“Second, the Act’s expansion of the Medicaid program is based on an equally boundless interpretation of Congress’s spending power, which would render any remaining limits on Congress’s enumerated powers illusory. By piling new conditions on enormous pre-existing blocks of federal grants, - literally billions of dollars – Congress has given the Sates no practical choice but to comply.” P.2-3

Summary of Argument
“Congress has substantial power to regulate interstate commerce, but it may not compel individuals to enter into such commerce so that Congress may better regulate them.” P.14

Statement of the Case
“Congress did not impose the Act’s additional Medicaid provisions as a condition of accepting new federal funding. It instead conditioned each State’s entire federal Medicaid grant – on average, at least a billion dollars – on adoption of the Act’s substantial expansions of state obligations under the program.” p.8

Individual Mandate Exceeds Congress’s Authority to Regulate Interstate Commerce
“Requiring everyone to buy an airplane would certainly have a substantial effect on interstate commerce, but that hardly brings such a mandate with Congress’s Commerce Clause authority.” P.27

“The government’s novel theory – that Congress may exercise its plenary commerce power over all individuals at all times based on the likelihood that most citizens will participate in broadly defined national market at some time – fails for the additional reason that it would vastly expand congressional power at the expense of States and our system of dual federalism.’ P.32

“The federal government’s interest in controlling the cost of health care would likewise give Congress authority to order individuals to eat more vegetables and fewer desserts, to exercise at least 45 minutes per day, to sleep at least eight hours per day, and to drink one glass of wine a day but never any beer.” P.34

Congress’s Conditioning of Billions of Dollars in Medicaid Funding on States’ Acceptance of the ACA’s [Affordable Care Act] Expansion of Medicaid is Impermissibly Coercive
“Whether Congress employed impermissible coercion in the ACA is not a close question; under any meaningful analysis, it did. The ACA seeks to significantly expand Medicaid eligibility and coverage. Yet rather than simply hold out the promise of additional funding should States agree to these expansions, Congress has threatened to withhold all Medicaid funding – literally billions of dollars for most States – if States do not accept Congress’s terms. That is unquestionably coercive, as States quite literally cannot afford to sacrifice billions in federal funds raised from the State’s own residents, and therefore have no real choice as to whether to accept these new conditions. Medicaid is the single largest federal grant-in-aid program, accounting for a staggering 40% of all federal funds paid to States…” P.52 “Florida, for example, currently devotes 26% of its entire state budget to Medicaid; if Florida lost federal funding, it would have to devote more than 60% of all state tax revenues to Medicaid in order to maintain existing, pre-ACA benefits… The federal funds are themselves supplied by taxpayers in the State, so a State cannot simply take on the responsibility and increase State tax revenues accordingly… ”the loss of all Medicaid funding would be devastating to any State. The federal government does not – and could not – deny this basic reality.” P.53

The core health care reforms are not severable
“There is no basis for suggesting that the mandate is severable from some but not all of the core, interrelated health insurance reforms – and the government is careful not to do so in this Court, and not to argue that Congress would have enacted any of the ACA’s core insurance reforms without the individual mandate.” P.63