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Page Number: 37.0

14 

MOYLE v. UNITED STATES 

ALITO, J., dissenting 

even if he or she does not meet the State’s licensing require-
ments. 

While  the  Government  is  not  troubled  by  the  potential 
consequences  of  its  preemption  argument,  Congress  was
sensitive to state prerogatives.  The Medicare Act, in which 
EMTALA  is  situated,  disclaims  any  construction  that
would “authorize any Federal officer or employee to exercise
any supervision or control over the practice of medicine or 
the  manner  in  which  medical  services  are  provided”  in  a 
particular  State.    42  U. S. C.  §1395.    This  disclaimer  evi-
dences  a  desire  to  “minimize  federal  intrusion”  into  state 
healthcare  regulation.  Massachusetts  Medical  Soc.  v. 
Dukakis, 815 F. 2d 790, 791 (CA1 1987) (opinion of Breyer, 
J.).  EMTALA’s  narrow  preemption  clause  also  respects 
core  state  powers  by  providing  that  the  Act  “do[es]  not
preempt any State or local law requirement, except to the 
extent  that  the  requirement  directly  conflicts  with  a  re-
quirement of this section.”  §1395dd(f ).  This phrasing sig-
nals  that  EMTALA’s  default  position  is  coexistence  with
state law. 

In  response  to  the  Legislature’s  argument,  the  Govern-
ment  claims  that  a  handful  of  our  cases  have  held  that 
Spending Clause statutes can preempt the laws of non-con-
senting  States,  but  those  cases  do  not  begin  to  settle  the 
question at hand.  Two are entirely inapposite.15  And the 
remaining cases simply upheld the Federal Government’s
ability  to  prevent  the  use  of  federal  money  for  purposes 
—————— 

15 Coventry  Health  Care  of  Mo.,  Inc.  v.  Nevils,  581  U. S.  87,  95–99 
(2017), held that Missouri’s anti-subrogation law was preempted by the 
Federal  Employee  Health  Benefits  Act  with  regard  to  contracts  for 
health benefits negotiated between the Federal Government and insur-
ance carriers.  It did not present the question whether Spending Clause
conditions placed on private parties could preempt States from enforcing 
their criminal statutes against any of their residents—including parties
that did not contract with the Federal Government.  And in Townsend v. 
Swank,  404  U. S.  282  (1971),  the  State  itself  was  the  recipient  of  the
funds in question.