NFIB Sebelius Roberts

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 no different from the previous changes to Medicaid, such
that “”a State would be hard put to complain that it lacked
fair notice.”” Post, at 56.  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 amend-
ment requiring States to cover pregnant women and in-
creasing the number of eligible children.  Ibid. But this
modification can hardly be described as a major change in
a program that—-from its inception-—provided health care
for “”families with dependent children.”” Previous Medicaid
amendments simply do not fall into the same category as
the one at stake here.

  The Court in Steward Machine did not attempt to ““fix
the outermost line”” where persuasion gives way to coer-
cion. 301 U. S., at 591.  The Court found it ““[e]nough for
present purposes that wherever the line may be, this
statute is within it.””  Ibid. 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. Congress may not
simply “”conscript state [agencies] into the national bu-
reaucratic army,””    FERC v. Mississippi, 456 U. S. 742, 775
(1982) (O’’Connor, J., concurring in judgment in part and
dissenting in part), and that is what it is attempting to do
with the Medicaid expansion.

B

 Nothing in our opinion precludes Congress from offering
funds under the Affordable Care Act to expand the availa-
bility 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 1396c gives the
Secretary of Health and Human Services the authority to 

56

do just that. It allows her to withhold all “”further [Medi-
caid] payments . . . to the State”” if she determines that the
State is out of compliance with any Medicaid requirement,
including those contained in the expansion. 42 U. S. C.
§1396c. In light of the Court’s holding, the Secretary
cannot apply §1396c to withdraw existing Medicaid funds
for failure to comply with the requirements set out in the
expansion.

 That fully remedies the constitutional violation we have
identified. The chapter of the United States Code that
contains §1396c includes a severability clause confirming
that we need go no further. That clause specifies that ““[i]f
any provision of this chapter, or the application thereof to
any person or circumstance, is held invalid, the remainder
of the chapter, and the application of such provision to
other persons or circumstances shall not be affected thereby.””
§1303. Today’’s holding does not affect the continued ap-
plication of §1396c to the existing Medicaid program. Nor
does it affect the Secretary’’s ability to withdraw funds pro-
vided under the Affordable Care Act if a State that has
chosen to participate in the expansion fails to comply with
the requirements of that Act.

   This is not to say, as the joint dissent suggests, that we
are “”rewriting the Medicaid Expansion.””  Post, at 48.
Instead, we determine, first, that §1396c is unconstitu-
tional when applied to withdraw existing Medicaid funds
from States that decline to comply with the expansion.
We then follow Congress’’s explicit textual instruction to
leave unaffected “”the remainder of the chapter, and the
application of [the challenged] provision to other persons
or circumstances.”” §1303. When we invalidate an applica-
tion of a statute because that application is unconstitu-
tional, we are not “”rewriting”” the statute; we are merely
enforcing the Constitution.
The question remains whether today’s holding affects
other provisions of the Affordable Care Act.  In considering