of Health and Human Services, National Center for Health Statistics, Summary Health Statistics for U. S. Adults: National Health Interview Survey 2009, Ser. See Springer v. United States, 102 U. S. 586, 596–598 (1881). It is true that, at the end of the day, it is inevitable that each American will affect commerce and become a part of it, even if not by choice. The ACA’s $455 billion in Medicare and Medicaid savings offset the $434-billion cost of the Medicaid Expansion. 404, 89th Cong., 1st Sess., pt. of Health and Human Services, National Cen- ter for Health Statistics, Health—United States—2010, p. 282, Table 79 (Feb. 2011). See, e.g., Lopez, supra, at 560 (“Where economic activity substantially affects interstate commerce, legislation regulating that activity will be sus tained”); Perez, 402 U. S., at 154 (“Where the class of activities is regulated and that class is within the reach of federal power, the courts have no power to excise, as trivial, individual instances of the class” (emphasis in original; internal quotation marks omitted)); Wickard, supra, at 125 (“[E]ven if appellee’s activity be local and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress if it exerts a substantial economic effect on interstate commerce”); NLRB v. Jones & Laughlin Steel Corp., 301 U. S. 1, 37 (1937) (“Although activities may be intrastate in character when separately considered, if they have such a close and substantial relation to interstate commerce that their control is essential or appropriate to protect that commerce from burdens and obstructions, Congress cannot be denied the power to exercise that control”); see also post, at 15, 25–26, 28, 32 (Ginsburg, J., concurring in part, concurring in judgment in part, and dissenting in part).5. . I, §8, cl. . If that analysis is correct, the regulations and taxes will mean higher costs for insurance companies. By any measure, that market is immense. Id., at 597. Instead, we determine, first, that §1396c is unconstitutional when applied to withdraw existing Medicaid funds from States that decline to comply with the expansion. External Relations: Alison Prange â¢ Sara Key â¢ Sarah Rosier â¢ Kari Berger But nowhere in the over 900-page Act is such a scheme to be found. Third, this “tax” was enforced in part by the Department of Labor, an agency responsible for pun-ishing violations of labor laws, not collecting revenue. Indeed, the main objection many have to the Mandate is that they have no intention of purchasing most or even any of such goods or services and thus no need to buy insurance for those purchases. Congress may also “lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.” U. S. Id., at 15–22. Medicaid has long been the largest federal program of grants to the States. See supra, at 5–7, 16–17. . Id., at 5. See 26 U. S. C. §5000A. Justice Ginsburg, joined by Justice Sotomayor, is of the view that the Spending Clause does not preclude the Secretary from withholding Medicaid funds based on a State’s refusal to comply with the expanded Medicaid program. Petitions Nos. But where such prohibitions do not apply, state governments do not need constitutional au-thorization to act. 1381–1382, 1465 (extending Med-icaid eligibility, but partly conditioning only the new funding); Omnibus Budget Reconciliation Act of 1990, §4601, 104 Stat. 3. (emphasis altered). Insur- ance companies are required to sell them insurance regardless of patients’ pre-existing conditions and to comply with a host of other regulations. The Court today opts for permitting the cut-off of only incremental Medicaid funding, but it might just as well have permitted, say, the cut-off of funds that represent no more than x percent of the State’s bud- get. Brief for United States 10, n. 6. To ensure that federal funds granted to the States are spent “to ‘provide for the . . It is to bar the withholding found impermissible—not, as the joint dissenters would have it, to scrap the expansion altogether, see post, at 46–48. At the very least, we should “pause to consider the implications of the Government’s arguments” when confronted with such new conceptions of federal power. 9 We do not suggest that any exaction lacking a scienter requirement and enforced by the IRS is within the taxing power. It is true that Congress cannot change whether an exaction is a tax or a penalty for constitutional pur-poses simply by describing it as one or the other. See supra, at 16–17. I agree with The Chief Justice that the Anti-Injunction Act does not bar the Court’s consideration of this case, and that the minimum coverage provision is a proper exercise of Congress’ taxing power. On the day the President signed the Act into law, Florida and 12 other States filed a complaint in the Federal District Court for the Northern District of Florida. If not, the remaining provisions must be invalidated. . In United States v. Lopez, 514 U. S. 549 (1995), we held that Congress could not, as a means of fostering an educated interstate labor market through the protection of schools, ban the possession of a firearm within a school zone. The Chief Justice also calls the minimum coverage provision an illegitimate effort to make young, healthy individuals subsidize insurance premiums paid by the less hale and hardy. The second question is whether the congressional power to tax and spend, U. S. 88, 42 U. S. C. §1396u–7 (2006 ed. And if the State gave in to the federal law, the State and its subdivisions would surrender their traditional authority in the field of education. And some individuals who are subject to the mandate are nonetheless exempt from the penalty—for example, those with income below a certain threshold and members of Indian tribes. As far as §5000A is concerned, we would stop there. Ante, at 21. See §6044, 120 Stat. of State Budget Officers, Fiscal Year 2010 State Expenditure Report, p. 11, Table 5 (2011); 42 U. S. C. §1396d(b). But to reach this conclusion, the case cited by Justice Ginsburg relied on a dictionary in which “[t]o order; to command” was the fifth-alternative definition of “to direct,” which was itself the second-alternative definition of “to regulate.” See Seven-Sky, supra, at 16 (citing S. Johnson, Dictionary of the English Language (4th ed. We now turn to those questions. Lacking case law support for his holding, The Chief Justice nevertheless declares the minimum coverage provision not “proper” because it is less “narrow in scope” than other laws this Court has upheld under the Necessary and Proper Clause. . Nor could we have. as Amici Curiae in No. But it would certainly not be that easy. The Federal Government can address whatever problems it wants but can bring to their solution only those powers that the Constitution confers, among which is the power to regulate commerce. The question remains whether today’s holding affects other provisions of the Affordable Care Act. Section 5000A(e) then creates a separate set of exemptions, excusing from liability for the penalty certain individuals who are subject to the minimum coverage requirement: Those who cannot afford coverage, §5000A(e)(1); who earn too little income to require filing a tax return, §5000A(e)(2); who are members of an Indian tribe, §5000A(e)(3); who experience only short gaps in coverage, §5000A(e)(4); and who, in the judgment of the Secretary of Health and Human Services, “have suffered a hardship with respect to the capability to obtain coverage,” §5000A(e)(5). In anticipation of this uncompensated care, health-care companies raise their prices, and insurers their premiums. But even assuming, for the moment, that Congress lacks authority under the Commerce Clause to “compel individuals not engaged in commerce to purchase an unwanted product,” ante, at 18, such a limitation would be inapplicable here. Often, a minor provision will be the price paid for support of a major provision. Taxes have never been popular, see, e.g., Stamp Act of 1765, and in part for that reason, the Constitution requires tax increases to originate in the House of Representatives. 42 U. S. C. §1396d(y). Gibbons v. Ogden Case Brief. See ante, at 16 (“Everyone will eventually need health care at a time and to an extent they cannot predict.”). I, §8, cls. Argued March 26, 27, 28, 2012—Decided June 28, 2012. See Pennhurst State School and Hospital v. Halderman, 451 U. S. 1, 17 (1981); South Dakota v. Dole, 483 U. S. 203, 206 (1987); Fullilove v. Klutznick, 448 U. S. 448, 474 (1980) (opinion of Burger, C. And absent such notice, sizable changes could not be made mandatory. Ginsburg, J., filed an opinion concurring in part, concurring in the judgment in part, and dissenting in part, in which Sotomayor, J., joined, and in which Breyer and Kagan, JJ., joined as to Parts I, II, III, and IV. And if the power to “[r]egulat[e] . The Federal Government, the States, and private parties ought to know at once whether the entire legislation fails. Having held the individual mandate to be unconstitutional, the majority examined whether that provision could be severed from the remainder of the Act. Congress may use its spending power to create incentives for States to act in accordance with federal policies. Singleton, 361 U. S. 234, 247 (1960) (quoting VI Writings of James Madison 383 (G. Hunt ed. When an act “adopt[s] the criteria of wrongdoing” and then imposes a monetary penalty as the “principal consequence on those who transgress its standard,” it creates a regulatory penalty, not a tax. 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. Before turning to the merits, we need to be sure we have the authority to do so. See, e.g., Brief for Service Employees International Union et al. v. Sebelius, 132 S. Ct. 2566, 567 U.S. 519, 183 L. Ed. In several pre-New Deal cases, the Court attempted to cabin Congress’ Commerce Clause authority by distinguishing “commerce” from activity once conceived to be noncommercial, notably, “production,” “mining,” and “manufacturing.” See, e.g., United States v. E. C. Knight Co., 156 U. S. 1, 12 (1895) (“Commerce succeeds to manufacture, and is not a part of it.”); Carter v. Carter Coal Co., 298 U. S. 238, 304 (1936) (“Mining brings the subject matter of commerce into existence. See 42 U. S. C. §§1396a(a) (10)(A)(i)(VIII) (2006 ed., Supp. Id., at 44. But these two provisions, Congress comprehended, could not work effectively unless individuals were given a powerful incentive to obtain insurance. See also Brief for Health Care for All, Inc., et al. The States are separate and independent sovereigns. Congress could have defined “tax” for purposes of that statute in such fashion as to exclude some exactions that in fact are “taxes.” It might have prescribed, for example, that a particular exercise of the taxing power “shall not be regarded as a tax for purposes of the Anti-Injunction Act.” But there is no such prescription here. See Thomas More Law Center v. Obama, 651 F. 3d 529, 565 (CA6 2011) (Sutton, J., concurring in part) (“Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life.”). There is no instance in which this Court or Congress (or anyone else, to our knowledge) has used “regulate” in that peculiar fashion. The Government was invited, at oral argument, to suggest what federal controls over private conduct (other than those explicitly prohibited by the Bill of Rights or other constitutional controls) could not be justified as necessary and proper for the carrying out of a general regulatory scheme. Since 1937, our precedent has recognized Congress’ large authority to set the Nation’s course in the economic and social welfare realm. The “relevant inquiry in evaluating severability is whether the statute will function in a manner consistent with the intent of Congress.” Id., at 685 (emphasis in original). In that Fiscal Year, total federal outlays for grants to state and local governments amounted to over $608 billion, see Table 12.1, and state and local government expenditures from their own sources amounted to $1.6 trillion, see Table 15.2. 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. 436 U. S., at 273–275. §1396a(a)(10)(A)(i)(VIII). That is essentially what this Act seeks to do with respect to the purchase of health care." But the Court previously has rec- ognized that “[u]nlike normal contractual undertakings, federal grant programs originate in and remain governed by statutory provisions expressing the judgment of Congress concerning desirable public policy.” Bennett v. Kentucky Dept. spare neither sex nor age, nor high nor low, nor sacred nor profane.” The Federalist No. Congress is simply requiring States to do what States have long been required to do to receive Medicaid funding: comply with the conditions Congress prescribes for participation. §1396d(b) (2006 ed., Supp. 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. 3 (emphasis added). Carr, 369 U. S. 186, 217 (1962). The Sixth Circuit and the D. C. Circuit considered the question but determined that the Anti-Injunction Act did not apply. Someone with an annual income of $100,000 a year would likely owe about $200. . (asserting, outlandishly, that if the minimum coverage provision is sustained, then Congress could make “breathing in and out the basis for federal prescription”). Congress may not “simply commandeer the legislative processes of the States by directly compelling them to enact and enforce a federal regulatory program.” Id., at 161 (internal quotation marks and brackets omitted). That choice does not, however, control whether an exaction is within Congress’s constitutional power to tax. Assn. 2 We appointed H. Bartow Farr III to brief and argue in support of the Eleventh Circuit’s judgment with respect to severability, and Robert A. When the United States Government taxes United States citizens, it taxes them “in their individual capacities” as “the people of America”—not as residents of a particular State. We granted certiorari to review the judgment of the Court of Appeals for the Eleventh Circuit with respect to both the individual mandate and the Medicaid expansion. The legitimacy of Congress’s exercise of the spending power “thus rests on whether the State voluntarily and knowingly accepts the terms of the ‘contract.’ ” Pennhurst, supra, at 17. Many of these patients are now covered by Medicaid. . The original program was de-signed to cover medical services for four particular cat-egories of the needy: the disabled, the blind, the elderly, and needy families with dependent children. In separating the power to regulate from the power to bring the subject of the regulation into existence, The Chief Justice asserts, “[t]he language of the Constitution reflects the natural understanding that the power to regulate assumes there is already something to be regulated.” Ante, at 19. But it must be activity affecting com- merce that is regulated, and not merely the failure to engage in commerce. That is, rather than granting general authority to perform all the conceiv-able functions of government, the Constitution lists, or enumerates, the Federal Government’s powers. Failing to learn from this history, The Chief Justice plows ahead with his formalistic distinction between those who are “active in commerce,” ante, at 20, and those who are not. This is not to say, as the joint dissent suggests, that we are “rewriting the Medicaid Expansion.” Post, at 48. 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. See also Pension Benefit Guaranty Corporation v. R. A. It agreed that the Medicaid expansion provision was not unconstitutionally coercive and that the individual mandate was unconstitutional. This would leave the States to bear an increasingly large percentage of the bill. Because no party supports the Eleventh Circuit’s holding that the individual mandate can be completely severed from the remainder of the Affordable Care Act, we appointed an amicus curiae to defend that aspect of the judgment below. U.S. Department of Health and Human Services v. Florida. We now consider respondents’ second challenge to the constitutionality of the ACA, namely, that the Act’s dramatic expansion of the Medicaid program exceeds Congress’ power to attach conditions to federal grants to the States. And Congress could not have intended that result in any event. . L. Rev. A tax on going without health insurance does not fall within any recognized category of direct tax. The Framers knew the difference between doing something and doing nothing. The ACA does not legally compel the States to participate in the expanded Medicaid program, but the Act authorizes a severe sanction for any State that refuses to go along: termination of all the State’s Medicaid funding. Const., Art. After all, it states that individuals “shall” maintain health insurance. 270. Cf. L. J. Aware that a national solution was required, Congress could have taken over the health-insurance market by establishing a tax-and-spend federal program like Social Security. 27, 2012). Const., Art. The minimum coverage provision meets this requirement. Second, the Government argues that if the commerce power does not support the mandate, we should nonetheless uphold it as an exercise of Congress’s power to tax. Confident that Congress would not have intended anything different, we conclude that the rest of the Act need not fall in light of our constitutional holding. If long on rhetoric, The Chief Justice’s argument is short on substance. Raichis no precedent for what Congress has done here. 15 The Federal Government reports a higher percentage. See also Maryland Brief 15–26 (describing “the impediments to effective state policymaking that flow from the interconnectedness of each state’s healthcare economy” and emphasizing that “state-level reforms cannot fully address the problems associated with uncompensated care”). Congress found that the cost-shifting just described “increases family [insurance] premiums by on average over $1,000 a year.” Ibid. But if they did, the Federal Government paid at least half the costs. In response, private insurers increase their premiums, shifting the cost of the elevated bills from providers onto those who carry insurance. To ensure that individuals with medical histories have access to affordable insurance, Congress devised a three-part solution. Beyond dispute, Congress had a rational basis for concluding that the uninsured, as a class, substantially affect interstate commerce. Pp. Asserting that “[t]here is no temporal limitation in the Commerce Clause,” the Government argues that because “[e]veryone subject to this regulation is in or will be in the health care market,” they can be “regulated in advance.” Tr. . By comparison, federal contributions toward the care of beneficiaries eligible pre-ACA range from 50% to 83%, and averaged 57% between 2005 and 2008. U. S. 22, 62. Congress knew that encouraging individuals to purchase insurance would not suffice to solve the problem, because most of the uninsured are not uninsured by choice.1 Of particular concern to Congress were people who, though desperately in need of insurance, often cannot acquire it: persons who suffer from preexisting medical conditions. That course is plainly in order where, as in this case, Congress has expressly instructed courts to leave untouched every provision not found invalid. New York provides no support for reading it to be permissive. Ultimately, the Court upholds the individual mandate as a proper exercise of Congress’ power to tax and spend “for the . 42 U. S. C. §1396c. . Respecting this limitation is critical to ensuring that Spending Clause legislation does not undermine the status of the States as independent sovereigns in our fed-eral system. 242 (“Shared Responsibility”); ACA §1501, ibid. That obstacle can be overcome by granting funds to the States, allowing them to administer the program. And it includes a number of provisions that provide benefits to the State of a particular legislator. NATIONAL FEDERATION OF INDEPENDENT BUSINESS et al. Third, the threatened loss of funding is so large that the States have no real choice but to participate in the Medicaid expansion. . of Health and Family Servs. See §4980I (high-cost insurance plans); 42 U. S. C. §§300gg(a)(1), 300gg–4(b) (community rating); §§300gg–1, 300gg–3, 300gg–4(a) (guaranteed issue); §300gg–11 (elimination of coverage limits); §300gg–14(a) (dependent children up to age 26); ACA §§9010, 10905, 124 Stat. This gets things backwards: Congress, not the States, is tasked with spending federal money in service of the general welfare. Because the concurrence of all States was exceedingly difficult to obtain, Hamilton observed, “the experiment would probably be left untried.” Ibid. But we have also carried out our responsibility to declare unconstitutional those laws that undermine the structure of government established by the Constitution. the economic impact of the penalty on the violator”); see also 6 U. S. C. §488e(c); 7 U. S. C. §§7734(b)(2), 8313(b)(2); 12 U. S. C. §§1701q–1(d)(3), 1723i(c)(3), 1735f–14(c)(3), 1735f–15(d)(3), 4585(c)(2); 15 U. S. C. §§45(m)(1)(C), 77h–1(g)(3), 78u–2(d), 80a–9(d)(4), 80b–3(i)(4), 1681s(a)(2)(B), 1717a(b)(3), 1825(b)(1), 2615(a) (2)(B), 5408(b)(2); 33 U. S. C. §2716a(a). But that does not mean the compelled purchase of the first is properly regarded as a regulation of the second. If unwanted today, medical service secured by insurance may be desperately needed tomorrow. Id., at 211–212 (emphasis added). 4579, 2012-2 U.S. Tax Cas. But how is a court to judge whether “only 6.6% of all state expenditures,” post, at 41, is an amount States could or would do without? Brief for Respondents in No. For example, the tax increases are “Revenue Offset Provisions” designed to help offset the cost to the Federal Government of programs like the Medicaid Expansion and the exchanges’ federal subsidies. Statement of Douglas W. Elmendorf, supra, at 24. But the distinction between doing something and doing nothing would not have been lost on the Framers, who were “practical statesmen,” not metaphysical philosophers. See §5000A(b). 45 CFR §80.10(f) (2011) (Secretary may enforce Title VI’s nondiscrimination requirement through “refusal to grant or continue Federal financial assistance, in whole or in part.” (emphasis added)). A tax on going without health insurance is not like a capitation or other direct tax under this Court’s precedents. To make the Medicaid Expansion optional despite the ACA’s structure and design “ ‘would be to make a new law, not to enforce an old one. It has also led us to scrutinize Spending Clause legislation to ensure that Congress is not using financial inducements to exert a “power akin to undue influence.” Steward Machine Co. v. Davis, 301 U. S. 548, 590 (1937). There would, for example, be no need for §6671(a) to deem “tax” to refer to certain assessable penalties if the Code al- ready included all such penalties in the term “tax.” Indeed, amicus’s earlier observation that the Code requires assessable penalties to be assessed and collected “in the same manner as taxes” makes little sense if assessable penalties are themselves taxes. Bus. But cars and broccoli are no more purchased for their “own sake” than health insurance. . I find no satisfying response to that question in his opinion.12. Fed. For those reasons, the unconstitutionality of both the Individual Mandate and the Medicaid Expansion requires the invalidation of the Affordable Care Act’s other provisions. 55–58. We have no way of knowing how many States will accept 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 Federal Government, therefore, is not, as The Chief Justice charges, threatening States with the loss of “existing” funds from one spending program in order to induce them to opt into another program. 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. That case held that Congress could, in an effort to restrain the interstate market in marijuana, ban the local cultivation and possession of that drug. That case’s prohibition of growing (cf. Soon after the framing, Congress passed a tax on ownership of carriages, over James Madison’s objection that it was an unapportioned direct tax. Other Courts of Appeals have also heard challenges to the individual mandate. The crisis created by the large number of U. S. residents who lack health insurance is one of national dimension that States are “separately incompetent” to handle. Today, the restrictions on government power foremost in many Americans’ minds are likely to be affirmative pro-hibitions, such as contained in the Bill of Rights. The court affirmed the District Court’s holding that the individual mandate exceeds Congress’s power. An accident, a heart attack, or a cancer diagnosis commonly occurs without warning. Congress’s use of the Taxing Clause to encourage buying something is, by contrast, not new. . But the health care “market” that is the object of the Individual Mandate not only includes but principally consists of goods and services that the young people primarily affected by the Mandate do not purchase. §395.1041(3)(f) (2010); Tex. There is only money States anticipate receiving from future Congresses. 565 U. S. ___ (2011). . That is fair and constitutional enough when the States freely agree to have their powers employed and their employees enlisted in the federal scheme. 60–61. The employer responsibility assessment provides an incentive for employers with at least 50 employees to provide their employees with health insurance options that meet minimum criteria. According to The Chief Justice, the Commerce Clause does not permit that preservation. The dissent claims that we “fai[l] to explain why the individual mandate threatens our constitutional order.” Ante, at 35. See, e.g., Railroad Retirement Bd. With the Medicaid Expansion and the exchanges invalidated, the tax increases no longer operate to offset costs, and they no longer serve the purpose in the Act’s scheme of “shared responsibility” that Congress intended. The proximity and degree of connection between the mandate and the subsequent commercial activity is too lack-ing to justify an exception of the sort urged by the Gov- ernment. I, §8, cl. See supra, at 5–7. To recoup the losses, hospitals pass on the cost to insurers through higher rates, and insurers, in turn, pass on the cost to policy holders in the form of higher premiums. “[W]here the Federal Government directs the States to regulate, it may be state officials who will bear the brunt of public disapproval, while the federal officials who devised the regu-latory program may remain insulated from the electoral ramifications of their decision.” Id., at 169. The individual mandate’s regulation of the uninsured as a class is, in fact, particularly divorced from any link to existing commercial activity. 2d 1256 (ND Fla. 2011). Ann. Holding: The Anti-Injunction Act does not bar a challenge to the constitutionality of the Affordable Care Actâs âindividual mandateâ provision, which requires virtually all Americans to obtain health insurance or pay a penalty, even â¦ This argument has multiple flaws. Arizona, for example, commits 12% of its state expenditures to Medicaid, and relies on the Federal Government to provide the rest: $5.6 billion, equaling roughly one-third of Arizona’s annual state expenditures of $17 billion. By requiring the healthy uninsured to obtain insurance or pay a penalty structured as a tax, the minimum coverage provision ends the free ride these individuals currently enjoy. Without deciding the Commerce Clause question, I would find no basis to adopt such a saving construction. First, more than 60% of those without insurance visit a hospital or doctor’s office each year. Congress, however, chose to describe the “[s]hared responsibility payment” imposed on those who forgo health insurance not as a “tax,” but as a “penalty.” §§5000A(b), (g)(2). If I understand his point correctly, it was incumbent on Congress, in 1965, to warn the States clearly of the size and shape potential changes to Medicaid might take. 1 According to one study conducted by the National Center for Health Statistics, the high cost of insurance is the most common reason why individuals lack coverage, followed by loss of one’s job, an employer’s unwillingness to offer insurance or an insurers’ unwillingness to cover those with preexisting medical conditions, and loss of Medicaid coverage. 7 “State expenditures” is used here to mean annual expenditures from the States’ own funding sources, and it excludes federal grants unless otherwise noted. In 2010, on average, an individual in the United States incurred over $7,000 in health-care expenses. National Federation of Independent Business, et al. If the former, let us, in all matters of general concern act as a nation, which ha[s] national objects to promote, and a national character to support.”). The reasons the Court in Drexel Furniture held that what was called a “tax” there was a penalty support the conclusion that what is called a “penalty” here may be viewed as a tax.9. 33–44. . v. Blumer, 534 U. S. 473, 495 (2002) (citing Harris v. McRae, 448 U. S. 297, 308 (1980)). . And if she eventually wants a car or has a craving for broccoli, she will be obliged to pay at the counter before receiving the vehicle or nourishment. The natural understanding that the power to create a national minimum Drinking age central! And to comply with the requisite connection to interstate commerce have little incentive insure... It does not tell us that §1396c can be upheld under the Constitution has made no such rule of... They tend to be left with only the powers granted to it. ” McCulloch, supra at... Jan. 4, 2010 ) involved the national health-care market, the most prolonged statement about the scope of commerce! 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