National Federation of Independent Business v. Sebelius

Health care: individual mandate and Medicaid expansion: in 2010, Congress enacted the Patient Protection and Affordable Care Act in order to increase the number of Americans covered by health insurance and decrease the cost of health care. One key provision is the individual mandate, which requires most Americans to maintain “minimum essential” health insurance coverage. 26 U. S. C. §5000A. For individuals who are not exempt, and who do not receive health insurance through an employer or government program, 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 “shared responsibility payment” to the Fed­eral Government. §5000A(b)(1). The Act provides that this “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. §§5000A(c), (g)(1). Another key provision of the Act is the Medicaid expansion. The current Medicaid program offers federal funding to States to assist pregnant women, children, needy families, the blind, the elderly, and the disabled in obtaining medical care. 42 U. S. C. §1396d(a). The Affordable Care Act expands the scope of the Medicaid program and increases the number of individuals the States must cover. For ex­ample, the Act requires state programs to provide Medicaid coverage by 2014 to adults with incomes up to 133 percent of the federal pov­erty level, whereas many States now cover adults with children only if their income is considerably lower, and do not cover childless adults at all. §1396a(a)(10)(A)(i)(VIII). The Act increases federal funding to cover the States’ costs in expanding Medicaid coverage. §1396d(y)(1). But if a State does not comply with the Act’s new coverage require­ments, it may lose not only the federal funding for those require­ments, but all of its federal Medicaid funds. §1396c.

Twenty-six States, several individuals, and the National Federa­tion of Independent Business brought suit in Federal District Court, challenging the constitutionality of the individual mandate and the Medicaid expansion. The Court of Appeals for the Eleventh Circuit upheld the Medicaid expansion as a valid exercise of Congress’s spending power, but concluded that Congress lacked authority to en­act the individual mandate. Finding the mandate severable from the Act’s other provisions, the Eleventh Circuit left the rest of the Act in­tact.

Held: The judgment is affirmed in part and reversed in part. 648 F. 3d 1235, affirmed in part and reversed in part.

1. CHIEF JUSTICE ROBERTS delivered the opinion of the Court with respect to Part II, concluding that the Anti-Injunction Act does not bar this suit; 2. CHIEF JUSTICE ROBERTS concluded in Part III–A that the indi­vidual mandate is not a valid exercise of Congress’s power under the Commerce Clause and the Necessary and Proper Clause.

(a) The Constitution grants Congress the power to “regulate Commerce.” Art. I, §8, cl. 3. The power to regulate commerce presupposes the existence of commercial activity to be reg­ulated. This Court’s precedent reflects this understanding: as ex­pansive as this Court’s cases construing the scope of the commerce power have been, they uniformly describe the power as reaching “ac­tivity.” E.g., United States v. Lopez, 514 U. S. 549, 560. The individ­ual mandate, however, does not regulate existing commercial activi­ty. It instead compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce.

Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. Con­gress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the prin­ciple that the Federal Government is a government of limited and enumerated powers. The individual mandate thus cannot be sus­tained under Congress’s power to “regulate Commerce.”

(b) Nor can the individual mandate be sustained under the Nec­essary and Proper Clause as an integral part of the Affordable Care Act’s other reforms. Each of this Court’s prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power. E.g., United States v. Comstock, 560 U. S. ___. The individual mandate, by contrast, vests Congress with the extraordinary ability to create the necessary predicate to the ex­ercise of an enumerated power and draw within its regulatory scope those who would otherwise be outside of it. Even if the individual mandate is “necessary” to the Affordable Care Act’s other reforms, such an expansion of federal power is not a “proper” means for mak­ing those reforms effective. 

3. CHIEF JUSTICE ROBERTS concluded in Part III–B that the individ­ual mandate must be construed as imposing a tax on those who do not have health insurance, if such a construction is reasonable.

The most straightforward reading of the individual mandate is that it commands individuals to purchase insurance. But, for the reasons explained, the Commerce Clause does not give Congress that power. It is therefore necessary to turn to the Government’s alternative ar­gument: that the mandate may be upheld as within Congress’s power to “lay and collect Taxes.” Art. I, §8, cl. 1. In pressing its taxing power argument, the Government asks the Court to view the man­date as imposing a tax on those who do not buy that product. Be­cause “every reasonable construction must be resorted to, in order to save a statute from unconstitutionality,” Hooper v. California, 155 U. S. 648, 657, the question is whether it is “fairly possible” to inter­pret the mandate as imposing such a tax, Crowell v. Benson, 285 U. S. 22, 62. 

4. CHIEF JUSTICE ROBERTS delivered the opinion of the Court with respect to Part III–C, concluding that the individual mandate may be upheld as within Congress’s power under the Taxing Clause. 

(a) The Affordable Care Act describes the “shared responsibility payment” as a “penalty,” not a “tax.” That label is fatal to the appli­cation of the Anti-Injunction Act. It does not, however, control whether an exaction is within Congress’s power to tax. In answering that constitutional question, this Court follows a functional approach, “disregarding the designation of the exaction, and viewing its sub­stance and application.” United States v. Constantine, 296 U. S. 287, 294. 

(b) Such an analysis suggests that the shared responsibility payment may for constitutional purposes be considered a tax. The payment is not so high that there is really no choice but to buy health insurance; the payment is not limited to willful violations, as penal­ties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation. Cf. Bailey v. Drexel Furniture Co., 259 U. S. 20, 36–37. None of this is to say that pay­ment is not intended to induce the purchase of health insurance. But the mandate need not be read to declare that failing to do so is un­lawful. Neither the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS. And Congress’s choice of language—stating that individuals “shall” obtain insurance or pay a “penalty”—does not require reading §5000A as punishing unlawful conduct. It may also be read as imposing a tax on those who go without insur­ance. See New York v. United States, 505 U. S. 144, 169–174. CHIEF JUSTICE ROBERTS, joined by JUSTICE BREYER and JUSTICE KAGAN, concluded in Part IV that the Medicaid expansion violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion.  

(a) The Spending Clause grants Congress the power “to pay the Debts and provide for the . . . general Welfare of the United States.” Art. I, §8, cl. 1. Congress may use this power to establish cooperative state-federal Spending Clause programs. The legitimacy of Spending Clause legislation, however, depends on whether a State voluntarily and knowingly accepts the terms of such programs. Pennhurst State School and Hospital v. Halderman, 451 U. S. 1, 17. “The Constitu­tion simply does not give Congress the authority to require the States to regulate.” New York v. United States, 505 U. S. 144, 178. When Congress threatens to terminate other grants as a means of pressur­ing the States to accept a Spending Clause program, the legislation runs counter to this Nation’s system of federalism. Cf. South Dakota v. Dole, 483 U. S. 203, 211. 

(b) Section 1396c gives the Secretary of Health and Human Ser­vices the authority to penalize States that choose not to participate in the Medicaid expansion by taking away their existing Medicaid fund­ing. 42 U. S. C. §1396c. The threatened loss of over 10 percent of a State’s overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion. The Government claims that the expansion is properly viewed as only a modification of the existing program, and that this modification is permissible because Congress reserved the “right to alter, amend, or repeal any provision” of Medicaid. §1304. But the expansion accom­plishes a shift in kind, not merely degree. The original program was designed to cover medical services for particular categories of vulner­able individuals. Under the Affordable Care Act, Medicaid is trans­formed into a program to meet the health care needs of the entire nonelderly population with income below 133 percent of the poverty level. A State could hardly anticipate that Congress’s reservation of the right to “alter” or “amend” the Medicaid program included the power to transform it so dramatically. The Medicaid expansion thus violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expan­sion. 

(c) The constitutional violation is fully remedied by precluding the Secretary from applying §1396c to withdraw existing Medicaid funds for failure to comply with the requirements set out in the ex­pansion. See §1303. The other provisions of the Affordable Care Act are not affected. 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 Medicaid expansion. In our federal system, the National Government pos­sesses only limited powers; the States and the people retain the remainder. Nearly two centuries ago, Chief Justice Marshall observed that “the question respecting the extent of the powers actually granted” to the Federal Government “is perpetually arising, and will probably continue to arise, as long as our system shall exist.” McCulloch v. Maryland, 4 Wheat. 316, 405 (1819). In this case we must again determine whether the Constitution grants Congress powers it now asserts, but which many States and individuals believe it does not possess. Resolv­ing this controversy requires us to examine both the limits of the Government’s power, and our own limited role in policing those boundaries.

The Federal Government “is acknowledged by all to be one of enumerated powers.” Ibid. That is, rather than granting general authority to perform all the conceiv­able functions of government, the Constitution lists, or enumerates, the Federal Government’s powers. Congress may, for example, “coin Money,” “establish Post Offices,” and “raise and support Armies.” Art. I, §8, cls. 5, 7, 12. The enumeration of powers is also a limitation of pow­ers, because “the enumeration presupposes something not enumerated.” Gibbons v. Ogden, 9 Wheat. 1, 195 (1824). The Constitution’s express conferral of some powers makes clear that it does not grant others. And the Federal Government “can exercise only the powers granted to it.” McCulloch, supra, at 405.

Today, the restrictions on government power foremost in many Americans’ minds are likely to be affirmative pro­hibitions, such as contained in the Bill of Rights. These affirmative prohibitions come into play, however, only where the Government possesses authority to act in the first place. If no enumerated power authorizes Congress to pass a certain law, that law may not be enacted, even if it would not violate any of the express prohibitions in the Bill of Rights or elsewhere in the Constitution.

Indeed, the Constitution did not initially include a Bill of Rights at least partly because the Framers felt the enu­meration of powers sufficed to restrain the Government. As Alexander Hamilton put it, “the Constitution is itself, in every rational sense, and to every useful purpose, A BILL OF RIGHTS.” The Federalist No. 84, p. 515 (C. Ros­siter ed. 1961). And when the Bill of Rights was ratified, it made express what the enumeration of powers neces­sarily implied: “The powers not delegated to the United States by the Constitution . . . are reserved to the States respectively, or to the people.” U. S. Const., Amdt. 10. The Federal Government has expanded dramatically over the past two centuries, but it still must show that a consti­tutional grant of power authorizes each of its actions. See, e.g., United States v. Comstock, 560 U. S. ___ (2010).

The same does not apply to the States, because the Con­stitution is not the source of their power. The Consti­tution may restrict state governments—as it does, for example, by forbidding them to deny any person the equal protection of the laws. But where such prohibitions do not apply, state governments do not need constitutional au­thorization to act. The States thus can and do perform many of the vital functions of modern government—punishing street crime, running public schools, and zoning property for development, to name but a few—even though the Constitution’s text does not authorize any government to do so. Our cases refer to this general power of govern­ing, possessed by the States but not by the Federal Gov­ernment, as the “police power.” See, e.g., United States v. Morrison, 529 U. S. 598, 618–619 (2000).

“State sovereignty is not just an end in itself: rather, federalism secures to citizens the liberties that derive from the diffusion of sovereign power.” New York v. United States, 505 U. S. 144, 181 (1992). Because the police power is controlled by 50 different States instead of one national sovereign, the facets of governing that touch on citizens’ daily lives are normally administered by smaller governments closer to the governed. The Framers thus ensured that powers which “in the ordinary course of affairs, concern the lives, liberties, and properties of the people” were held by gov­ernments more local and more accountable than a distant federal bureaucracy. The Federalist No. 45, at 293 (J. Madison). The independent power of the States also serves as a check on the power of the Federal Government: “By denying any one government complete jurisdiction over all the concerns of public life, federalism protects the liberty of the individual from arbitrary power.” Bond v. United States, 564 U. S. ___, ___ (2011) (slip op., at 9–10).

Our permissive reading of these powers is explained in part by a general reticence to invalidate the acts of the Nation’s elected leaders. “Proper respect for a co-ordinate branch of the government” requires that we strike down an Act of Congress only if “the lack of constitutional authority to pass the act in question is clearly demon­strated.” United States v. Harris, 106 U. S. 629, 635 (1883). Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.

Our deference in matters of policy cannot, however, become abdication in matters of law. “The powers of the legislature are defined and limited; and that those limits may not be mistaken, or forgotten, the constitution is written.” Marbury v. Madison, 1 Cranch 137, 176 (1803). Our respect for Congress’s policy judgments thus can never extend so far as to disavow restraints on federal power that the Constitution carefully constructed. “The peculiar circumstances of the moment may render a measure more or less wise, but cannot render it more or less constitutional.” Chief Justice John Marshall, A Friend of the Constitution No. V, Alexandria Gazette, July 5, 1819, in John Marshall’s Defense of McCulloch v. Mary­land 190–191 (G. Gunther ed. 1969). And there can be no question that it is the responsibility of this Court to en­force the limits on federal power by striking down acts of Congress that transgress those limits. Marbury v. Madi­son, supra, at 175–176 (U.S.S.Ct., 28.06.12, National Federation of Independent Business v. Sebelius, C.J. Roberts).

Droit de la santé et assurance maladie : notion d’obligation individuelle : en 2010, le Congrès fédéral a promulgué une loi fédérale en vue d’augmenter le nombre d’Américains couverts par une assurance maladie et en vue de diminuer les coûts de la santé. Une des dispositions essentielles de la loi est dite « obligation individuelle », qui impose à la plupart des Américains de maintenir une couverture d’assurance minimum couvrant les soins essentiels. Pour les personnes qui ne sont pas exemptées et qui ne sont pas assurées par l’intermédiaire de leur employeur ou par l’intermédiaire du Gouvernement, le moyen de satisfaire à cette obligation est de souscrire une assurance maladie privée. Dès l’année 2014, ceux qui ne satisfont pas à cette obligation sont tenus de procéder à un « paiement de responsabilité partagée » à verser au Gouvernement fédéral, par l’IRS, en même temps que le règlement de la créance fiscale. Cette somme sera recouvrée de la même manière qu’une amende fiscale.

Une autre disposition essentielle de la nouvelle loi fédérale est l’expansion du régime Medicaid. Le programme Medicaid antérieur offre des subventions fédérales aux états pour aider à obtenir des soins médicaux les femmes enceintes, les enfants, les familles dans le besoin, les mal voyants, les personnes âgées, et les invalides. La nouvelle loi étend le cadre du programme Medicaid et augmente le nombre de personnes que l’état doit couvrir. Par exemple, la nouvelle loi impose aux programmes des états de couvrir par Medicaid, dès l’année 2014, les adultes disposant d’un revenu jusqu’à 133% du niveau fédéral de pauvreté. Sous l’ancien régime, de nombreux états ne couvrent que les adultes avec des enfants et que si leur revenu est considérablement plus bas. La loi nouvelle augmente les subventions fédérales en vue de couvrir les frais encourus par les états du fait de l’extension de la couverture offerte par Medicaid. Mais si un état ne se conforme pas aux nouvelles conditions de couverture prévues par la nouvelle loi fédérale, il pourra perdre non seulement les subventions fédérales liées à ces nouvelles conditions, mais aussi l’ensemble des subventions liées à Medicaid.

Sont contestées en l’espèce l’obligation individuelle et l’extension du régime Medicaid.

Dans son opinion, le Juge Roberts conclut que l’obligation individuelle telle que prévue dans la nouvelle loi ne peut pas être avalisée sous l’angle de la Clause de commerce de la Constitution fédérale, qui n’autorise pas le Congrès fédéral a prévoir une telle obligation individuelle. La Necessary and Proper clause ne saurait elle non plus autoriser la promulgation de l’obligation individuelle.

S’agissant de la clause de commerce, le Juge Roberts rappelle que la Constitution fédérale accorde au Congrès la compétence de réguler le commerce. La compétence de réguler le commerce présuppose l’existence d’une activité commerciale à réguler. La jurisprudence de la Cour est le reflet de ce principe. Même si dite jurisprudence a interprété la Clause de commerce de manière extensive, ces décisions décrivent la compétence du Congrès à ce niveau comme portant sur une « activité ». Or l’obligation individuelle objet du présent litige ne régule pas d’une activité commerciale existante. Au contraire, elle contraint les personnes à devenir commercialement actives en achetant un produit d’assurance, basée sur le fait que l’omission d’achat affecte le commerce entre états. Dès lors, interpréter la Clause de commerce comme attribuant au Congrès la compétence de réglementer la conduite des personnes précisément parce que ces personnes ne font rien est de nature à attribuer de nouvelles et potentiellement vastes compétences au Congrès. Le Congrès détient déjà de vastes compétences de régler ce que les personnes font. Confirmer la conformité à la Constitution de la loi fédérale en question sous l’angle de la Clause de commerce reviendrait à attribuer au Congrès la même liberté de réglementer ce que les personnes ne font pas. Les Fondateurs de la Constitution connaissaient la différence entre faire quelque chose et ne rien faire. Ils ont attribué au Congrès la compétence de régler le commerce, non de le contraindre. Ignorer cette distinction porterait préjudice au principe selon lequel le Gouvernement fédéral est un Gouvernement de compétences limitées et énumérées.

L’obligation individuelle ne peut pas non plus être jugée conforme à la Constitution sous l’angle de la Necessary and Proper Clause. La jurisprudence de la Cour portant sur dite Clause a toujours précisé que pour être conforme à la Clause, l’action du Congrès devait dériver d’une compétence déjà attribuée, ce qui n’est pas le cas ici.

Le Juge Roberts conclut ensuite que l’obligation individuelle s’analyse en une taxe imposée à ceux qui sont dépourvus d’assurance-maladie. Le Congrès dispose en effet de la compétence de lever l’impôt, et l’argument du Gouvernement dans cette affaire était que le Congrès disposait de la compétence d’imposer l’achat d’une assurance maladie sous l’angle de la compétence de taxer attribuée au Congrès. Le Juge Roberts rappelle que la Cour doit recourir à toutes les interprétations raisonnables possibles  pour éviter de déclarer une loi comme étant contraire à la Constitution fédérale. La question est donc de savoir s’il est de bonne foi possible d’interpréter l’obligation individuelle comme imposant une taxe. La réponse est affirmative, et l’obligation individuelle prévue par la nouvelle loi fédérale est conforme à la Constitution fédérale. De même, le paiement d’une pénalité par ceux qui n’achèteraient pas d’assurance maladie s’analyse en une taxe, et non une peine d’une autre nature que fiscale, nonobstant l’usage du terme « pénalité », qui doit être analysé selon sa substance et selon son application, indépendamment de son libellé. A ce niveau, il convient de considérer que la « pénalité » n’est pas élevée au point de contraindre l’achat d’une assurance. La pénalité n’est en outre pas limitée aux cas de violations intentionnelles, comme les pénalités le sont usuellement. Et son paiement relève de la compétence de l’IRS par les voies habituelles de recouvrement de l’impôt.

Les Juges Roberts, Breyer et Kagan concluent que l’extension du régime Medicaid est contraire à la Constitution en ce qu’il menace les états de perdre leurs subventions liées à Medicaid en cas de refus de se conformer à l’extension du régime.

Quant à la Clause de la dépense (Spending Clause), elle attribue au Congrès la compétence de payer les dettes et d’accomplir le bien-être général des Etats-Unis. Le Congrès fédéral peut se fonder sur cette Clause pour accorder des subventions aux états coopérants avec le programme de subventions. Mais la Constitution n’accorde pas au Congrès l’autorité d’imposer aux états de légiférer. Lorsque le Congrès menace de mettre fin à d’autres subventions comme moyen d’imposer à l’état d’accepter un programme de subvention déterminé, le Congrès agit contrairement au système fédéral des Etats-Unis, donc contrairement à la Constitution. Le système d’expansion de Medicaid prévu par la loi nouvelle dispose précisément que les états qui n’accepteraient pas de se conformer au nouveau programme perdraient leurs subventions résultant de l’ancien programme. Une telle réglementation est comme indiqué précédemment contraire à la Constitution, de sorte que la partie de la loi nouvelle qui régit l’extension du régime Medicaid est annulée par la Cour.

La Cour rappelle que le Gouvernement fédéral dispose des compétences que la Constitution fédérale lui attribue. Les autres compétences restent aux états et au peuple. Les limites de compétences prévues par le Bill of Rights ne s’appliquent que lorsqu’elles se rapportent à une compétence déjà attribuée au Gouvernement fédéral. Le Bill of Rights limite cette compétence. Mais si aucune compétence n’est attribuée au Gouvernement fédéral, il ne peut pas légiférer. L’expansion du Gouvernement fédéral fut certes considérable pendant les 200 dernières années, mais il doit toujours démontrer qu’une attribution de compétence constitutionnelle autorise chacune de ses actions.

Sont ensuite rappelées les notions de fédéralisme à la base de la Constitution des Etats-Unis, qui sont les mêmes que les principes à la base de la Constitution suisse (fédéralisme, attributions de compétences au Gouvernement fédéral, compétences non attribuées qui restent en main des états et du peuple, les états et leur entités décentralisées  étant par ailleurs plus proches de la population, ce qui est vu comme un principe important).

S’agissant de ses propres compétences, la Cour Suprême fédérale rappelle sa réticence générale à invalider les actes du Congrès, composés des élus de la nation. La Cour n’annulera un acte du Congrès que si son inconstitutionnalité est clairement démontrée. Les Juges de la Cour sont investis de l’autorité d’interpréter la loi. Ils ne détiennent ni l’expertise ni la compétence de procéder à des jugements de nature politique. Ce dernier type de jugements compète aux membres du Congrès, qui peuvent ne pas être élus à nouveau si leurs actions déplaisent aux électeurs. Il n’appartient pas à la Cour de protéger la population des conséquences de leurs choix politiques. Le respect de la Cour pour les jugements politiques du Congrès ne saurait toutefois dépasser le cadre des compétences fédérales que la Constitution a déterminées avec soin.