Health Care

National Federation of Independent Business v. Sebelius

At issue in National Federation of Independent Business v. Sebelius was whether two core components of the Affordable Care Act–the individual mandate and the Medicaid expansion–were constitutional.

Case Summary

CAC has defended the constitutionality of the Patient Protection and Affordable Care Act (ACA) since it was first challenged in 2010. Representing a group of state legislators that grew to include more than 500 legislators from all 50 states, Puerto Rico, and the District of Columbia, CAC filed briefs supporting the Act’s constitutionality in the federal district court, appellate court, and the U.S. Supreme Court, which ultimately upheld the Act’s individual mandate provision.

On November 19, 2010, CAC filed a brief in the U.S. District Court for the Northern District of Florida on behalf of a bipartisan group of 78 State Legislators from 27 States, supporting the federal government’s argument that the ACA is constitutional.  As CAC’s brief showed, the Constitution creates a vibrant system of federalism that gives broad power to the federal government to act in circumstances in which a national solution is necessary or preferable, while reserving a significant role for the States to craft innovative policy solutions that showcase the diversity of America’s people, places, and ideas. Far from violating state sovereignty or the principles of federalism in our Constitution, the ACA respects the federal-state partnership and builds upon it.

As CAC’s brief further demonstrated, the conservative state Attorneys General and their allies’ constitutional claims regarding the Act’s expansion of Medicaid—which helps the Act achieve expanded coverage, lower costs, and health insurance security for millions of Americans—are groundless. States cannot be “coerced” or “commandeered” into complying with the new Medicaid requirements for the simple reason that Medicaid is and always has been a wholly voluntary partnership. States are free to opt out and create their own state alternative at any time.

On January 31, 2011, Judge Roger Vinson rejected the constitutional claims regarding the Act’s expansion of Medicaid, as we had urged. However, Judge Vinson went on to rule that the ACA’s individual mandate is unconstitutional and issued a declaratory judgment striking down the law in its entirety. According to Judge Vinson, Congress lacked the constitutional authority, including under the Commerce Clause, to adopt the individual mandate. This ruling was appealed to the Eleventh Circuit.

On April 8, 2011, CAC filed a brief in the U.S. Court of Appeals for the Eleventh Circuit, supporting the government’s appeal and continuing to defend the ACA’s constitutionality. On August 12, a divided panel of the Eleventh Circuit upheld Judge Vinson’s ruling striking down the Act’s individual mandate. Read CAC’s press release blasting the decision here.

On September 28, 2011, the Obama Administration petitioned the Supreme Court for review of the decision, and on November 14, 2011, the Supreme Court granted review in the case.

On January 12, 2012, CAC filed two separate briefs in the Supreme Court demonstrating that the text and history of the Constitution support the constitutionality of both the individual mandate and the Medicaid expansion.

On March 26-28, 2012, the Supreme Court heard oral arguments. Read CAC’s reaction to the arguments here.

On June 28, 2012, the Supreme Court upheld the ACA in a huge victory for the landmark legislation and the rule of law. Chief Justice John Roberts broke with the Court’s conservative wing to uphold the Act in a 5-4 decision. Justice Ruth Bader Ginsburg, writing separately to express her disagreement with portions of the Chief Justice’s opinion, made a powerful case for the constitutional text and history behind Congress’s power to enact the law, citing a resolution from the Constitutional Convention that was described in CAC’s brief to the Court. Read CAC’s statement on the ruling here.

Case Timeline

More from Health Care

Health Care

Oklahoma v. United States Department of Health and Human Services

In Oklahoma v. United States Department of Health and Human Services, the United States Court of Appeals for the Tenth Circuit is considering whether Title X reproductive healthcare clinics in Oklahoma can defy the federal...
Health Care
April 24, 2024

RELEASE: Justices Grapple with Scope and Effect of Conflict Between EMTALA and Idaho’s Near-Total Abortion Ban

WASHINGTON, DC – Following oral argument at the Supreme Court this morning in Idaho v....
By: Miriam Becker-Cohen
Health Care
March 29, 2024

Amicus Briefs Filed in Support of EMTALA, The Federal Right to Emergency Care, Including Abortion, in Idaho v. United States and Moyle v. United States

National Women's Law Center
A broad coalition of amici filed 27 briefs to the U.S. Supreme Court in support...
Health Care
U.S. Supreme Court

Idaho v. United States

In Idaho v. United States, the Supreme Court is considering whether EMTALA, a federal law requiring hospitals to provide stabilizing treatment to patients experiencing medical emergencies, preempts Idaho’s near-total abortion ban in situations where abortion...
Health Care
March 22, 2024

Supreme Court to rule on FDA approval of abortion drug mifepristone

Fox News
Call it wishful thinking or strategic amnesia, but just two years removed from its controversial...
By: Brianne J. Gorod, Shannon Bream, Bill Mears
Health Care
March 7, 2024

The Biggest Anti–Abortion Rights Lie Is Back at the Supreme Court

One of the most consistent and adamant claims of the anti-abortion movement is that opponents...
By: Miriam Becker-Cohen