Document ID: ./input/supremecourt_opinions/opinions/20pdf/19-840_6jfm.pdf
Page Number: 38

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

13 

ALITO, J., dissenting 

to  cover  adult  children  would  expose  many  state  health
plans  to  penalties  under  42  U. S. C.  §300gg–22(b)(2),  and 
those penalties can amount to $100 per day for each person
offered noncompliant coverage.  Ibid.  Thus, the States are 
presented  with  the  choice  of  spending  millions  to  cover 
adult children or risking untold sums for failing to do so.

In  this  way,  the  States’  financial  injuries  from  offering
health coverage to adult children are traceable to the loom-
ing threat of enforcement actions.  And those financial in-
juries can be prospectively redressed by a declaratory judg-
ment making clear that the States are not, in fact, obligated
to offer health coverage to children up to age 26. 

While I have outlined two examples of concrete, tracea-
ble,  and  redressable  injuries  demonstrated  by  the  state
plaintiffs, these examples are not exhaustive.  The ACA is 
an enormously complex statute, and the States have offered 
evidence of ongoing financial injuries relating to compliance
with  many  other  different  (and  enforceable)  ACA  provi-
sions.  See, e.g., App. 81–86 (Texas’s compliance costs); id., 
at 139 (Kansas); id., at 158–162, 165–170 (Missouri); id., at 
182–184 (South Carolina); id., at 186–190 (South Dakota); 
id., at 345–350 (Georgia). 

B 
The Court largely ignores the theory of standing outlined
above.  It devotes most of its attention to two other theories, 
see ante, at 4–14, and when it does address the relevant in-
juries, its arguments are deeply flawed.

The Court’s primary argument rests on a patent distor-
tion  of  the  traceability  prong  of  our  established  test  for 
standing.  Partially quoting a line in Allen,  the Court  de-
mands a showing that the “Government’s conduct in ques-
tion is . . . ‘fairly traceable’ to enforcement of the ‘allegedly 
unlawful’  provision  of  which  the  plaintiffs  complain— 
§5000A(a).”  Ante, at 15 (quoting 468 U. S., at 751; emphasis 
added).  This is a flat-out misstatement of the law and what