The dissenters argued that the individual mandate represented an unprecedented abuse of federal power, for the federal government has "never before used the Commerce Clause to compel entry into commerce. 42 U. S. C. §1396d(a). See NASBO Report 7, 47. 11–400, Florida et al. Justice Scalia, Justice Kennedy, Justice Thomas, and Justice Alito, dissenting. Under that theory, the mandate is not a legal command to buy insurance. Penalties for absolute-liability offenses are commonplace. Instead, acceptance of the offer will impose very substantial costs on participating States. Most people will do so repeatedly. The Court regards its strained statutory interpretation as judicial modesty. Congress’ actions are even more rational in this case, where the future activity (the consumption of medical care) is certain to occur, the sole uncertainty being the time the activity will take place. Cf. The threatened loss of over 10 percent of a State’s overall budget, in contrast, is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.12, Justice Ginsburg claims that Dole is distinguishable because here “Congress has not threatened to withhold funds earmarked for any other program.” Post, at 47. state governments.”).17. As a matter of law, a State could turn down that offer, but if it did so, its residents would not only be required to pay the federal taxes needed to support this expensive new program, but they would also be forced to pay an equivalent amount in state taxes. Many individuals will receive the required cov-erage through their employer, or from a government program such as Medicaid or Medicare. That program previously had been operated jointly by the Federal and State Governments, as is the case with Medicaid today. The Federalist No. Nor does any other provision state that references to taxes in Title 26 shall also be “deemed” to apply to the individual mandate. See Thomas More, 651 F. 3d, at 539–540 (CA6); Seven-Sky, 661 F. 3d, at 5–14 (CADC). For the reasons explained above, the minimum coverage provision is valid Commerce Clause legislation. §§1396a(k)(1), 1396u–7(b)(5), 18022(b). Just as this benefactor might assume that all of these 50 individuals would snap up his offer, so Congress assumed that every State would gratefully accept the federal funds (and conditions) to go with the expansion of Medicaid. Indeed, as the D. C. Circuit observed, “[a]t the time the Constitution was [framed], to ‘regulate’ meant,” among other things, “to require action.” See Seven-Sky v. Holder, 661 F. 3d 1, 16 (2011). This analysis also shows how closely interrelated the Act is, and this is all the more reason why it is judicial usurpation to impose an entirely new mechanism for withdrawal of Medicaid funding, see Part IV–F, supra, which is one of many examples of how rewriting the Act alters its dynamics. The other provisions of the Affordable Care Act are not affected. As our decision in Steward Machine confirms, Congress may attach appropriate conditions to federal taxing and spending programs to preserve its control over the use of federal funds. The Court in Dole mentioned, but did not adopt, a further limitation, one hypothetically raised a half-century earlier: In “some circumstances,” Congress might be prohibited from offering a “financial inducement . See Center for Applied Ethics, Voluntary Health Risks: Who Should Pay?, 6 Issues in Ethics 6 (1993) (noting “overwhelming evidence that individuals with unhealthy habits pay only a fraction of the costs associated  with their behaviors; most of the expense is borne by the rest of society in the form of higher insurance premiums, government expenditures for health care, and disability benefits”). And the nail in the coffin is that the mandate and penalty are located in Title I of the Act, its operative core, rather than where a tax would be found—in Title IX, containing the Act’s “Revenue Provisions.” In sum, “the terms of [the] act rende[r] it unavoidable,” Parsons v. Bedford, 3 Pet. If the Federal Government makes a controversial decision while acting on its own, “it is the Federal Government that makes the decision in full view of the public, and it will be federal officials that suffer the consequences if the decision turns out to be detrimental or unpopular.” New York, 505 U. S., at  168. 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. 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. . Even if courts were inclined to second-guess Congress’ conception of the character of its legislation, how would reviewing judges divine whether an Act of Congress, purporting to amend a law, is in reality not an amendment, but a new creation? That is true whether Congress directly commands a State to regulate or indirectly coerces a State to adopt a federal regulatory system as its own. The Secretary, it is worth noting, may herself experience political pressures, which would make her all the more reluctant to cut off funds Congress has appropriated for a State’s needy citizens. We do not make light of the se-vere burden that taxation—especially taxation motivated by a regulatory purpose—can impose. See §5000A(g)(2)(A) (barring criminal prosecutions); §5000A(g)(2)(B) (prohibiting the Secretary from using notices of lien and levies). The ACA does not jettison this approach. The mandating of economic activity does, and since it is a field so limitless that it converts the Commerce Clause into a general authority to direct the economy, that mandating is not “consist[ent] with the letter and spirit of the constitution.” McCulloch v. Maryland, 4 Wheat. Finally, for low-income individuals who are simply not able to obtain insurance, Congress expanded Medicaid, transforming it from a program covering only members of a limited list of vulnerable groups into a program that provides at least the requisite minimum level of coverage for the poor. These amendments added millions to the Medicaid-eligible population. Id., at 46. . 2258; Om- nibus Budget Reconciliation Act of 1990, §4601, 104 Stat. There is another point related to the Individual Mandate that we must discuss—a point that logically should have been discussed first: Whether jurisdiction over the challenges to the minimum-coverage provision is precluded by the Anti-Injunction Act, which provides that “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person,” 26 U. S. C. §7421(a) (2006 ed.). See Eisner v. Macom-ber, 252 U. S. 189, 218–219 (1920). The Government next contends that Congress has the power under the Necessary and Proper Clause to enact the individual mandate because the mandate is an “integral part of a comprehensive scheme of economic regulation”— the guaranteed-issue and community-rating insurance reforms. NOTICE: This opinion is subject to formal revision before publication in the preliminary print of the United States Reports. Ibid. See, e.g., Finkelstein, Trogdon, Cohen, & Dietz, Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates, 28 Health Affairs w822 (2009) (detailing the “undeniable link between ris-ing rates of obesity and rising medical spending,” and esti-mating that “the annual medical burden of obesity has risen to almost 10 percent of all medical spending and could amount to $147 billion per year in 2008”). When a court confronts an unconstitutional statute, its endeavor must be to conserve, not destroy, the legislation. 11–398, p. 9 (hereinafter AAPD Brief). Another provision, §2006, id., at 284, increases Medicaid payments only in Louisiana. There is only money States anticipate receiving from future Congresses. And it is hardly just the currently sick or injured among the uninsured who prompt elevation of the price of health care and health insurance. See also §18091(2)(I) (goal of “lower[ing] health insurance premiums”); §18091(2)(J) (same). So the question is, quite simply, whether the exaction here is imposed for violation of the law. 14  Justice Ginsburg suggests that the States can have no objection to the Medicaid expansion, because “Congress could have repealed Medicaid [and,] [t]hereafter, . People, for reasons of their own, often fail to do things that would be good for them or good for society. The Court does not strike down any provision of the  ACA. Given its expansive scope, it is no surprise that Congress has employed the commerce power in a wide variety of ways to address the pressing needs of the time. For decades, the Court has declined to override legislation because of its novelty, and for good reason. This is typical of the whole dynamic of the Act. But given the majority view, she agrees with The Chief Justice’s conclusion in Part IV–B that the Medicaid Act’s severability clause, 42 U. S. C. §1303, determines the appropriate remedy. The enumeration of powers is also a limitation of pow- ers, because “[t]he enumeration presupposes something not enumerated.” Gibbons v. Ogden, 9 Wheat. . 270 (“[T]his Act will reduce the Federal deficit between 2010 and 2019”). Therefore, if Arizona lost federal Medicaid funding, the State would have to commit an additional 33% of all its state expenditures to fund an equivalent state program along the lines of pre-expansion Medicaid. The ACA, in contrast, relates solely to the federally funded Medicaid program; if States choose not to comply, Congress has not threatened to withhold funds earmarked for any other program. A key purpose of an exchange is to provide a marketplace of insurance options where prices are standardized regardless of the buy- er’s pre-existing conditions. . Co. v. United States, 148 U. S. 312, 335–337 (1893), and Cherokee Nation v. Southern Kansas R. Co., 135 U. S. 641, 657–659 (1890)). Such provisions validate the Senate Majority Leader’s statement, “ ‘I don’t know if there is a senator that doesn’t have something in this bill that was important to them. Such a massive undertaking would hardly be “ritualistic.” Ibid. See also Pension Benefit Guaranty Corporation v. R. A. In 1880, for example, we explained that “direct taxes, within the meaning of the Constitution, are only capitation taxes, as expressed in that instrument,  and taxes on real estate.” Springer, supra, at 602. The Judiciary, if it orders uncritical severance, then assumes the legislative function; for it imposes on the Nation, by the Court’s decree, its own new statutory regime, consisting of poli cies, risks, and duties that Congress did not enact. For ex- ample, the Federal Government bears the burden of paying billions for the new entitlements mandated by the Medicaid Expansion and federal subsidies for insurance purchases on the exchanges; but it benefits from reductions in the reimbursements it pays to hospitals. It is not. Given the nature of the threat and the programs at issue here, we must agree. The Chief Justice does not dispute that all U. S. residents participate in the market for health services over the course of their lives. 459, 521, 522, n. 307 (2003) (citing, e.g., Scalia, The Rule of Law as a Law of Rules, 56 U. Chi. IV), and that such penalties “shall be assessed and collected in the same manner as taxes,” §6671(a) (2006 ed.). The proposition that Congress may dictate the conduct of an individual today because of prophesied future ac-tivity finds no support in our precedent. Thus the dissent, on the theories proposed for the validity of the Mandate, would alter the accepted constitutional relation between the individual and the National Government. See supra, at 41–42. See, e.g., ACA §1563, 124 Stat. . Times, Apr. . 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. Under Wickard it is within Congress’s power to regulate the market for wheat by supporting its price. 26 U. S. C. §5000A(a). . Supplementing these legal restraints is a formidable check on congressional power: the democratic process. Its regulations include requirements ranging from a break time and secluded place at work for nursing mothers, see 29 U. S. C. §207(r)(1) (2006 ed., Supp. Several of our opinions have suggested that the power to tax and spend cannot be used to coerce state administration of a federal program, but we have never found a law enacted under the spending power to be coercive. . 3 (emphasis added). . The question posed by the 2010 Medicaid expansion, then, is essentially this: To cover a notably larger population, must Congress take the repeal/reenact route, or may it achieve the same result by amending existing law? See 505 U. S., at 169–170. But see ante, at 44–45 (“[T]he Act dramatically increases state obligations under Medicaid.”); post, at 45 (joint opinion of Scalia, Kennedy, Thomas, and Alito, JJ.) By what right does a court stop Congress from building up without first tearing down? The Affordable Care Act expands the scope of the Medicaid program and increases the number of individuals the States must cover. To an economist, perhaps, there is no difference between activity and inactivity; both have measurable economic effects on commerce. . 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. To receive federal Medicaid funds, States must provide health benefits to specified categories of needy persons, including pregnant women, children, parents, and adults with disabilities. The Sixth Circuit and the D. C. Circuit upheld the mandate as a valid exercise of Congress’s commerce power. Coercing States to accept conditions risks the destruction of the “unique role of the States in our system.”  Davis, supra, at 685 (Kennedy, J., dissenting). See supra, at 11–12. But that clause tells us only that other provisions in Chapter 7 should not be invalidated if §1396c, the authorization for the cut-off of all Medicaid funds, is unconstitutional. [4], On June 28, 2012, the Supreme Court overturned the judgment of the Eleventh Circuit in a 5-4 decision. We see no insurmountable obstacle to a similar approach here.10. ORDER OF NOVEMBER 18, 2011 H. BARTOW FARR, III, ESQ. 68 (Mar. 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. The reductions allowed Congress to find that the ACA “will reduce the Federal deficit between 2010 and 2019” and “will continue to reduce budget deficits after 2019.” ACA §§1563(a)(1), (2), 124 Stat. But “if Congress intends to impose a condition on the grant of federal moneys, it must do so unambiguously.” Pennhurst, 451 U. S., at 17. 1. 249, p. 124, Table 37 (Dec. 2010) (Over 99.5% of adults above 65 have visited a health-care professional.). . Congress would remain unable to regulate noneconomic conduct that has only an attenuated effect on interstate commerce and is traditionally left to state law. See supra, at 7–8. Post, at 44. As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. 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. 45, at 293 (J. Madison). 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