Document ID: ./input/supremecourt_opinions/opinions/20pdf/19-840_6jfm.pdf
Page Number: 16.0

Cite as:  593 U. S. ____ (2021) 

13 

Opinion of the Court 

Medicaid enrollees that can be attributed to the [Act], dur-
ing the time period the [Act] was implemented the Medicaid
caseload increased”); id., at 341–342 (decl. of Blake Fulen-
wider) (observing that “Georgia residents were necessarily
required to secure health care coverage or pay a fine to the 
federal government” and stating that “I believe that the in-
dividual mandate played a substantial role in the increase 
in  the  number  of  Medicaid  recipients  since  2011”);  id.,  at 
139 (decl. of Mike Michael) (describing costs associated with 
“[p]lan changes to cover individual mandate” spread “over
the years of 2013 to 2018”).

One  other  declaration  refers  to  increased  costs  to  the 
States as employers, but it is vague as to the time period at
issue.  See  id.,  at  347–348  (decl.  of  Teresa  MacCartney) 
(“After  the  implementation  of  the  [Act]’s  individual  man-
date, [Georgia’s Department of Community Health] experi-
enced a substantial increase in employee elections to obtain
health insurance”).

The  state  plaintiffs  emphasize  one  further  piece  of  evi-
dence, a CBO Report released in 2017.  See id., at 306–311. 
At that time, Congress was considering whether to repeal 
the  minimum  essential  coverage  provision  or,  instead, 
simply set the penalty for failure to obtain coverage to $0
for  all  taxpayers.  The  state  plaintiffs  focus  on  the  para-
graph of the CBO Report that says that either way, the re-
sult  would  be  “very  similar,”  for  “only  a  small  number  of
people” would continue to enroll in health insurance solely 
out of a “willingness to comply with the law.”  Id., at 307. 
And they argue that a “small number” is sufficient (by rais-
ing costs in furnishing Medicaid and CHIP) to provide them 
with standing. 

In  our  view,  however,  this  predictive  sentence  without 
more  cannot  show  that  the  minimum  essential  coverage 
provision was the cause of added enrollment to state health 
plans.  It does not explain, for example, who would buy in-
surance that they would not otherwise have bought.  (For