Without the Individual Mandate and Medicaid Expansion, the Affordable Care Act’s insurance regulations and insurance taxes impose risks on insurance companies and their customers that this Court cannot measure. 205, 206 (John Harvard Library ed. By including in the Act “a clause expressly reserving to it ‘[t]he right to alter, amend, or repeal any provision’ of the Act,” we held, Congress put States on notice that the Act “created no contractual rights.” Id., at 51–52. Congress’s attempt to regulate the interstate market for marijuana would therefore have been substantially undercut if it could not also regulate intrastate possession and consumption. 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. can be more fallacious,” Alexander Hamilton emphasized, “than to infer the extent of any power, proper to be lodged in the national government, from . 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. Federal and state law, as well as professional obligations and embedded social norms, require hospitals and physicians to provide care when it is most needed, regardless of the patient’s ability to pay. 26, 2012). The ACA enlarges the population of needy people States must cover to include adults under age 65 with incomes up to 133% of the fed- eral poverty level. To go beyond that, and to say that the failure to grow wheat or the refusal to make loans affects commerce, so that growing and lending can be federally compelled, is to extend federal power to virtually everything. levied to support a federal program that offers large grants to the States . . There is only money States anticipate receiving from future Congresses. Id., at 559–563. Justice Holmes made the same point a century later: “[T]he rule is settled that as between two possible interpretations of a statute, by one of which it would be unconstitutional and by the other valid, our plain duty is to adopt that which will save the Act.” Blodgett v. Holden, 275 U. S. 142, 148 (1927) (concurring opinion). There is no reason to believe that Congress would have enacted them independently. Id., at 127–129. See, e.g., Dole, supra, at 207–208; id., at 207 (spending power is “subject to several general re-  strictions articulated in our cases”). . Congress, aiming to assist the needy, has appropriated federal money to subsidize state health-insurance programs that meet federal standards. South Dakota v. Dole, 483 U. S. 203, 211. as Amici Curiae 19. We afford Congress the leeway “to undertake to solve national problems directly and realistically.” American Power & Light Co. v. SEC, 329 U. S. 90, 103 (1946). The Constitution authorizes Congress to “regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.” Art. Put simply, Congress may tax and spend. The lawsuit was brought to the federal District Court for the Northern District of Florida by Florida state Attorney General Bill McCollum on March 23, 2010. . IV). Instead, it concerned only the constitutionality of “individual applications of a concededly valid statutory scheme.” Raich, supra, at 23 (emphasis added). The presence of such a requirement suggests a penalty—though one can imagine a tax imposed only on willful action; but the absence of such a requirement does not suggest a tax. Even if a State believes that the federal program is ineffective and inefficient, withdrawal would likely force the State to impose a huge tax increase on its residents, and this new state tax would come on top of the federal taxes already paid by residents to support subsidies to participating States.13. United States v. Kahriger, 345 U. S. 22, 28, n. 4 (1953). Knox, 277 U. S. 218, 223 (1928) (Holmes, J., dissenting)). The Government’s second theory in support of the In- dividual Mandate is that §5000A is valid because it is actually a “regulat[ion of] activities having a substantial relation to interstate commerce, . The text of the pertinent statutes suggests otherwise. Even if one agreed that a change of as little as 7 percentage points carries constitutional significance, is it not passing strange to suggest that the purported incursion on state sovereignty might have been averted, or at least mitigated, had Congress offered States less money to carry out the same obligations? Between 1966 and 1990, annual federal Medicaid spending grew from $631.6 million to $42.6 billion; state spending rose to $31 billion over the same period. See supra, at 11–12. Neither would prompt the purchase of insurance before sickness or injury occurred. Post, at 23 (citing United States v. Reorganized CF&I Fabricators of Utah, Inc., 518 U. S. 213, 224 (1996)). . I, §8, cl. 11–398, p. 4 (“[O]ut-of-state residents continue to seek and receive millions of dollars in uncompensated care in Massachusetts hospitals, limiting the State’s efforts to improve its health care system through the elimination of uncompensated care.”). And it leaves the public and the States to expend vast sums of money on requirements that may or may not survive the necessary congressional revision. The Court resolved this dispute in Butler. But sometimes “the most telling indication of [a] severe con-stitutional problem . She will get no free ride or food, at the expense of another consumer forced to pay an inflated price. How is a judge to decide, when ruling on the constitutionality of a federal statute, whether Congress employed an “independent power,” ante, at 28, or merely a “derivative” one, ante, at 29. The States, however, argue that the Medicaid expansion is far from the typical case. In Dole, the condition—set 21 as the minimum drinking age— did not tell the States how to use funds Congress pro- vided for highway construction. The portion of the State’s budget at stake? 5, 2012, p. A23 (telling of an uninsured 32-year-old woman who, healthy one day, became a quadriplegic the next due to an auto accident). See 42 U. S. C. §18091(2)(C) and (I) (2006 ed., Supp. Our opinion then proceeded to “consider each [of the three operative provisions] in turn.” Ibid. . See §5000A(f). v. SEBELIUS Syllabus pret the mandate as imposing such a tax, Crowell. See Schweiker v. Gray Panthers, 453 U. S. 34, 38 (1981). general Welfare of the United States.” Art. Cf. . The ACA does not describe operational aspects of the program for these newly eligible persons; for that information, one must read the existing Medicaid Act. No one would doubt that this law imposed a tax, and was within Congress’s power to tax. These line-drawing exercises were untenable, and the Court long ago abandoned them. See, e.g., 26 U. S. C. §527(j) (2006 ed.) The requirement to pay is found in the Internal Revenue Code and enforced by the IRS, which—as we previously explained—must assess and collect it “in the same manner as taxes.” Supra, at 13–14. . The minimum coverage provision could therefore be described as regulating activists in the self-insurance market.7 Wickard is another example. In the early 20th century, this Court regularly struck down economic regulation enacted by the peoples’ representatives in both the States and the Federal Government. State of Maryland and 10 other States national federation of independent business vs sebelius failed decides to save a statute providing every. A catastrophic loss, even though only a portion of the ACA a... Dakota stood to lose federal funding to induce the purchase of health HUMAN! 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