IN THE UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

Pensacola Division

STATE OF FLORIDA, by and through

BILL McCOLLUM, ATTORNEY GENERAL

OF THE STATE OF FLORIDA;

STATE OF SOUTH CAROLINA, by and through

HENRY McMASTER, ATTORNEY GENERAL

OF THE STATE OF SOUTH CAROLINA;

STATE OF NEBRASKA, by and through

JON BRUNING, ATTORNEY GENERAL

OF THE STATE OF NEBRASKA;

STATE OF TEXAS, by and through

GREG ABBOTT, ATTORNEY GENERAL

OF THE STATE OF TEXAS;

STATE OF UTAH, by and through

MARK L. SHURTLEFF, ATTORNEY GENERAL

OF THE STATE OF UTAH;

STATE OF LOUISIANA, by and through

JAMES D. “BUDDY” CALDWELL, ATTORNEY

GENERAL OF THE STATE OF LOUISIANA;

STATE OF ALABAMA, by and through

TROY KING, ATTORNEY GENERAL

OF THE STATE OF ALABAMA;

STATE OF MICHIGAN, by and through

MICHAEL A. COX, ATTORNEY GENERAL

OF THE STATE OF MICHIGAN;

STATE OF COLORADO, by and through

JOHN W. SUTHERS, ATTORNEY GENERAL

OF THE STATE OF COLORADO;

COMMONWEALTH OF PENNSYLVANIA, by

and through THOMAS W. CORBETT, Jr., 

ATTORNEY GENERAL OF THE

COMMONWEALTH OF PENNSYLVANIA;

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STATE OF WASHINGTON, by and through

ROBERT M. McKENNA, ATTORNEY GENERAL

OF THE STATE OF WASHINGTON;

STATE OF IDAHO, by and through

LAWRENCE G. WASDEN, ATTORNEY GENERAL

OF THE STATE OF IDAHO; and

STATE OF SOUTH DAKOTA, by and through

MARTY J. JACKLEY, ATTORNEY GENERAL

OF THE STATE OF SOUTH DAKOTA;

Plaintiffs,

v. Case No. 3:10-cv-91

UNITED STATES DEPARTMENT OF

HEALTH AND HUMAN SERVICES;

KATHLEEN SEBELIUS, in her official

capacity as the Secretary of the United States

Department of Health and Human Services;

UNITED STATES DEPARTMENT OF

THE TREASURY; TIMOTHY F.

GEITHNER, in his official capacity as the

Secretary of the United States Department

of the Treasury; UNITED STATES

DEPARTMENT OF LABOR; and HILDA

L. SOLIS, in her official capacity as Secretary

of the United States Department of Labor,

Defendants.

___________________________________________/

COMPLAINT 

Plaintiffs, STATE OF FLORIDA, by and through BILL McCOLLUM, 

ATTORNEY GENERAL OF THE STATE OF FLORIDA; STATE OF SOUTH 

CAROLINA, by and through HENRY McMASTER, ATTORNEY GENERAL OF THE 

STATE OF SOUTH CAROLINA; STATE OF NEBRASKA, by and through JON 

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BRUNING, ATTORNEY GENERAL OF THE STATE OF NEBRASKA; STATE OF 

TEXAS, by and through GREG ABBOTT, ATTORNEY GENERAL OF THE STATE 

OF TEXAS; STATE OF UTAH, by and through MARK L. SHURTLEFF, ATTORNEY 

GENERAL OF THE STATE OF UTAH; STATE OF LOUISIANA, by and through

JAMES D. “BUDDY” CALDWELL, ATTORNEY GENERAL OF THE STATE OF 

LOUISIANA; STATE OF ALABAMA, by and through TROY KING, ATTORNEY 

GENERAL OF THE STATE OF ALABAMA; STATE OF MICHIGAN, by and through

MICHAEL A. COX, ATTORNEY GENERAL OF THE STATE OF MICHIGAN;

STATE OF COLORADO, by and through JOHN W. SUTHERS, ATTORNEY 

GENERAL OF THE STATE OF COLORADO; COMMONWEALTH OF 

PENNSYLVANIA, by and through THOMAS W. CORBETT, Jr., ATTORNEY 

GENERAL OF THE COMMONWEALTH OF PENNSYLVANIA; STATE OF 

WASHINGTON, by and through ROBERT M. McKENNA, ATTORNEY GENERAL

OF THE STATE OF WASHINGTON; STATE OF IDAHO, by and through

LAWRENCE G. WASDEN, ATTORNEY GENERAL OF THE STATE OF IDAHO; 

and STATE OF SOUTH DAKOTA, by and through MARTY J. JACKLEY, 

ATTORNEY GENERAL OF THE STATE OF SOUTH DAKOTA, file this action 

against Defendants, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN 

SERVICES (HHS); KATHLEEN SEBELIUS, in her official capacity as the Secretary of 

HHS; UNITED STATES DEPARTMENT OF THE TREASURY (Treasury); TIMOTHY 

F. GEITHNER, in his official capacity as the Secretary of the Treasury; UNITED 

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STATES DEPARTMENT OF LABOR (DOL); and HILDA L. SOLIS, in her official 

capacity as the Secretary of DOL, and state:

NATURE OF THE ACTION

1. On March 23, 2010, a new universal healthcare regime, titled the “Patient 

Protection and Affordable Care Act,” H.R. 3590 (the Act), was signed into law by the 

President. The Act, which exceeds 2,400 pages, is available at

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:

h3590pp.txt.pdf (accessed March 23, 2010).

2. The Act represents an unprecedented encroachment on the liberty of 

individuals living in the Plaintiffs’ respective states, by mandating that all citizens and 

legal residents of the United States have qualifying healthcare coverage or pay a tax 

penalty. The Constitution nowhere authorizes the United States to mandate, either 

directly or under threat of penalty, that all citizens and legal residents have qualifying 

healthcare coverage. By imposing such a mandate, the Act exceeds the powers of the 

United States under Article I of the Constitution and violates the Tenth Amendment to 

the Constitution. 

3. In addition, the tax penalty required under the Act, which must be paid by 

uninsured citizens and residents, constitutes an unlawful capitation or direct tax, in 

violation of Article I, sections 2 and 9 of the Constitution of the United States.

4. The Act also represents an unprecedented encroachment on the 

sovereignty of the states. For example, it requires that Florida vastly broaden its 

Medicaid eligibility standards to accommodate upwards of 50 percent more enrollees, 

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many of whom must enroll or face a tax penalty under the Act, and imposes onerous new 

operating rules that Florida must follow. The Act requires Florida to spend billions of 

additional dollars, and shifts substantial administrative costs to Florida for, inter alia, 

hiring and training new employees, as well as requiring that new and existing employees 

devote a considerable portion of their time to implementing the Act. This onerous 

encroachment occurs at a time when Florida faces having to make severe budget cuts to 

offset shortfalls in its already-strained budget, which the state constitution requires to be 

balanced each fiscal year (unlike the federal budget), and at a time when Florida’s 

Medicaid program already consumes more than a quarter of the State’s financial outlays. 

Plaintiffs cannot effectively withdraw from participating in Medicaid, because Medicaid 

has, over the more than four decades of its existence, become customary and necessary 

for citizens throughout the United States, including the Plaintiffs’ respective states; and 

because individual enrollment in Plaintiffs’ respective Medicaid programs, which 

presently cover tens of millions of residents, can only be accomplished by their continued 

participation in Medicaid.

5. Further, the Act converts what had been a voluntary federal-state 

partnership into a compulsory top-down federal program in which the discretion of the 

Plaintiffs and their sister states is removed, in derogation of the core constitutional 

principle of federalism upon which this Nation was founded. In so doing, the Act 

exceeds the powers of the United States and violates the Tenth Amendment to the 

Constitution.

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6. The Act contains several unfunded mandates that will cost state 

governments significantly.

7. For example, no Florida government entity or infrastructure exists to 

discharge sufficiently all of the responsibilities that will be necessary to implement the 

Act, to meet requirements related to increases in Medicaid enrollment under the Act, and 

to operate healthcare insurance exchanges required by the Act.

8. By making federal funds potentially available at the discretion of federal 

agencies, the Act acknowledges the immediate burden on Plaintiffs to invest and 

implement the Act, but provides no guarantee that they will receive such funds or that the 

Act’s implementation costs will be met.

9. Plaintiffs seek declaratory and injunctive relief against the Act’s operation 

to preserve their respective sovereignty and solvency, and to protect the individual 

freedom, public health, and welfare of their citizens and residents.

JURISDICTION AND VENUE

10. The Court has subject-matter jurisdiction pursuant to 28 U.S.C. § 1331

because this action arises under the Constitution and laws of the United States. 

11. Venue is proper in this district pursuant to 28 U.S.C. § 1391(e)(3) because 

no real property is involved, the district is situated in Florida, and the defendants are 

agencies of the United States or officers thereof acting in their official capacity. 

PARTIES

12. The State of Florida is a sovereign state and protector of the individual 

freedom, public health, and welfare of its citizens and residents. Bill McCollum, 

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Attorney General of Florida, has been directly elected by the people of Florida to serve as 

their chief legal officer and exercises broad statutory and common law authority to 

protect the rights of the State of Florida and its people; Fla. Const. art. IV, § 4(b). The 

State, by and through the Attorney General, has standing to assert the unconstitutionality 

of the Act. He is authorized to appear in and attend all suits in which the state is 

interested. § 16.02(4) & (5), Fla. Stat.

13. The State of South Carolina, by and through Henry McMaster, Attorney 

General of South Carolina, is a sovereign state in the United States of America.

14. The State of Nebraska, by and through Jon Bruning, Attorney General of 

Nebraska, is a sovereign state in the United States of America.

15. The State of Texas, by and through Greg Abbott, Attorney General of 

Texas, is a sovereign state in the United States of America.

16. The State of Utah, by and through Mark L. Shurtleff, Attorney General of 

Utah, is a sovereign state in the United States of America.

17. The State of Alabama, by and through Troy King, Attorney General of 

Alabama, is a sovereign state in the United States of America.

18. The State of Louisiana, by and through James D. “Buddy” Caldwell, 

Attorney General of Louisiana, is a sovereign state in the United States of America.

19. The State of Michigan, by and through Michael A. Cox, Attorney General 

of Michigan, is a sovereign state in the United States of America.

20. The State of Colorado, by and through John W. Suthers, Attorney General 

of Colorado, is a sovereign state in the United States of America.

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21. The Commonwealth of Pennsylvania, by and through Thomas W. Corbett, 

Jr., Attorney General of Pennsylvania, is a sovereign state in the United States of 

America.

22. The State of Washington, by and through Robert A. McKenna, Attorney 

General of Washington, is a sovereign state in the United States of America.

23. The State of Idaho, by and through Lawrence G. Wasden, Attorney 

General of Idaho, is a sovereign state in the United States of America.

24. The State of South Dakota, by and through Marty J. Jackley, Attorney 

General of South Dakota, is a sovereign state in the United States of America

25. HHS is an agency of the United States, and is responsible for 

administration and enforcement of the Act, through its center for Medicare and Medicaid 

Services.

26. Kathleen Sebelius is Secretary of HHS, and is named as a party in her 

official capacity.

27. Treasury is an agency of the United States, and is responsible for 

administration and enforcement of the Act.

28. Timothy F. Geithner is Secretary of the Treasury, and is named as a party 

in his official capacity.

29. DOL is an agency of the United States, and is responsible for 

administration and enforcement of the Act.

30. Hilda L. Solis is Secretary of DOL, and is named as a party in her official 

capacity.

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BACKGROUND

The Medicaid Program Prior to the Act

31. Medicaid was established by Title XIX of the Social Security Act of 1965, 

42 U.S.C. §§ 1396 et seq., as the nation’s major healthcare initiative for low-income 

persons. Each participating state’s Medicaid program has been funded jointly by the state 

and the federal government.

32. From the beginning of Medicaid until passage of the Act, the states were 

given considerable discretion to implement and operate their respective optional 

Medicaid programs in accordance with state-specific designs regarding eligibility, 

enrollment, and administration, so long as the programs met broad federal requirements.

33. The states were free to opt out of Medicaid and set up their own state 

health or welfare plans, or to provide no such benefits at all. States, including Plaintiffs, 

agreed to participate in Medicaid with the understanding that their continuing 

participation was voluntary, as a matter of both law and fact.

34. None of the Plaintiffs agreed to become a Medicaid partner of the federal 

government with an expectation that the terms of its participation would be altered 

significantly by the federal government so as to make it financially infeasible for that 

state either to remain in or to withdraw from the Medicaid program. 

35. None of the Plaintiffs agreed to become a Medicaid partner of the federal 

government with an expectation that the federal government would increase significantly 

its control and reduce significantly that state’s discretion with respect to the Medicaid 

program. 

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36. None of the Plaintiffs agreed to become a Medicaid partner of the federal 

government with an expectation that, after the Medicaid program became entrenched in 

the state, the federal government would alter the program’s requirements to expand 

eligibility for enrollment beyond the state’s ability to fund its participation.

37. None of the Plaintiffs agreed to become a Medicaid partner of the federal 

government with an expectation that the federal government would exploit its control 

over Medicaid terms and eligibility as part of a coercive scheme to force all citizens and 

residents to have healthcare coverage.

The Patient Protection and Affordable Care Act

38. The Act mandates that all United States citizens and legal residents have 

qualifying healthcare coverage. If a person fails to do so, the federal government will 

force that person to pay a penalty, the amount of which will be increased gradually 

through 2016, reaching $750 per year up to a maximum of three times that amount 

($2,250) per family, or 2 percent of household income, whichever is greater. After 2016, 

the penalty will increase annually based on a cost-of-living adjustment. Exemptions to 

the tax penalty only apply for individuals with certain religious objections, American 

Indians, those persons without coverage for less than three months, undocumented 

immigrants, incarcerated individuals, or some individuals with financial hardships.

39. The Act greatly alters the federal-state relationship, to the detriment of the 

states, with respect to Medicaid programs specifically and healthcare coverage generally.

40. The Act requires states to expand massively their Medicaid programs and 

to create exchanges through which individuals can purchase healthcare insurance 

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coverage. The federal government is to provide partial funding for the exchanges, but 

will cease doing so after 2015. Should a state not wish to participate in the exchanges, it 

can opt out only if it provides coverage for uninsured individuals with incomes between 

133 percent and 200 percent of the federal poverty level, a higher income level than that 

which would be applied for participating states under the Act. The only other way for a 

state to avoid the Act’s requirements is to drop out of the Medicaid program, leaving 

millions of persons uninsured.

41. Those states left with no practical alternative but to participate in the Act 

will have to expand their Medicaid coverage to include all individuals under age 65 with 

incomes up to 133 percent of the federal poverty level. The states’ coverage burdens will 

increase significantly after 2016, both in actual dollars and in proportion to the 

contributions of the federal government.

42. The federal government will not provide necessary funding or resources to 

the states to administer the Act. Nevertheless, states will be required to provide oversight 

of the newly-created insurance markets, including, inter alia, instituting regulations, 

consumer protections, rate reviews, solvency and reserve fund requirements, and 

premium taxes. States also must enroll all of the newly-eligible Medicaid beneficiaries

(many of whom will be subject to a penalty if they fail to enroll), coordinate enrollment 

with the new exchanges, and implement other specified changes. The Act further 

requires states to establish an office of health insurance consumer assistance or an 

ombudsman program to advocate for people in the new programs.

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The Act’s Impact on Florida’s Medicaid Program, as an Example

43. The Act will have an impact on all Plaintiffs and in a manner similar to its 

impact on Florida, as described herein by way of example.

44. Florida is the Nation’s fourth largest state in population. Based on United 

States Census Bureau statistics from 2008, Florida has 3,641,933 uninsured persons 

living in the state. Of those persons, 1,259,378 are below 133 percent of the federal 

poverty line, and therefore must be added to Florida’s Medicaid rolls under the Act.

45. Even before passage of the Act, the Medicaid program imposed an

overwhelming cost on Florida, consuming 26 percent of its annual budget. For fiscal 

year 2009-2010 alone, Florida will spend more than $18 billion on Medicaid, servicing 

more than 2.7 million persons. Florida’s Medicaid contributions and burdens, from the 

implementation of its Medicaid program in 1970 to the present, have gradually increased 

to the point where it would be infeasible for Florida to cease its participation in Medicaid.

46. Although the federal government currently contributes 67.64 percent of 

every dollar Florida spends on Medicaid, that percentage is artificially and temporarily 

raised because of federal stimulus outlays. After this year, the percentage of Florida’s 

Medicaid program expenses covered by the federal government will decline, and by 2011 

will reach 55.45 percent, a level that is closer to the recent average. The federal 

government’s contribution will not compensate for the dramatic increase to Florida’s 

Medicaid rolls and the correspondingly soaring costs to be borne by Florida under the 

Act.

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47. Florida’s Agency for Health Care Administration (AHCA) estimates that 

at least 80 percent of persons who have some form of health insurance but fall below 133 

percent of the federal poverty level will drop their current plans and enroll in Medicaid, 

because they are newly eligible under the Act. The federal government does not offer 

any funding for these persons, because they qualified for insurance other than Medicaid 

prior to passage of the Act. These persons represent a significant additional cost to 

Florida under the Act.

48. The Act also makes a large new class of persons eligible for Medicaid in 

Florida. Prior to passage of the Act, only certain specified low-income individuals and 

families qualified for Medicaid. Moreover, the qualifying income level set by Florida 

was much lower than the level of 133 percent of the federal poverty line set by the federal 

government under the Act. Now, Florida also must add to its Medicaid rolls all childless 

adults whose income falls below 133 percent of the federal poverty line.

49. Prior to passage of the Act, AHCA was Florida’s designated state 

Medicaid agency tasked with developing and carrying out policies related to the 

Medicaid program. The Act will strip away much of AHCA’s authority to set policies, 

transferring that authority to the federal government, which will dictate those policies to 

Florida. AHCA and the other Florida agencies will be rendered arms of the federal 

government, and AHCA employees will be conscripted and forced to administer what 

now is essentially a federal Medicaid program for which Florida must bear a substantial 

cost.

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50. AHCA has prepared limited projections for the fiscal impact of the Act. 

The new additional costs to the state are as follows: $149,001,478 for 2014; 

$431,307,547 for 2015; $484,803,557 for 2016; $938,807,336 for 2017; $993,836,882 for 

2018, and $1,048,866,307 for 2019. Beyond this time frame, the costs to Florida will 

continue to grow. These projections understate the Act’s adverse impact on Florida. 

They do not include estimated costs to be borne by Florida to administer the Act or to 

prepare for the Act’s implementation. Such costs will include hiring and training new 

staff, creating new information technology infrastructures, developing an adequate 

provider base, creating a scheme for accountability and quality assurance, and many other 

expenses.

51. The Act effectively requires that Florida immediately begin to devote 

funds and resources to implement the Act’s sweeping reforms across multiple agencies of 

government. Such implementation burdens include, but are not limited to: enforcing the 

Act’s immediately-effective terms, including new mandates regarding healthcare 

insurance coverage; determining gaps between current resources in state government and 

the Act’s requirements; evaluating infrastructure to consider how new programs and 

substantial expansion of existing programs will be implemented (e.g., new agencies, 

offices, etc.); developing a strategic plan and coordinating common issues across state 

agencies; initiating legislative and regulatory processes, while at the same time 

monitoring and engaging the substantial federal regulatory processes to ensure that 

Florida’s interests are protected; and developing a communications structure and plan to 

disseminate new information regarding changes brought about by the Act to the many 

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affected persons and entities (legislators, state agencies, insurers, hospitals, doctors, 

community clinics, major employers, small businesses, advocacy groups, insurance 

brokers, legislators, the uninsured, and Floridians generally), and to achieve such 

dissemination in sufficient time for them to understand and adapt to the changes in 

accordance with federal timetables, without interruption or confusion in the provision of 

healthcare services.

52. In sum, while the Act infringes on Florida’s constitutional status as a 

sovereign, entitled to cooperate with but not to be controlled by the federal government 

under the Medicaid program, the Act also will force Florida to cover more than one 

million additional persons and, in so doing, to spend billions of additional dollars, a price 

it simply cannot afford to pay.

53. At the same time, like the other Plaintiffs, Florida cannot avoid the Act’s 

requirements by ending its longstanding participation in the Medicaid program, thereby 

leaving millions of current Medicaid recipients stranded without coverage. In effect, the 

Plaintiffs’ participation under the Act cannot be avoided, despite its devastating effects.

CAUSES OF ACTION

COUNT ONE

UNCONSTITUTIONAL EXERCISE OF FEDERAL POWER

AND VIOLATION OF THE TENTH AMENDMENT 

(Const. art. I & amend. X) 

54. Plaintiffs reallege, adopt, and incorporate by reference paragraphs 1 

through 53 above as though fully set forth herein.

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55. Plaintiffs cannot afford the exorbitant and unfunded costs of participating 

under the Act, but have no choice other than to participate.

56. The Act exceeds Congress’s powers under Article I of the Constitution of 

the United States, and cannot be upheld under the Commerce Clause, Const. art. I, §8; the 

Taxing and Spending Clause, id.; or any other provision of the Constitution.

57. By effectively co-opting the Plaintiffs’ control over their budgetary 

processes and legislative agendas through compelling them to assume costs they cannot 

afford, and by requiring them to establish health insurance exchanges, the Act deprives 

them of their sovereignty and their right to a republican form of government, in violation 

of Article IV, section 4 of the Constitution of the United States.

58. The Act violates the Tenth Amendment of the Constitution of the United 

States, and runs afoul of the Constitution’s principle of federalism, by commandeering 

the Plaintiffs and their employees as agents of the federal government’s regulatory 

scheme at the states’ own cost. 

WHEREFORE, Plaintiffs respectfully request that the Court:

A. Declare the Patient Protection and Affordable Care Act to be in violation 

of Article I of and the Tenth Amendment to the Constitution of the United States;

B. Declare Defendants to have violated the Plaintiffs’ rights as sovereigns

and protectors of the freedom, public health, and welfare of their citizens and residents, 

as aforesaid;

C. Enjoin Defendants and any other agency or employee acting on behalf of 

the United States from enforcing the Act against the Plaintiffs, their citizens and 

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residents, and any of their agencies or officials or employees, and to take such actions as 

are necessary and proper to remedy their violations deriving from any such actual or 

attempted enforcement; and

D. Award Plaintiffs their reasonable attorney’s fees and costs, and grant such 

other relief as the Court may deem just and proper.

COUNT TWO

VIOLATION OF CONSTITUTIONAL PROHIBITION OF

UNAPPORTIONED CAPITATION OR DIRECT TAX 

(Const. art. I, §§ 2, 9) 

59. Plaintiffs reallege, adopt, and incorporate by reference paragraphs 1 

through 53 above as though fully set forth herein.

60. The tax penalty on uninsured persons under the Act constitutes a 

capitation and a direct tax that is not apportioned among the states according to census 

data, thereby injuring the sovereign interests of Plaintiffs.

61. Said tax penalty applies without regard to property, profession, or any 

other circumstance, and is unrelated to any taxable event or activity. It is to be levied 

upon persons for their failure or refusal to do anything other than to exist and reside in 

the United States.

62. Said tax penalty violates article I, sections 2 and 9 of the Constitution of 

the United States. By its imposition of the penalty tax, and by the resulting coercion of 

many persons to enroll in Medicaid at a substantial cost to the Plaintiffs, the Act injures 

their interests as sovereigns vested with exclusive authority, except to the extent 

permitted to the federal government by the Constitution, to make all taxing decisions 

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affecting their citizens and to confer a right upon persons in their states to make 

healthcare decisions without government interference. The tax penalty is 

unconstitutional on its face and cannot be applied constitutionally.

WHEREFORE, Plaintiffs respectfully request that the Court:

A. Declare the Patient Protection and Affordable Care Act to be in violation 

of Article I, sections 2 and 9 of the Constitution of the United States;

B. Declare Defendants to have violated the Plaintiffs’ rights as sovereigns

and protectors of the freedom, public health, and welfare of their citizens and residents, 

as aforesaid;

C. Enjoin Defendants and any other agency or employee acting on behalf of 

the United States from enforcing the Act against the Plaintiffs, their citizens and 

residents, and any of their agencies or officials or employees, and to take such actions as 

are necessary and proper to remedy their violations deriving from any such actual or 

attempted enforcement; and

D. Award Plaintiffs their reasonable attorney’s fees and costs, and grant such 

other relief as the Court may deem just and proper.

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COUNT THREE

UNCONSTITUTIONAL MANDATE THAT ALL INDIVIDUALS 

HAVE HEALTH INSURANCE COVERAGE OR PAY TAX 

PENALTY

(Const. art. I & amend. X)

63. Plaintiffs reallege, adopt, and incorporate by reference paragraphs 1 

through 53 above as though fully set forth herein.

64. The Act forces citizens and residents to have healthcare coverage or pay a 

tax penalty. In effect, the Act compels said persons to have healthcare coverage, whether 

or not they wish to do so, or be subject to sanction. The Act thus compels persons to 

perform an affirmative act or incur a penalty, simply on the basis that they exist and 

reside in the United States.

65. The Act is directed to a lack of or failure to engage in activity that is 

driven by the choices of individual Americans. Such inactivity by its nature cannot be 

deemed to be in commerce or to have any substantial effect on commerce, whether 

interstate or otherwise. As a result, the Act cannot be upheld under the Commerce 

Clause, Const. art. I, § 8. The Act infringes upon Plaintiffs’ interests in protecting the 

freedom, public health, and welfare of their citizens and their state fiscs, by coercing 

many persons to enroll in Medicaid at a substantial cost to Plaintiffs; and denies Plaintiffs

their sovereign ability to confer rights upon their citizens and residents to make 

healthcare decisions without government interference, including the decision not to 

participate in any healthcare insurance program or scheme, in violation of the Tenth 

Amendment to the Constitution of the United States.

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66. The tax penalty on uninsured persons under the Act unlawfully coerces

persons to obtain healthcare coverage, thereby injuring the Plaintiffs’ fiscs, because many 

persons will be compelled to enroll in Medicaid at a substantial cost to Plaintiffs. As a 

result, the Act cannot be upheld under the Taxing and Spending Clause, Const. art. I, § 8. 

67. In so coercing citizens and residents to have healthcare coverage, the Act 

exceeds Congress’s powers under Article I of the Constitution of the United States, and 

cannot be upheld under any provision of the Constitution.

WHEREFORE, Plaintiffs respectfully request that the Court:

A. Declare the Patient Protection and Affordable Care Act to be in violation 

of Article I, section 8 of and the Tenth Amendment to the Constitution of the United 

States;

B. Declare Defendants to have violated the Plaintiffs’ rights as sovereigns

and protectors of the freedom, health, and welfare of their citizens and residents, as 

aforesaid;

C. Enjoin Defendants and any other agency or employee acting on behalf of 

the United States from enforcing the Act against the Plaintiffs, their citizens and 

residents, and any of their agencies or officials or employees, and to take such actions as 

are necessary and proper to remedy their violations deriving from any such actual or 

attempted enforcement; and

D. Award Plaintiffs their reasonable attorney’s fees and costs, and grant such 

other relief as the Court may deem just and proper.

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COUNT FOUR

DECLARATORY JUDGMENT

(28 U.S.C. § 2201)

68. Plaintiffs reallege, adopt, and incorporate by reference paragraphs 1 

through 53 above as though fully set forth herein.

69. There is an actual controversy of sufficient immediacy and concreteness 

relating to the legal rights and duties of the Plaintiffs and their legal relations with the 

Defendants to warrant relief under 28 U.S.C. § 2201. 

70. The harm to the Plaintiffs as a direct result of the Act is sufficiently real 

and imminent to warrant the issuance of a conclusive declaratory judgment clarifying the 

legal relations of the parties. 

WHEREFORE, Plaintiffs respectfully request that the Court:

A. Declare the Patient Protection and Affordable Care Act to be in violation 

of Article I of and the Tenth Amendment to the Constitution of the United States;

B. Declare Defendants to have violated the Plaintiffs’ rights as sovereigns

and protectors of the freedom, health, and welfare of their citizens and residents, as 

aforesaid;

C. Enjoin Defendants and any other agency or employee acting on behalf of 

the United States from enforcing the Act against the Plaintiffs, their citizens and 

residents, and any of their agencies or officials or employees, and to take such actions as 

are necessary and proper to remedy their violations deriving from any such actual or 

attempted enforcement; and

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D. Award Plaintiffs their reasonable attorney’s fees and costs, and grant such 

other relief as the Court may deem just and proper.

Respectfully submitted,

BILL MCCOLLUM

ATTORNEY GENERAL OF FLORIDA

HENRY McMASTER

ATTORNEY GENERAL OF SOUTH

CAROLINA;

JON BRUNING

ATTORNEY GENERAL OF

NEBRASKA;

GREG ABBOTT

ATTORNEY GENERAL OF TEXAS;

MARK L. SHURTLEFF

ATTORNEY GENERAL OF UTAH;

JAMES D. “BUDDY” CALDWELL

ATTORNEY GENERAL OF

LOUISIANA;

TROY KING

ATTORNEY GENERAL OF 

ALABAMA;

MICHAEL A. COX

ATTORNEY GENERAL OF

MICHIGAN;

JOHN W. SUTHERS

ATTORNEY GENERAL OF

COLORADO;

THOMAS W. CORBETT, Jr.

ATTORNEY GENERAL OF

PENNSYLVANIA;

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ROBERT M. McKENNA

ATTORNEY GENERAL OF

WASHINGTON;

LAWRENCE G. WASDEN

ATTORNEY GENERAL OF IDAHO

MARTY J. JACKLEY

ATTORNEY GENERAL OF SOUTH

DAKOTA

/s/ Blaine H. Winship 

Of counsel: Blaine H. Winship (FBN 0356913)

David B. Rivkin, Jr. Assistant Attorney General

Lee A. Casey Joseph W. Jacquot (FBN 189715)

1050 Connecticut Avenue, N.W. Deputy Attorney General

Suite 1100 Scott D. Makar (FBN 709697)

Washington, DC 20036 Solicitor General

Telephone: (202) 861-1731 Louis F. Hubener (FBN 0140084)

Facsimile: (202) 861-1783 Timothy D. Osterhaus (FBN 0133728)

Charles B. Upton II (FBN 0037241)

Deputy Solicitors General

The Capitol, Suite PL-01

Tallahassee, Florida 32399-1050

Telephone: (850) 414-3300

Facsimile: (850) 488-4872

Email: blaine.winship@myfloridalegal.com

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