National Federation of Independent Business V. Sebelius: The Patient Protection and Affordable Care Act

Harvard Law Review, November 2012 | Go to article overview

National Federation of Independent Business V. Sebelius: The Patient Protection and Affordable Care Act


This government is acknowledged by all, to be one of enumerated powers. The principle, that it can exercise only the powers granted to it ... is now universally admitted. But the question respecting the extent of the powers actually granted, is perpetually arising, and will probably continue to arise, so long as our system shall exist.

-- Chief Justice John Marshall, McCulloch v. Maryland (1)

The taxing power of the Federal Government, my dear; the taxing power is sufficient for everything you want and need.

-- Justice Harlan Fiske Stone to Secretary of Labor Frances Perkins (2)

"In 2010, Congress enacted the Patient Protection and Affordable Care Act." (3) The Act, containing "10 titles[,] ... over 900 pages[,] and ... hundreds of provisions," (4) had been the subject of intense public debate and political maneuvering, from at least as early as the time that President Barack Obama articulated to Congress the principles he believed should guide health care reform, (5) through the Act's controversial passage using budget reconciliation, (6) and up to the Supreme Court's ultimate decision over its constitutionality in National Federation of Independent Business v. Sebelius (7) (NFIB) in June 2012. (8) Two "key provisions" of the Act reached the Court for constitutional review: the "individual mandate" and the "Medicaid expansion." (9) In brief, the individual mandate "requires most Americans to maintain 'minimum essential' health insurance coverage" (10) or else "make a '[s]hared responsibility payment' to the Federal Government." (11) The Medicaid expansion "expand[ed] the scope of the Medicaid program and increase[d] the number of individuals the States must cover" (12) by dictating that any state that "d[id] not comply with the Act's new coverage requirements ... [might] lose not only the federal funding for those requirements, but all of its federal Medicaid funds. " (13)

"[M]inutes after the President signed" the Act into law, (14) "Florida and 12 other States filed a complaint in the Federal District Court for the Northern District of Florida." (15) Later, "13 more states, several individuals, and the National Federation of Independent Business" joined the original plaintiffs. (16) Having disposed of several of the plaintiffs' other claims in a prior ruling (17)--as well as the defendants' arguments that the individual mandate was a tax and that the challenge was therefore barred by the Anti-Injunction Act (18)-on January 31, 2011, Judge Vinson addressed the plaintiffs' arguments (1) that the Act's individual mandate violated the Commerce Clause and (2) that the Act's expansion of Medicaid "violate[d] the Spending Clause and principles of federalism protected under the Ninth and Tenth Amendments." (19) Despite disagreeing over "numerous facts," the parties had filed cross-motions for summary judgment, leading Judge Vinson to conclude that they "appear[ ed] to agree that disposition of [the] case by summary judgment [was] appropriate" because issues of law were ultimately dispositive. (20)

Judge Vinson granted summary judgment to the defendants regarding the validity of the Medicaid expansion under the Spending Clause; however, he granted summary judgment to the plaintiffs as to their requests for declaratory relief regarding the individual mandate. (21) Addressing the Medicaid expansion first, Judge Vinson "join[ed] all courts to have considered this issue" in rejecting the plaintiffs' argument that the federal government's threat to withhold all Medicaid funding for noncompliance with the Act was impermissibly coercive. (22) While expressing sympathy for the states' lack of power relative to the federal government due to the latter's "enormous economic advantage," he concluded that absent Supreme Court revision of its Spending Clause jurisprudence, "the states have little recourse to remaining the very junior partner in this partnership." (23)

Next, analyzing the validity of the individual mandate, Judge Vinson found that, because "[i]t would be a radical departure from existing case law to hold that Congress can regulate inactivity under the Commerce Clause," (24) the mandate's constitutionality "turn[ed] on whether the failure to buy health insurance is 'activity. …

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National Federation of Independent Business V. Sebelius: The Patient Protection and Affordable Care Act
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