, and Mr. Mead, Governor of Wyoming. Mr. Carvin argued the cause for private respondents in No. 11–398 (Minimum Coverage Provision). With him on the brief were Mr. Katsas, Mr. Marshall, Mr. Mooppan, Ms. Harned, and Mr. Barnett.

Mr. Clement argued the cause and filed briefs for petitioners in Nos. 11–393 and 11–400 (Severability). With him on the briefs for state petitioners were Ms. Murphy, Ms. Bondi, Attorney General of Florida, Mr. Makar, Solicitor General, and Mr. Hubener, Mr. Osterhaus,  and Mr. Winship, Mr. Strange, Attorney General of Alabama, Mr. Geraghty, Attorney General of Alaska, and Richard Svobodny, Acting Attorney General, Ms. Brewer, Governor of Arizona, and Mr. Horne, Attorney General, Mr. Suthers, Attorney General of Colorado, Mr. Olens, Attorney General of Georgia, Mr. Wasden, Attorney General of Idaho, Mr. Zoeller, Attorney General of Indiana, Mr. Branstad,  Governor of Iowa, Mr. Schmidt, Attorney General of Kansas, Mr. Caldwell, At- [p527] torney General of Louisiana, Mr. Schneider, Attorney General of Maine, Mr. Schuette, Attorney General of Michigan, Mr. Wallace, by and through Mr. Bryant, Governor of Mississippi, Mr. Bruning, Attorney General of Nebraska, and Ms. Spohn, Mr. Sandoval, Governor of Nevada, Mr. Stenehjem, Attorney General of North Dakota, Mr. DeWine, Attorney General of Ohio, and Mr. Rivkin and Mr. Casey, Mr. Corbett, Governor of Pennsylvania, and Ms. Kelly, Attorney General, Mr. Wilson, Attorney General of South Carolina, Mr. Jackley, Attorney General of South Dakota, Mr. Abbott, Attorney General of Texas, and Mr. Cobb, Deputy Attorney General, Mr. Shurtleff, Attorney General of Utah, Mr. Mc-Kenna, Attorney General of Washington, Mr. Van Hollen, Attorney General of Wisconsin, and Mr. Mead, Governor of Wyoming. Mr. Carvin, Mr. Katsas, Mr. Marshall, Mr. Mooppan, Ms. Harned, and Mr. Barnett filed briefs for private petitioners.

Deputy Solicitor General Kneedler argued the cause for respondents in Nos. 11–393 and 11–400 (Severability). With him on the briefs were Solicitor General Verrilli, Assistant Attorney General West, Deputy Assistant Attorney General Brinkmann, Mr. Palmore, Mr. Stern, Ms. Klein, Ms. Smith, Mr. Schultz, and Mr. Choe.

H. Bartow Farr III, by invitation of the Court, 565 U.S. 1048, argued the cause in Nos. 11–393 and 11–400 (Severability) and filed a brief as amicus curiae in support of the judgment below.

Mr. Clement argued the cause for petitioners in No. 11–400 (Medicaid). With him on the briefs were Ms. Murphy, Ms. Bondi, Attorney General of Florida, and Mr. Makar, Solicitor General, and Mr. Hubener, Mr. Osterhaus,  and Mr. Winship, Mr. Strange, Attorney General of Alabama, Mr. Svobodny, Acting Attorney General of Alaska, Ms. Brewer, Governor of Arizona, and Mr. Horne, Attorney General, Mr. Suthers, Attorney General of Colorado, Mr. Olens, Attorney General of Georgia, Mr. Wasden, Attorney Gen- [p528] eral of Idaho, Mr. Zoeller,  Attorney General of Indiana, Mr. Branstad, Governor of Iowa, Mr. Schmidt, Attorney General of Kansas, Mr. Caldwell, Attorney General of Louisiana, Mr. Schneider,  Attorney General of Maine, Mr. Schuette, Attorney General of Michigan, Mr. Bruning, Attorney General of Nebraska, and Ms. Spohn, Mr. Sandoval, Governor of Nevada, Mr. Stenehjem, Attorney General of North Dakota, Mr. DeWine, Attorney General of Ohio, and Mr. Rivkin and Mr. Casey, Mr. Corbett, Governor of Pennsylvania, and Ms. Kelly, Attorney General, Mr. Wilson, Attorney General of South Carolina, Mr. Jackley, Attorney General of South Dakota, Mr. Abbott, Attorney General of Texas, and Mr. Cobb, Deputy Attorney General, Mr. Shurtleff, Attorney General of Utah, Mr. McKenna, Attorney General of Washington, Mr. Van Hollen, Attorney General of Wisconsin, and Mr. Mead, Governor of Wyoming.

Solicitor General Verrilli argued the cause for respondents in No. 11–400 (Medicaid). With him on the brief were Assistant Attorney General West, Deputy Solicitor General Kneedler, Deputy Assistant Attorney General Brinkmann, Ms. Kruger, Mr. Stern, Ms. Klein, Ms. Smith, Mr. Schultz,  and Mr. Choe.  

* Together with No. 11–398, Department of Health and Human Services et al. v. Florida et al., and No. 11–400, Florida et al. v. Department of Health and Human Services et al., also on certiorari to the same court.

† Briefs of amici curiae were filed in No. 11–398 (Anti-Injunction Act) for the American Center for Law & J by Jay Alan Sekulow, Stuart J. Roth, Colby M. May, James M. Henderson, Sr., Walter M. Weber, Edward L. White III, and Erik M. Zimmerman; for the Cato Institute by Ilya Shapiro; for the Center for the Fair Administration of Taxes by A. Lavar Taylor; for Liberty University, Inc., et al. by Mathew D. Staver, Anita L. Staver, Stephen M. Crampton, and Mary E. McAlister; for the State Chambers of Commerce et al. by William V. Custer; for Tax Law Professors by Michael B. de Leeuw; and for Mortimer Caplin et al. by Alan B. Morrison and Brian Wolfman.

Briefs of amici curiae urging reversal in No. 11–398 (Minimum Coverage Provision) were filed for the State of Maryland et al. by Douglas F. Gansler, Attorney General of Maryland, John B. Howard, Jr., Deputy Attorney General, William F. Brockman, Acting Solicitor General, and Joshua N. Auerbach, Stephen M. Ruckman, and Sarah W. Rice, Assistant Attorneys General, and by the Attorneys General for their respective jurisdictions as follows: Kamala D. Harris of California, George Jepsen of [p529] Connecticut, Joseph R. Biden III of Delaware, Irvin B. Nathan of the District of Columbia, David M. Louie of Hawaii, Lisa Madigan of Illinois, Tom Miller of Iowa, Gary K. King of New Mexico, Eric T. Schneiderman of New York, John R. Kroger of Oregon, William H. Sorrell of Vermont, and Vincent F. Frazer of the Virgin Islands; for AARP by Thomas C. Goldstein, Kevin K. Russell, Stuart R. Cohen, Stacy Canan, and Michael Schuster; for Advocacy for Patients with Chronic Illness, Inc., by Jennifer C. Jaff; for the American Association of People with Disabilities et al. by Rochelle Bobroff and Simon Lazarus; for the American Cancer Society et al. by Mary P. Rouvelas and F. Sheffield Hale; for the American Federation of Labor and Congress of Industrial Organizations by Lynn K. Rhinehart, James B. Coppess, and Laurence Stephen Gold; for the American Nurses Association et al. by Ian Millhiser; for the California Endowment by Kathleen M. Sullivan, William B. Adams,  and Crystal Nix Hines; for the California Public Employees' Retirement System by Peter H. Mixon; for Constitutional Law Scholars by Andrew J. Pincus, Gillian E. Metzger, and Trevor W. Morrison; for Health Care for All, Inc., et al. by Wendy E. Parmet and Lorianne M. Sainsbury-Wong; for Health Care Policy History Scholars by Geoffrey F. Aronow; for the Jewish Alliance for Law & Social Action et al. by Andrew M. Fischer; for the Lambda Legal Defense and Education Fund, Inc., et al. by Douglas Hallward-Driemeier, Susan L. Sommer, Hayley J. Gorenberg, and Jon W. Davidson; for the NAACP Legal Defense & Educational Fund, Inc., et al. by John Payton, Debo P. Adegbile, Elise C. Boddie, ReNika C. Moore, Joshua Civin, Steven R. Shapiro, and Lisa M. Bornstein; for the National Women's Law Center et al. by Melissa Hart, Marcia D. Greenberger, and Judith G. Waxman; for Prescription Policy Choices et al. by Michael Kevin Outterson; for the Service Employees International Union et al. by Scott A. Kronland, Jonathan Weissglass, P. Casey Pitts, Judith A. Scott, Walter Kamiat, Mark Schneider, and Patrick J. Szymanski; for the Small Business Majority Foundation, Inc., et al. by Douglas L. McSwain; for State Legislators from all Fifty States et al. by Douglas T. Kendall and Elizabeth B. Wydra; and for Senate Majority Leader Harry Reid et al. by Walter Dellinger, Christopher J. Wright, and Timothy J. Simeone.

Briefs of amici curiae urging affirmance in No. 11–398 (Minimum Coverage Provision) were filed for the State of Oklahoma by E. Scott Pruitt, Attorney General of Oklahoma, and Patrick R. Wyrick, Solicitor General; [p530] for the Commonwealth of Virginia ex rel. Kenneth T. Cuccinelli II by Mr. Cuccinelli, Attorney General of Virginia, pro se, E. Duncan Getchell, Jr., Solicitor General, Charles E. James, Jr., Chief Deputy Attorney General, and Wesley G. Russell, Jr., Deputy Attorney General; for Missouri Attorney General Chris Koster by Mr. Koster, pro se, and Jeremiah J. Morgan, Deputy Solicitor General; for the American Catholic Lawyers Association, Inc., by Bertram P. Goltz, Jr.; for the American Center for Law & J et al. by Mr. Sekulow, Mr. Roth, Mr. May, Mr. Henderson, Mr. Weber, Mr. White, and Mr. Zimmerman; for the American College of Pediatricians et al. by Nikolas T. Nikas, Dorinda C. Bordlee, Mark L. Rienzi, Mailee R. Smith, Denise M. Burke, Steven H. Aden, Matthew S. Bowman, and Catherine W. Short; for the American Legislative Exchange Council by John P. Elwood and Seth L. Cooper; for the Association of American Physicians and Surgeons, Inc., et al. by David P. Felsher and Andrew L. Schlafly; for the Authors of The Origins of the Necessary and Proper Clause et al. by David B. Kopel; for Blue Cross and Blue Shield of Massachusetts, Inc., by Dean Richlin, Robert E. Toone, and Joseph Halpern; for the Catholic Vote et al. by Patrick T. Gillen; for the Cato Institute et al. by Robert A. Levy, Ilya Shapiro,  and Timothy Sandefur;  for the Caesar Rodney Institute by Grant M. Lally; for the Center for Constitutional Jurisprudence et al. by Christopher R. J. Pace, John C. Eastman, Anthony T. Caso, Edwin Meese III, Todd F. Gaziano, Brian C. Baker, Carrie Severino, and Manuel S. Klausner; for Docs4PatientCare by Erik S. Jaffe and John Hoff; for Economists by Steven G. Bradbury, Steven A. Engel, and Michael H. Park; for the Employer Solutions Staffing Group LLC by Rebecca J. Levine; for the HSA Coalition, Inc., et al. by Ed R. Haden; for the Independent Women's Forum by Kevin J. Hasson; for Judicial Watch, Inc., by Paul J. Orfanedes; for Members of the United States Senate by Ms. Severino; for the Mountain States Legal Foundation by James M. Manley and Steven J. Lechner; for the Montana Shooting Sports Association, Inc., by Quentin M. Rhoades; for Single Payer Action et al. by Oliver B. Hall; for the Tax Foundation by Joseph D. Henchman; for the Washington Legal Foundation et al. by Ilya Somin, Daniel J. Popeo, and Cory L. Andrews; for the 1851 Center for Constitutional Law by Christopher P. Finney and Curt C. Hartman; for Speaker of the House John Boehner by Ms. Severino; for Virginia Delegate Bob [p531] Marshall et al. by William J. Olson, Herbert W. Titus, John S. Miles, and Gary G. Kreep; for Sen. Rand Paul by Bridget Maloney Bush; and for Stephen M. Trattner by Mr. Trattner, pro se.

Briefs of amici curiae were filed in No. 11–398 (Minimum Coverage Provision) for the Commonwealth of Massachusetts by Martha Coakley, Attorney General, and Thomas M. O'Brien, Daniel J. Hammond, and Emiliano Mazlen, Assistant Attorneys General; for the Governor of Washington Christine Gregoire by Kristin Houser, Adam J. Berger, Rebecca J. Roe, and William Rutzick; for the American Civil Rights Union et al. by Peter Ferrara; for the American Hospital Association et al. by Sheree R. Kanner, Catherine E. Stetson, Dominic F. Perella, Lisa Gilden,  and Frank R. Trinity; for the American Life League by Robert L. Sassone;  for Child Advocacy Organizations by Jeffrey O. Bramlett, Emmet J. Bondurant, and Barbara B. Woodhouse; for Citizens and Legislators in the Fourteen Health Care Freedom States by Nicholas C. Dranias, Clint D. Bolick, and Linda W. Knight; for the Citizens' Council for Health Freedom by John Remington Graham; for Constitutional Law and Economics Professors by Wilson R. Huhn; for Economic Scholars by Richard L. Rosen and Michael D. Thorpe; for Former United States Department of J Officials by Theodore B. Olson, Amir C. Tayrani, Joshua S. Lipshutz, Terence J. Pell, and Michael E. Rosman; for the Foundation for Moral Law, Inc., by John A. Eidsmoe and Benjamin D. DuPré; for the Health Foundation of Greater Cincinnati by James A. Feldman; for the Institute for J by William H. Mellor, Dana Berliner, Steven M. Simpson, and Elizabeth Price Foley; for the Landmark Legal Foundation by Richard P. Hutchison; for the Liberty Legal Foundation by Van R. Irion; for Liberty University, Inc., et al. by Mr. Staver, Ms. Staver, Mr. Crampton, and Mr. McAlister; for the Partnership for America by Charles J. Cooper, David H. Thompson, Howard C. Nielson, Jr., and Brian S. Koukoutchos; for Project Liberty by Allan E. Parker, R. Clayton Trotter, Kathleen Cassidy Goodman, and Steven W. Fitschen; for The Rutherford Institute by Alfred W. Putnam, Jr., Jason P. Gosselin, D. Alicia Hickok, and John W. Whitehead; for the Thomas More Law Center et al. by Robert J. Muise, David Yerushalmi, and Richard Thompson; for Young Invincibles by Paolo Annino; for Barry Friedman et al. by Jeffrey A. Lamken, Robert K. Kry, Martin V. Totaro, and Mr. Friedman, pro se; for Egon Mittelmann [p532] by Mr. Mittelmann, pro se; and for David R. Riemer et al. by Dean A. Strang.

Briefs of amici curiae urging reversal in Nos. 11–393 and 11–400 (Severability) were filed for the American Center for Law & J et al. by Mr. Sekulow, Mr. Roth, Mr. May, Mr. Henderson, Mr. Weber, Mr. White, and Mr. Zimmerman; for the American Civil Rights Union by Mr. Ferrara; for America's Health Insurance Plans et al. by Patricia A. Millett, Orly Degani, James E. Tysse, and Roger G. Wilson; for the Chamber of Commerce of the United States of America by K. Lee Blalack II, Brian D. Boyle, Anton Metlitsky, Robin S. Conrad, Shane B. Kawka,  and Kathryn Comerford Todd; for Economists by Mr. Bradbury, Mr. Engel,  and Mr. Park; for the Family Research Council et al. by Nelson Lund; and for the National Restaurant Association by Leon R. Sequeira, David M. Weiner, and Jennifer A. Kraft.

Briefs of amici curiae urging affirmance in Nos. 11–393 and 11–400 (Severability) were filed for Missouri Attorney General Chris Koster by Mr. Koster, pro se, and Mr. Morgan, Deputy Solicitor General; for Michigan Legal Services, Inc., by Gary A. Benjamin; and for the Washington and Lee University School of Law Black Lung Clinic by Timothy C. MacDonnell.

Briefs of amici curiae were filed in Nos. 11–393 and 11–400 (Severability) for the State of California et al. by Ms. Harris, Attorney General of California, Travis LeBlanc, Special Assistant Attorney General, Manuel M. Medeiros, State Solicitor General, and Daniel J. Powell, Deputy Attorney General, by Christine O. Gregoire, Governor of Washington, and by the Attorneys General for their respective jurisdictions as follows: Mr. Jepsen of Connecticut, Mr. Biden of Delaware, Mr. Nathan of the District of Columbia, Mr. Louie of Hawaii, Ms. Madigan  of Illinois, Mr. Miller of Iowa, Mr. Gansler of Maryland, Mr. King of New Mexico, Mr. Schneiderman of New York, Mr. Kroger of Oregon, and Mr. Sorrell  of Vermont; for AARP et al. by Ms. Bobroff, Mr. Cohen, Ms. Canan, Bruce Vignery, and Mr. Schuster; for the American Academy of Actuaries by Kannon K. Shanmugam and Mary E. Downs; for the American Benefits Council by James R. Napoli, Mark D. Harris, Charles S. Sims, and Kathryn M. Wilber; for the American Hospital Association et al. by Ms. Kanner, Ms. Stetson, Mr. Perella, and Mr. Trinity; for the American Medical Student Association et al. by Mr. Millhiser;  for the American Public [p533] Health Association et al. by Martha Jane Perkins and Corey S. Davis; for the Asian & Pacific Islander American Health Forum et al. by Mark A. Packman, Jonathan M. Cohen, and Priscilla Huang; for the Association of American Physicians and Surgeons et al. by Mr. Felsher and Mr. Schlafly; for the Competitive Enterprise Institute et al. by Thomas M. Christina, Jeffrey P. Dunlaevy, Sam Kazman, and Hans Bader; for Freedom Watch by Larry Klayman; for the J and Freedom Fund by Deborah J. Dewart and James L. Hirsen; for Members of the United States Senate by James F. Bennett and Ms. Severino; for the National Indian Health Board et al. by Geoffrey D. Strommer, Carol L. Barbero, Elliott Milhollin, and William R. Norman; for the Texas Public Policy Foundation et al. by Mario Loyola, Richard Epstein, and Ilya Shapiro; for David R. Riemer et al. by Mr. Strang; and for Joella Swan et al. by Thomas E. Johnson and ''Grant Crandall. Mr. Kreep filed a brief for the Western Center for Journalism as amicus curiae'' in No. 11–393.

Briefs of amici curiae urging reversal were filed in No. 11–400 (Medicaid) for the American Civil Rights Union et al. by Mr. Ferrara; for Economists by Mr. Bradbury, Mr. Engel, and Mr. Park; for the Independence Institute by Mr. Kopel; for the Texas Public Policy Foundation et al. by Mr. Loyola and Mr. Epstein; and for James F. Blumstein by Mr. Blumstein, pro se.

Briefs of amici curiae urging affirmance were filed in No. 11–400 (Medicaid) for the State of Oregon et al. by Mr. Kroger, Attorney General of Oregon, Anna M. Joyce, Solicitor General, and Keith Dubanevich,  by Mr. Sorrell, Attorney General of Vermont, and Bridget C. Asay, Assistant Attorney General, by Ms. Gregoire, Governor of Washington, and Mr. Berger, Special Assistant Attorney General, and by the Attorneys General for their respective States as follows: Ms. Harris of California, Mr. Jepsen of Connecticut, Mr. Biden of Delaware, Mr. Louie of Hawaii, Ms. Madigan of Illinois, Mr. Miller of Iowa, Mr. Gansler of Maryland, Ms. Coakley of Massachusetts, Mr. King of New Mexico, and Mr. Schneider-man of New York; for the American Hospital Association et al. by Ms. Kanner, Ms. Stetson, Mr. Perella, Mr. Trinity, and Ms. Gilden; for Catholic Sisters by David J. Burman; for the Disability Rights Legal Center by Chris M. Amantea; for Faithful Reform in Health Care et al. by Thomas W. Coons, Charles M. English, and Wendy M. Yoviene; for Health Law & Policy Scholars et al. by Mr. Outterson; for the Leadership Confer- [p534] ence on Civil and Human Rights et al. by Martha F. Davis and Risa E. Kaufman; for the National Health Law Program et al. by Ms. Perkins; for the National Minority AIDS Council et al. by Deanne E. Maynard and Marc A. Hearron; for the Service Employees International Union et al. by Stephen P. Berzon, Mr. Kronland, Ms. Scott, Mr. Kamiat, Mr. Schneider, and Mr. Szymanski; for State Legislators from the Fifty States et al. by Mr. Kendall and Ms. Wydra; for Senate Majority Leader Harry Reid et al. by Mr. Wright, Mr. Simeone, Mark D. Davis, and Mr. Dellinger; for David R. Riemer et al. by Mr. Strang; and for David Satcher, M. D., et al. by Samuel R. Bagenstos, Ira A. Burnim, and Jennifer Mathis.

Briefs of amici curiae were filed in No. 11–400 (Medicaid) for the Association of American Physicians and Surgeons et al. by Mr. Felsher and Mr. Schlafly; for the Center for Constitutional Jurisprudence et al. by Mr. Eastman, Mr. Caso, Mr. Meese, Mr. Sandefur, and Ilya Shapiro; for Freedom Watch by Mr. Klayman; for Indiana State Legislators et al. by Asheesh Agarwal and Mr. Christina; and for Michigan Legal Services, Inc., by Mr. Benjamin.