Document ID: ./input/supremecourt_opinions/opinions/20pdf/19-840_6jfm.pdf
Page Number: 14.0

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

11 

Opinion of the Court 

costs of serving those new enrollees.  As with the individual 
plaintiffs, the States also have failed to show how this in-
jury is directly traceable to any actual or possible unlawful
Government conduct in enforcing §5000A(a).  Cf. Clapper v. 
Amnesty Int’l USA, 568 U. S. 398, 414, n. 5 (2013) (“plain-
tiffs bear the burden of . . . showing that the defendant’s ac-
tual  action  has  caused  the  substantial  risk  of  harm”  (em-
phasis added)).  That alone is enough to show that they, like 
the individual plaintiffs, lack Article III standing. 

But setting aside that pure issue of law, we need only ex-
amine the initial factual premise of their claim to uncover 
another fatal weakness: The state plaintiffs have failed to
show that the challenged minimum essential coverage pro-
vision, without any prospect of penalty, will harm them by 
leading more individuals to enroll in these programs.

We have said that, where a causal relation between in-
jury and challenged action depends upon the decision of an
independent  third  party  (here  an  individual’s  decision  to 
enroll in, say, Medicaid), “standing is not precluded, but it 
is  ordinarily  ‘substantially  more  difficult’  to  establish ”  
Lujan, 504 U. S., at 562 (quoting Allen, 468 U. S., at 758); 
see also Clapper, 568 U. S., at 414 (expressing “reluctance
to endorse standing theories that rest on speculation about 
the decisions of independent actors”).  To satisfy that bur-
den, the plaintiff must show at the least “that third parties
will likely react in predictable ways.”  Department of Com-
merce v. New York, 588 U. S. ___, ___ (2019) (slip op., at 10). 
And, “at the summary judgment stage, such a party can no
longer rest on . . . mere allegations, but must set forth . . . 
specific  facts”  that  adequately  support  their  contention. 
Clapper,  568  U. S.,  at  411–412  (internal  quotation  marks 
omitted).  The state plaintiffs have not done so.

The  programs  to  which  the  state  plaintiffs  point  offer
their recipients many benefits that have nothing to do with 
the  minimum  essential  coverage  provision  of  §5000A(a). 
See,  e.g.,  42  U. S. C.  §§1396o(a)–(b)  (providing  for  no-cost