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. Along with their challenge to the individual mandate, the state plaintiffs in the Eleventh Circuit argued that the Medicaid expansion exceeds Congress’s constitutional powers. 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. Congress has imposed an extensive set of regulations on the health insurance industry, and compliance with those regulations will likely cost the in- dustry a great deal. In answering these questions, we presume the statute under review is constitutional and may strike it down only on a “plain showing” that Congress acted irrationally. IV) (working “together” to “add millions of new consumers to the health insurance market”); §18091(2)(E) (working “together” to “significantly reduce” the economic cost of the poorer health and shorter lifespan of the uninsured); §18091(2)(F) (working “together” to “lower health insurance premiums”); §18091(2)(G) (working “together” to “improve financial security for families”); §18091(2)(I) (working “together” to minimize “adverse selection and broaden the health insurance risk pool to include healthy individuals”); §18091(2)(J) (working “together” to “signif- icantly reduce administrative costs and lower health insurance premiums”). If I understand his point correctly, it was incumbent on Congress, in 1965, to warn the States clearly of the size and shape potential changes to Medicaid might take. — Excerpted from National Federation of Independent Business v. Sebelius on Wikipedia, the free encyclopedia. Congress may use this power to establish cooperative state-federal Spending Clause programs. The mandate does not apply to some individuals, such as prisoners and undocumented aliens. That §5000A imposes not a simple tax but a mandate to which a penalty is attached is demonstrated by the fact that some are exempt from the tax who are not ex- empt from the mandate—a distinction that would make no sense if the mandate were not a mandate. That clear principle carries the day here. Per the minimum coverage provision, an individual must either obtain insurance or pay a toll constructed as a tax penalty. That interpretation is consistent with the remainder of §5000A(g), which instructs the Secretary on the tools he may use to collect the penalty. See ante, at 16 (“Everyone will eventually need health care at a time and to an extent they cannot predict.”). Of course in many cases what was a regu- latory mandate enforced by a penalty could have been imposed as a tax upon permissible action; or what was im- posed as a tax upon permissible action could have been a regulatory mandate enforced by a penalty. If Congress had thought that States might actually refuse to go along with the expansion of Medicaid, Congress would surely have devised a backup scheme so that the most vulnerable groups in our society, those previously eligible for Medicaid, would not be left out in the cold. The Spending Clause grants Congress the power “to pay the Debts and provide for the . See, e.g., §§7421(b)(1), §6901(a); §6305(a), (b). . See 42 U. S. C. §§1396–1396v(b) (2006 ed. . See also supra, at 14–16. This rigid reading of the Clause makes scant sense and is stunningly retrogressive. The only thing they may not lawfully do is not buy health insurance and not pay the resulting tax. See also Raich, 545 U. S., at 22; Lopez, 514 U. S., at 557; Hodel v. Virginia Surface Mining & Reclamation Assn., Inc., 452 U. S. 264, 277 (1981); Katzenbach v. McClung, 379 U. S. 294, 303 (1964); Heart of Atlanta Motel, Inc. v. United States, 379 U. S. 241, 258 (1964); United States v. Carolene Products Co., 304 U. S. 144, 152–153 (1938). 26 U.S.C. A few respectful responses to Justice Ginsburg’s dissent on the issue of the Mandate are in order. See 42 CFR §430.12(c)(i) (2011). The purpose of the ACA is to increase the number of Americans with healthcare insurance, and decrease the cost of healthcare. See Brief for National Health Law Program et al. 1999) (As a result of the “want of concert in matters where common interest requires it,” the “national dignity, interest, and reve- nue [have] suffered.”).3. by Samuel R. Bagenstos, Ira A. Burnim, and Jennifer Mathis. 14, would have made superfluous the later provision for authority “[t]o raise and support Armies,” id., §8, cl. The Federal Government, therefore, is not, as The Chief Justice charges, threatening States with the loss of “existing” funds from one spending program in order to induce them to opt into another program. To achieve this goal, the ACA mandates that every person obtain a minimum level of coverage.
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