NFIB Sebelius Roberts


 that question, “”[w]e seek to determine what Congress
would have intended in light of the Court’’s constitutional
holding.”” United States v. Booker, 543 U. S. 220, 246
(2005) (internal quotation marks omitted). Our “”touch-
stone for any decision about remedy is legislative intent,
for a court cannot use its remedial powers to circum-
vent the intent of the legislature.””  Ayotte v. Planned
Parenthood of Northern New Eng., 546 U. S. 320, 330
(2006) (internal quotation marks omitted).  The question
here is whether 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 new Medicaid
expansion. Unless it is “”evident”” that the answer is no, we
must leave the rest of the Act intact.  Champlin Refining
Co. v. Corporation Comm’n of Okla., 286 U. S. 210, 234

  We are confident that Congress would have wanted to
preserve the rest of the Act. It is fair to say that Congress
assumed that every State would participate in the Medi-
caid expansion, given that States had no real choice but to
do so.  The States contend that Congress enacted the rest
of the Act with such full participation in mind; they point
out that Congress made Medicaid a means for satisfying
the mandate, 26 U. S. C. §5000A(f)(1)(A)(ii), and enacted
no other plan for providing coverage to many low-income
individuals. According to the States, this means that the
entire Act must fall.

 We disagree. The Court today limits the financial pres-
sure the Secretary may apply to induce States to accept
the terms of the Medicaid expansion. As a practical mat-
ter, that means States may now choose to reject the ex-
pansion; that is the whole point.  But that does not mean
all or even any will.  Some States may indeed decline to
participate, either because they are unsure they will be
able to afford their share of the new funding obligations,
or because they are unwilling to commit the administra-


tive resources necessary to support the expansion. Other
States, however, may voluntarily sign up, finding the idea
of expanding Medicaid coverage attractive, particularly
given the level of federal funding the Act offers at the

 We have no way of knowing how many States will ac-
cept the terms of the expansion, but we do not believe
Congress would have wanted the whole Act to fall, simply
because some may choose not to participate.  The other
reforms Congress enacted, after all, will remain “fully
operative as a law,” Champlin, supra, at 234, and will still
function in a way “”consistent with Congress’’ basic objec-
tives in enacting the statute,”” Booker, supra, at 259.
Confident that Congress would not have intended any-
thing different, we conclude that the rest of the Act need
not fall in light of our constitutional holding.

* * *

  The Affordable Care Act is constitutional in part and
unconstitutional in part.  The individual mandate cannot
be upheld as an exercise of Congress’s power under the
Commerce Clause. That Clause authorizes Congress to
regulate interstate commerce, not to order individuals to
engage in it.  In this case, however, it is reasonable to con-
strue what Congress has done as increasing taxes on those
who have a certain amount of income, but choose to go
without health insurance. Such legislation is within Con-
gress’’s power to tax.

 As for the Medicaid expansion, that portion of the Af-
fordable Care Act violates the Constitution by threatening
existing Medicaid funding. Congress has no authority to
order the States to regulate according to its instructions.
Congress may offer the States grants and require the
States to comply with accompanying conditions, but the
States must have a genuine choice whether to accept the
offer. The States are given no such choice in this case:


They must either accept a basic change in the nature of
Medicaid, or risk losing all Medicaid funding.  The remedy
for that constitutional violation is to preclude the Federal
Government from imposing such a sanction.  That remedy
does not require striking down other portions of the Af-
fordable Care Act.

 The Framers created a Federal Government of limited
powers, and assigned to this Court the duty of enforcing
those limits. The Court does so today. But the Court does
not express any opinion on the wisdom of the Affordable
Care Act.  Under the Constitution, that judgment is re-
served to the people.

 The judgment of the Court of Appeals for the Eleventh
Circuit is affirmed in part and reversed in part.

It is so ordered. 

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