Document ID: ./input/supremecourt_opinions/opinions/20pdf/19-840_6jfm.pdf
Page Number: 52.0

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

27 

ALITO, J., dissenting 

the individual mandate is, in fact, a mandate, it cannot be 
considered a mere suggestion to purchase insurance.

For these reasons, I conclude that the individual mandate 
exceeds the scope of Congress’s enumerated legislative pow-
ers. 

IV 
This  brings  me  to  the  next  question:  whether  the  state
plaintiffs have shown that the provisions of the ACA impos-
ing burdens on them are inseparable from the unconstitu-
tional individual mandate.  I conclude that those provisions
are inextricably linked to the individual mandate and that
the States have therefore demonstrated on the merits that 
those other provisions cannot be enforced against them.  Ac-
cordingly, the States are entitled to a judgment providing
that they are not obligated to comply with the ACA provi-
sions that burden them. 

All the opinions in NFIB acknowledged the central role of 
the individual mandate’s tax or penalty.  In brief, the ACA 
aimed to achieve “near-universal” health-care coverage.  42 
U. S. C. §18091(2)(D).  A major obstacle was the inability of 
many individuals to obtain adequate insurance due to the 
expensive medical care they were likely to require.  To ad-
dress  that  problem,  the  ACA  included  “guaranteed  issue” 
and “community rating” provisions.  These key provisions
prohibit  insurance  companies  from  denying  coverage  or 
charging  higher  premiums  to  the  individuals  described 
above.  And to compensate for the financial impact of these
provisions on insurers, the individual mandate required the
purchase of insurance by persons whose predicted medical 
expenses were substantially lower than the premiums they 
would  pay.  See  NFIB,  567  U. S.,  at  547–548  (opinion  of 
ROBERTS,  C. J.);  id.,  at  595–599  (opinion  of  Ginsburg,  J.); 
id., at 648–651, 691–696 (joint dissent); see also King, 576 
U. S.,  at  482  (“Congress  found  that  the  guaranteed  issue