NFIB Sebelius Roberts


In 2010, Congress enacted the Patient Protection and
Affordable Care Act, 124 Stat. 119. The Act aims to in-
crease the number of Americans covered by health in-
surance and decrease the cost of health care. The Act’’s 10
titles stretch over 900 pages and contain hundreds of
provisions. This case concerns constitutional challenges to
two key provisions, commonly referred to as the individual
mandate and the Medicaid expansion.

The individual mandate requires most Americans to
maintain “”minimum essential”” health insurance coverage.
26 U. S. C. §5000A. The mandate does not apply to some
individuals, such as prisoners and undocumented aliens.
§5000A(d). Many individuals will receive the required cov –
erage through their employer, or from a government pro-
gram such as Medicaid or Medicare. See §5000A(f). But
for individuals who are not exempt and do not receive
health insurance through a third party, the means of
satisfying the requirement is to purchase insurance from a
private company.

Beginning in 2014, those who do not comply with the
mandate must make a ““[s]hared responsibility payment””
to the Federal Government. §5000A(b)(1). That payment,
which the Act describes as a “”penalty,”” is calculated as a
percentage of household income, subject to a floor based on
a specified dollar amount and a ceiling based on the aver-
age annual premium the individual would have to pay for
qualifying private health insurance. §5000A(c). In 2016,
for example, the penalty will be 2.5 percent of an individ-
ual’s household income, but no less than $695 and no more
than the average yearly premium for insurance that co-
vers 60 percent of the cost of 10 specified services (e.g.,
prescription drugs and hospitalization). Ibid.; 42 U. S. C.
§18022. The Act provides that the penalty will be paid to
the Internal Revenue Service with an individual’’s taxes,
and ““shall be assessed and collected in the same manner””


as tax penalties, such as the penalty for claiming too
large an income tax refund. 26 U. S. C. §5000A(g)(1). The
Act, however, bars the IRS from using several of its nor-
mal enforcement tools, such as criminal prosecutions and
levies. §5000A(g)(2). And some individuals who are sub-
ject to the mandate are nonetheless exempt from the
penalty—for example, those with income below a certain
threshold and members of Indian tribes. §5000A(e).

On the day the President signed the Act into law, Flor-
ida and 12 other States filed a complaint in the Federal
District Court for the Northern District of Florida. Those
plaintiffs—-who are both respondents and petitioners here,
depending on the issue—-were subsequently joined by 13
more States, several individuals, and the National Fed-
eration of Independent Business. The plaintiffs alleged,
among other things, that the individual mandate provi-
sions of the Act exceeded Congress’’s powers under Article
I of the Constitution. The District Court agreed, holding
that Congress lacked constitutional power to enact the
individual mandate. 780 F. Supp. 2d 1256 (ND Fla. 2011).
The District Court determined that the individual man-
date could not be severed from the remainder of the Act,
and therefore struck down the Act in its entirety. Id., at

The Court of Appeals for the Eleventh Circuit affirmed
in part and reversed in part. The court affirmed the Dis-
trict Court’’s holding that the individual mandate exceeds
Congress’’s power. 648 F. 3d 1235 (2011). The panel
unanimously agreed that the individual mandate did not
impose a tax, and thus could not be authorized by Con-
gress’’s power to “”lay and collect Taxes.”” U. S. Const.,
Art. I, §8, cl. 1. A majority also held that the individual
mandate was not supported by Congress’’s power to “”regu-
late Commerce . . . among the several States.”” Id., cl. 3.
According to the majority, the Commerce Clause does not
empower the Federal Government to order individuals to

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