NFIB Sebelius Ginsburg

 

45

regulatory role”); Rose-Ackerman, Cooperative Federalism
and Co-optation, 92 Yale L. J. 1344, 1346 (1983) (““If
the federal government begins to take full responsibility
for social welfare spending and preempts the states, the
result is likely to be weaker . . . state governments.””).17

Although Congress “”has no obligation to use its Spend-
ing Clause power to disburse funds to the States,”” College
Savings Bank v. Florida Prepaid Postsecondary Ed. Ex-
pense Bd., 527 U. S. 666, 686 (1999), it has provided Medi-
caid grants notable for their generosity and flexibility.
““[S]uch funds,” we once observed, “are gifts,””  id., at 686–
687, and so they have remained through decades of expan-
sion in their size and scope.

B

  The Spending Clause authorizes Congress ““to pay the
Debts and provide for the . . . general Welfare of the
United States.””  Art. I, §8, cl. 1.  To ensure that federal funds
granted to the States are spent “to ‘provide for the . . .
general Welfare’ in the manner Congress intended,”” ante,
at 46, Congress must of course have authority to impose
limitations on the States’’ use of the federal dollars.  This
Court, time and again, has respected Congress’’ prescrip-
tion of spending conditions, and has required States to
abide by them. See,  e.g., Pennhurst, 451 U. S., at 17
(““[O]ur cases have long recognized that Congress may fix
the terms on which it shall disburse federal money to the
States.””). In particular, we have recognized Congress’’
prerogative to condition a State’’s receipt of Medicaid
—————— ——————-
17 THE CHIEF JUSTICE and the joint dissenters perceive in cooperative
federalism a “”threa[t]”” to “”political accountability.””  Ante, at 48; see
post, at 34-–35.  By that, they mean voter confusion: Citizens upset by
unpopular government action, they posit, may ascribe to state officials
blame more appropriately laid at Congress’’ door. But no such confu-
sion is apparent in this case: Medicaid’s status as a federally funded,
state-administered program is hardly hidden from view. 

46

 funding on compliance with the terms Congress set for
participation in the program.  See,   e.g., Harris, 448 U. S.,
at 301 (“”[O]nce a State elects to participate [in Medicaid],
it must comply with the requirements of [the Medicaid
Act].””);  Arkansas Dept. of Health and Human Servs. v.
Ahlborn, 547 U. S. 268, 275 (2006); Frew v. Hawkins, 540
U. S. 431, 433 (2004); Atkins v. Rivera, 477 U. S. 154, 156–
157 (1986).

  Congress’’ authority to condition the use of federal funds
is not confined to spending programs as first launched.
The legislature may, and often does, amend the law, im-
posing new conditions grant recipients henceforth must
meet in order to continue receiving funds. See infra, at 54
(describing Bennett v.   Kentucky Dept. of Ed., 470 U. S.
656, 659-–660 (1985) (enforcing restriction added five years
after adoption of educational program)).

 Yes, there are federalism-based limits on the use of
Congress’ conditional spending power.  In the leading
decision in this area, South Dakota v. Dole, 483 U. S. 203
(1987), the Court identified four criteria.  The conditions
placed on federal grants to States must (a) promote the
““general welfare,”” (b) “”unambiguously”” inform States what
is demanded of them, (c) be germane “”to the federal inter-
est in particular national projects or programs,”” and (d)
not “”induce the States to engage in activities that would
themselves be unconstitutional.””  Id., at 207–-208, 210
(internal quotation marks omitted).18

The Court in Dole mentioned, but did not adopt, a fur-
ther limitation, one hypothetically raised a half-century
earlier: In “”some circumstances,”” Congress might be pro-
hibited from offering a “”financial inducement . . . so coer-
—————— —————–
18 Although the plaintiffs, in the proceedings below, did not contest
the ACA’’s satisfaction of these criteria, see 648 F. 3d 1235, 1263 (CA11
2011), THE CHIEF JUSTICE appears to rely heavily on the second crite-
rion. Compare ante, at 52, 54, with  infra, at 52-–54.

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