Document ID: ./input/supremecourt_opinions/opinions/20pdf/19-840_6jfm.pdf
Page Number: 15.0

12 

CALIFORNIA v. TEXAS 

Opinion of the Court 

Medicaid  services  furnished  to  children  and  pregnant 
women,  and  for  emergency  services,  hospice  care,  and 
COVID–19 testing related services, among others, as well 
as  “nominal”  charges  for  other  individuals  and  services); 
§1396o(c) (prohibiting Medicaid premiums for certain indi-
viduals with family income below 150 percent of the poverty 
line and capping the premium at 10 percent of an eligible
individual’s  family  income  above  that  line);  26  U. S. C.
§36B(c)(2)(C)  (providing  premium  tax  credits  to  make
health  insurance  plans,  including  employer-sponsored 
plans, more affordable).  Given these benefits, neither logic 
nor  intuition  suggests  that  the  presence  of  the  minimum 
essential coverage requirement would lead an individual to 
enroll in one of those programs that its absence would lead 
them  to  ignore.  A  penalty  might  have  led  some  inertia-
bound individuals to enroll.  But without a penalty, what
incentive could the provision provide?

The  evidence  that  the  state  plaintiffs  introduced  in  the
District Court does not show the contrary.  That evidence 
consists  of  21  statements  (from  state  officials)  about  how 
new enrollees will increase the costs of state health insur-
ance programs, see App. 79–191, 339–363, along with one 
statement taken from a 2017 Congressional Budget Office 
(CBO) Report, see id., at 306–311. 

Of the 21 statements, we have found only 4  that allege
that added state costs are attributable to the minimum es-
sential coverage requirement.  And all four refer to that pro-
vision as it existed before Congress removed the penalty ef-
fective  beginning  tax  year  2019,  i.e.,  while  a  penalty  still
existed to be enforced.  See id., at 147–148 (decl. of Drew L.
Snyder)  (noting  “[e]fforts  to  avoid  imposition  of  the  fine
likely  prompted  more  individuals  to  seek  Medicaid  from 
[Mississippi]”); id., at 154 (decl. of Jennifer R. Tidball) (not-
ing that  “Missouri residents were  required to seek health
care coverage or pay a penalty to the federal government,” 
and  while  “it  is  difficult  to  quantify  the  exact  number  of