Texas et al v. United States of America et al

Filing 92

RESPONSE filed by Alex Azar, Department of Health & Human Services, David Kautter, United States Interval Revenue Services, United States of America re: 39 MOTION for Injunction (Mauler, Daniel)

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IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF TEXAS
FORT WORTH DIVISION

TEXAS, et al.,
Plaintiffs,
v.

Civil Action No. 4:18-cv-00167-O

UNITED STATES OF AMERICA, et al.,
Defendants,
and
CALIFORNIA, et al.,
Intervenors-Defendants.

FEDERAL DEFENDANTS’
MEMORANDUM IN RESPONSE TO PLAINTIFFS’ APPLICATION
FOR PRELIMINARY INJUNCTION

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TABLE OF CONTENTS
INTRODUCTION ......................................................................................................................... 1
BACKGROUND ........................................................................................................................... 3
A.

The Affordable Care Act .............................................................................................. 3

B.

The Supreme Court’s Decision in NFIB v. Sebelius ..................................................... 6

C. The Tax Cuts and Jobs Act ........................................................................................... 7
D.

This Case ...................................................................................................................... 7

LEGAL STANDARDS ................................................................................................................. 8
ARGUMENT ................................................................................................................................. 9
I.

THE INDIVIDUAL MANDATE IS UNCONSTITUTIONAL AFTER THE TCJA. ......... 9

II.

THE INDIVIDUAL MANDATE IS NOT SEVERABLE FROM THE GUARANTEEDISSUE AND COMMUNITY-RATING PROVISIONS, BUT THOSE THREE
PROVISIONS ARE SEVERABLE FROM THE REST OF THE ACA. .......................... 12
A.
B.

III.

The Guaranteed-Issue and Community-Rating Requirements Are Not Severable ... 13
The ACA’s Other Provisions Are Severable .............................................................. 16

PRELIMINARY INJUNCTIVE RELIEF IS NOT WARRANTED AT THIS TIME,
BUT A DECLARATORY JUDGMENT WOULD BE APPROPRIATE. ........................ 20

CONCLUSION ........................................................................................................................... 21

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TABLE OF AUTHORITIES
Cases

Page(s)

Alaska Airlines, Inc. v. Brock,
480 U.S. 678 (1987) ............................................................................................................... 12
Aransas Project v. Shaw,
775 F.3d 641 (5th Cir. 2014) .................................................................................................. 20
Babbitt v. United Farm Workers Nat’l Union,
442 U.S. 289 (1979) ............................................................................................................... 20
EEOC v. Hernando Bank, Inc.,
724 F.2d 1188 (5th Cir. 1984) ............................................................................................... 15
Fla. ex rel. Bondi v. U.S. Dep’t of Health & Human Servs.,
780 F. Supp. 2d 1256 (N.D. Fla. 2011) .................................................................................. 20
Harris v. United States,
536 U.S. 545 (2002) ............................................................................................................... 11
Jordan v. Fisher,
823 F.3d 805 (5th Cir. 2016) ................................................................................................ 8, 9
King v. Burwell,
135 S. Ct. 2480 (2015) ............................................................................................................ 13
Madsen v. Women’s Health Ctr., Inc.,
512 U.S. 753 (1994) ............................................................................................................... 12
Minnesota v. Mille Lacs Band of Chippewa Indians,
526 U.S. 172 (1999) ............................................................................................................... 12
Murphy v. NCAA,
138 S. Ct. 1461 (2018) ...................................................................................................... 12, 17
Nat’l Fed’n of Indep. Bus. v. Sebelius
567 U.S. 519 (2012) ....................................................................................................... passim
Nat’l Ass’n of Home Builders v. Defs. of Wildlife,
551 U.S. 644 (2007) ............................................................................................................... 16
New York v. United States,
505 U.S. 144 (1992) ............................................................................................................... 19
Nixon v. United States,
506 U.S. 224 (1993) ............................................................................................................... 12
Printz v. United States,
521 U.S. 898 (1997) ............................................................................................................... 12
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R.R. Retirement Bd. v. Alton R. Co.,
295 U.S. 330 (1935) ............................................................................................................... 12
Rodriguez v. United States,
480 U.S. 522 (1987) ................................................................................................................ 10
Town of Chester v. Laroe Estates, Inc.,
137 S. Ct. 1645 (2017) ............................................................................................................ 12
TRW Inc. v. Andrews,
534 U.S. 19 (2001) ................................................................................................................. 10
United States v. Booker,
543 U.S. 220 (2005) ............................................................................................................... 16
United States v. Fausto,
484 U.S. 439 (1987) ............................................................................................................... 10
Williams v. Standard Oil Co. of Louisiana,
278 U.S. 235 (1929) ............................................................................................................... 19
Winter v. Nat. Res. Def. Council, Inc.,
555 U.S. 7 (2008) ..................................................................................................................... 8
Statutes
21 U.S.C. § 343 ............................................................................................................................ 19
26 U.S.C. § 36B ......................................................................................................................... 3, 4
26 U.S.C. § 45R ............................................................................................................................. 3
26 U.S.C. § 106 .............................................................................................................................. 5
26 U.S.C. § 162 .............................................................................................................................. 5
26 U.S.C. § 4980H ..................................................................................................................... 3, 4
26 U.S.C. § 4980I .......................................................................................................................... 5
26 U.S.C. § 5000A ............................................................................................................... passim
26 U.S.C. § 6055 ............................................................................................................................ 5
26 U.S.C. § 6056 ............................................................................................................................ 5
42 U.S.C. § 300gg .......................................................................................................................... 3
42 U.S.C. § 300gg-1 ...................................................................................................................... 3
42 U.S.C. § 300gg-3 ...................................................................................................................... 3
42 U.S.C. § 300gg-4 ...................................................................................................................... 3
42 U.S.C. § 300gg-11 .................................................................................................................... 3
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42 U.S.C. § 300gg-12 .................................................................................................................... 3
42 U.S.C. § 300gg-14 .................................................................................................................... 3
42 U.S.C. § 300gg-18 .................................................................................................................... 3
42 U.S.C. § 1396a .......................................................................................................................... 4
42 U.S.C. § 18011 .......................................................................................................................... 4
42 U.S.C. § 18022 .......................................................................................................................... 3
42 U.S.C. § 18091 ................................................................................................................ passim
42 U.S.C. §§ 18031–18044 ............................................................................................................ 3
Pub. L. No. 111-148, 124 Stat. 119 (2010) ........................................................................... passim
Pub. L. No. 112-240, 126 Stat. 2313 (2013) .................................................................................. 5
Pub. L. No. 114-113, 129 Stat. 2242 (2015) .................................................................................. 5
Pub. L. No. 115-96, 131 Stat. 2044 (2017) ...................................................................................18
Pub. L. No. 115-97, 131 Stat. 2054 (2017) .....................................................................................1
Pub. L. No. 115-120, 132 Stat. 28 (2018) .......................................................................................5
Pub. L. No. 115-123, 132 Stat. 64 (2018) .....................................................................................18
Legislative Materials
H.R. Rep. No. 443, 111th Cong., 2d Sess. Pt. 2 (2010) ................................................................17
H.R.1, 115th Cong., “An Act to provide for reconciliation pursuant to titles II and V of the
concurrent resolution on the budget for fiscal year 2018”.............................................................16
Other Authorities
Cong. Research Serv., Bill Heniff Jr., The Budget Reconciliation Process: The Senate’s “Byrd
Rule” (Nov. 22, 2016),
https://fas.org/sgp/crs/misc/RL30862.pdf ...............................................................................16

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INTRODUCTION
In the Affordable Care Act (ACA), Pub. L. No. 111-148, 124 Stat. 119 (2010), Congress
fundamentally altered the American health-insurance system by imposing a “[r]equirement” for
most Americans “to maintain minimum essential coverage.” 26 U.S.C. § 5000A(a). In light of
the basis on which the Supreme Court previously held that this “individual mandate” survived
constitutional scrutiny, the United States agrees with the Plaintiffs that Section 5000A(a) must
now be struck down as unconstitutional in light of the amendments that were made to it in the Tax
Cuts and Jobs Act (TCJA), Pub. L. No. 115-97, 131 Stat. 2054 (2017).
Two years after the ACA’s passage, the Supreme Court held that the individual mandate
in Section 5000A(a) exceeded the scope of Congress’s commerce power. National Fed’n of Indep.
Bus. v. Sebelius (NFIB), 567 U.S. 519, 572 (2012) (“The Court today holds that our Constitution
protects us from federal regulation under the Commerce Clause so long as we abstain from the
regulated activity.”).

The Court nevertheless held that the provision “may reasonably be

characterized as a tax” because, among other things, it “yields the essential feature of any tax” in
that “[i]t produces at least some revenue for the Government.” Id. at 564; see id. at 574. Chief
Justice Roberts’ controlling opinion made clear, however, that “the statute reads more naturally as
a command to buy insurance than as a tax,” and that “it is only because [courts] have a duty to
construe a statute to save it, if fairly possible, that [the provision] can be interpreted as a tax” given
the revenue raised. Id. at 574; accord id. at 562–63 (opinion of Roberts, C.J.) (“The most
straightforward reading of the mandate is that it commands individuals to purchase insurance,” but
there is a savings construction under which it “can be regarded as establishing a condition . . . that
triggers a tax” in light of “the required payment to the IRS.”).
Critically, however, the Supreme Court’s saving construction of the individual mandate as
a tax is no longer available. The TCJA eliminated the penalty for failing to purchase minimum
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essential coverage (starting in 2019), but left untouched the statutory “[r]equirement to maintain
minimum essential coverage” in Section 5000A(a). See Pub. L. No. 115-97, § 11081, 131 Stat. at
2092. The individual mandate thus still exists, but it will no longer be fairly possible to describe
it as a tax because it will no longer generate any revenue.
As of 2019, therefore, the individual mandate will be unconstitutional under controlling
Supreme Court precedent holding that “[t]he Federal Government does not have the power to order
people to buy health insurance.” NFIB, 567 U.S. at 574‒75 (opinion of Roberts, C.J.); accord id.
at 547‒561; id. at 649‒60 (opinion of Scalia, Kennedy, Thomas, Alito, JJ. (“joint dissent”)).
Because the TCJA eliminated the basis for the Court’s saving construction in NFIB, the individual
mandate is untethered to any source of constitutional authority. Furthermore, as the United States
explained to the Court in NFIB, Congress’s own “findings establish that the guaranteed-issue and
community-rating provisions are inseverable from the minimum coverage provision.” Br. for
Resp’t (Severability) at 45, NFIB, No. 11-393 (citing 42 U.S.C. § 18091(2)(I)). The remainder of
the ACA, however, can stand despite the invalidation of those provisions. See id. at 26‒44.
Although Plaintiffs are likely to succeed in part on the merits, they are not entitled to a
preliminary injunction. As Plaintiffs agree that the mandate will not become unconstitutional until
the tax is eliminated in 2019, immediate relief is not warranted. That said, because this is a pure
question of law on which the Plaintiffs and Defendants do not disagree, this Court should consider
construing Plaintiffs’ motion as a request for summary judgment and then entering a declaratory
judgment that the ACA’s provisions containing the individual mandate as well as the guaranteedissue and community-rating requirements will all be invalid beginning on January 1, 2019.

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BACKGROUND
A.

The Affordable Care Act
The ACA established a framework of economic regulations and incentives concerning the

health-insurance and healthcare industries. It spans more than 900 pages of the session laws and
is divided into nine titles. Many of the ACA’s more familiar major provisions relating to the
regulation of health insurance are in Titles I and II. There, among other things, Congress:
•
•

•

•

•

Required certain individuals to maintain insurance. As detailed below, the ACA
required most Americans to maintain health insurance meeting specified standards,
subject to a monetary exaction for failure to do so. 26 U.S.C. § 5000A.
Subjected certain employers to tax consequences concerning sponsorship of insurance.
The ACA imposed tax liabilities under certain circumstances on large employers that
do not offer a minimum mandated level of coverage to full-time employees, 26 U.S.C.
§ 4980H—a provision sometimes referred to as the “employer mandate”—and
established tax incentives for eligible small businesses to purchase health insurance for
their employees, 26 U.S.C. § 45R.
Created health insurance exchanges. The ACA created health insurance “exchanges”
where qualified health plans could be purchased by individuals and small businesses.
42 U.S.C. §§ 18031–18044. A State may choose whether or not to set up an exchange;
if it elects not to, the federal government will establish one. Id. § 18041(b), (c).
Imposed numerous insurance-market regulations. Two of the insurance market
regulations prohibit insurers from either denying coverage because of an enrollee’s
medical condition or history (“guaranteed issue”), id. §§ 300gg-1, 300gg-3, 300gg4(a), or charging higher premiums because of an applicant’s or enrollee’s medical
condition or history (“community rating”), id. §§ 300gg(a)(1), 300gg-4(b). Among
other requirements, the ACA also:
o Required insurers providing family coverage to continue covering adult
children until age 26. Id. § 300gg-14(a).
o Barred insurers from placing lifetime dollar caps on benefits. Id. § 300gg-11.
o Prohibited insurers from canceling insurance absent fraud or intentional
misrepresentation. Id. § 300gg-12.
o Established medical loss ratios for insurers—i.e., minimum percentages of
premium revenues that insurers must spend on clinical services and activities
that improve health-care quality. See id. § 300gg-18(b).
o Required plans to cover certain “essential health benefits.” Id. § 18022.
Provided tax incentives to subsidize certain individuals’ purchase of insurance. The
ACA established a system of tax credits for eligible individuals (i.e., those with income
between 100% and 400% of the federal poverty level) to purchase health insurance. 26
U.S.C. § 36B.

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•

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Expanded the scope of the Medicaid program. The newly eligible are primarily nonelderly adults without dependent children with income below a certain threshold. 42
U.S.C. § 1396a(a)(10)(A)(i)(VIII). 1

Perhaps foremost among the ACA’s provisions is the individual mandate to maintain
insurance. 26 U.S.C. § 5000A. Subsection (a) of that provision imposes a “[r]equirement to
maintain minimum essential coverage” stating that certain individuals “shall . . . ensure” that they
are “covered under minimum essential coverage.” Id. § 5000A(a). Subsection (b) of that provision
then imposes “a penalty,” called a “shared responsibility payment,” on certain taxpayers who
“fail[] to meet the requirement of subsection (a).” Id. § 5000A(b). And subsection (c) provides
“[t]he amount of the penalty imposed.” Id. § 5000A(c). Notably, subsection (d) provides that
certain individuals—i.e., people with religious exemptions, individuals not lawfully present in the
United States, and incarcerated individuals—are entirely exempt from the requirement to maintain
minimum essential coverage, id. § 5000A(d), whereas subsection (e) provides that certain other
individuals remain subject to that requirement but are exempt from the penalty for noncompliance, id. § 5000A(e) (i.e., those who cannot afford coverage, taxpayers with income below
the filing threshold, members of Indian tribes, those experiencing short coverage gaps, and
individuals determined by the Secretary of Health and Human Services to have suffered a hardship
with respect to obtaining coverage). Finally, subsection (f) defines “minimum essential coverage”
to mean various types of insurance coverage, including government-sponsored programs such as
Medicare and Medicaid, id. § 5000A(f)(1)(A), as well as eligible employer-sponsored plans and
plans offered in the non-group market, id. § 5000A(f)(1)(B)–(D); 42 U.S.C. § 18011. 2
1

The ACA as originally enacted required States either to expand their Medicaid programs in this manner or lose all
federal Medicaid funding. The Supreme Court in NFIB invalidated the requirement and held that States may elect to
decline this expansion without jeopardizing funding for their existing Medicaid programs. 567 U.S. at 575–88.
2
The definition of “minimum essential coverage” in Section 5000A(f) also serves a variety of other purposes
throughout the Internal Revenue Code. For example, a large employer that fails to offer its employees minimum
essential coverage is in certain circumstances subject to a tax. 26 U.S.C. § 4980H(a), (b). An individual’s eligibility
for minimum essential coverage governs his or her eligibility for a tax credit for the purchase of insurance. Id. §

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The ACA contains a specific finding by Congress that the “individual responsibility
requirement” to maintain insurance is “essential” to “creating effective health insurance markets
in which improved health insurance products that are guaranteed issue and do not exclude coverage
of pre-existing conditions can be sold,” because “many individuals would wait to purchase health
insurance until they needed care” “if there were no requirement.” 42 U.S.C. § 18091(1), (2)(I).
More generally, Congress found that “[t]he requirement is an essential part” of the ACA’s
“regulation of the health insurance market.” Id. § 18091(2)(H); see also id. § 18091(2)(C)–(G),
(J) (identifying other ways in which the requirement furthered the ACA’s objectives).
Beyond Titles I and II, the ACA addresses numerous other issues. For example:
•

•

•
•
•
•
•

Title III amended Medicare. Among other provisions, it revised the Medicare Part D
prescription drug program, § 3301; modified certain Medicare reimbursement rates for
hospitals, § 3133; and required quality reporting for long-term care hospitals, inpatient
rehabilitation hospitals, and hospice programs, § 3004.
Title IV funded existing prevention programs and created new prevention programs.
For example, it created the National Prevention, Health Promotion and Public Health
Council, §§ 4001, 4002; required that chain restaurants disclose nutritional
information, § 4205; and funded school-based health clinics, § 4101.
Title V sought to expand the supply of health care workers, including through
modifications to the federal student loan program, § 5201, and a variety of subjectspecific grants.
Title VI enacted anti-fraud requirements for facilities participating in Medicare and
Medicaid, including screening providers, § 6401, and programs to reduce elder abuse.
Title VII expanded the 340B drug discount program, § 7101, and established a process
for FDA licensing of biosimilar products, § 7002.
Title VIII established a voluntary long-term care insurance program, § 8002 (which has
since been repealed, see Pub. L. No. 112-240, § 642(a), 126 Stat. 2313, 2358 (2013)).
Title IX addressed various taxes, including an excise tax on high-cost plans, § 9001,
which has not yet taken effect due to postponements, see Pub. L. No. 114-113, § 101(a),
129 Stat. 2242, 3037 (2015); Pub. L. No. 115-120, § 4002, 132 Stat. 28, 38 (2018).

36B(b)(3). A “person who provides minimum essential coverage” is required to make an informational return with
the IRS. Id. § 6055. Large employers must also make a return describing whether they offer minimum essential
coverage to their employees. Id. § 6056. The taxability of certain health insurance reimbursement arrangements for
employees depends on the definition of minimum essential coverage. Id. § 106(g). An excise tax on high-cost health
coverage also turns on the concept of minimum essential coverage, id. § 4980I, as does the deductibility of certain
business expenses by health insurance providers, id. § 162(m)(6)(C)–(D).

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B.

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The Supreme Court’s Decision in NFIB v. Sebelius
In the years immediately following the ACA’s enactment, a variety of challenges to its

constitutionality were filed in federal court, many of which focused on whether Congress had the
power under Article I of the Constitution to enact Section 5000A. That question was resolved by
the Supreme Court in NFIB, a case brought by a small-business association and several individuals
as well as 26 States, including 16 of the State Plaintiffs here. See 567 U.S. at 520.
In NFIB, the Supreme Court held that although Section 5000A was not authorized by
Congress’s commerce power, it was a valid exercise of the taxing power. As Chief Justice Roberts
explained in his controlling opinion, in light of the statutory language that individuals “‘shall’”
maintain coverage, the “most straightforward reading of the mandate is that it commands
individuals to purchase insurance.” 567 U.S. at 562 (quoting 26 U.S.C. § 5000A(a)). Furthermore,
the Chief Justice agreed with the four dissenters that the “Commerce Clause does not authorize
such a command,” id. at 574; accord id. at 547–561; id. at 649–60 (joint dissent)—a holding of
the Court that was acknowledged in the portion of the Chief Justice’s opinion that was joined by
a majority of the Court. Id. at 572 (“The Court today holds that our Constitution protects us from
federal regulation under the Commerce Clause so long as we abstain from the regulated activity.”).
Nevertheless, because “[u]nder the mandate, if an individual does not maintain health insurance,
the only consequence is that he must make an additional payment to the IRS when he pays his
taxes,” Chief Justice Roberts agreed with the government that “the mandate can be regarded as
establishing a condition . . . that triggers a tax,” given the obligation to adopt “a saving
construction” “if fairly possible.” Id. at 562–63 (citing 26 U.S.C. § 5000A(b)), 574–75. A
majority of the Court agreed that Section 5000A so construed could be upheld under Congress’s
taxing power. Id. at 570. But critical to the Court’s saving construction and constitutional holding

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was the fact that the individual mandate’s shared responsibility payment “yield[ed] the essential
feature of any tax: [i]t produces at least some revenue for the Government.” Id. at 564.
C.

The Tax Cuts and Jobs Act
In the TCJA, Congress enacted a variety of amendments to the Internal Revenue Code. As

relevant here, the Act amended Section 5000A(c) by reducing to $0 the monetary exaction
imposed for noncompliance with the “[r]equirement to maintain minimum essential coverage” for
tax-years 2019 and beyond. See Pub. L. No. 115-97, § 11081, 131 Stat. at 2092. Under the ACA,
the tax penalty for failing to maintain minimum essential coverage for those years was to be the
greater of 2.5% of household income or $695. The TCJA amended those figures to “Zero percent”
and “$0.” Id. The TCJA leaves the rest of Section 5000A intact, including the “[r]equirement” in
subsection (a) that applicable individuals “shall … ensure” they are covered by “minimum
essential coverage.” Congress also left untouched the congressional findings in Section 18091 that
the “individual responsibility requirement” to maintain insurance was “essential” to the
guaranteed-issue and community-rating insurance reforms. See 42 U.S.C. § 18091(2)(H)‒(I).
D.

This Case
Plaintiffs are 20 States and two individuals. Intervenors-Plaintiffs are two employers.

Among other things, the individual plaintiffs have declared that the individual mandate legally
obligates them to maintain minimum essential coverage, but that they wish instead to purchase
non-ACA-compliant insurance that better reflects their actuarial risks. See App’x in Support of
Application for Preliminary Injunction, Dkt. No. 41, at App.004 (“My preference would be to
purchase reasonably-priced insurance coverage that is consumer-driven in accordance with my
actuarial risk.”); App.008 (“The ACA prevents me from obtaining care from my preferred health
care providers and has greatly increased my health insurance costs. I would purchase reasonably
priced insurance coverage that allowed me to access care locally from my preferred service
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providers, were I not limited to the plans provided through the federal health insurance
marketplace.”).
The complaint and the complaint-in-intervention raise five claims. Their central contention
(Count 1) is that Section 5000A, as amended by the TCJA, falls outside of Congress’s Article I
powers and is inseverable from the rest of the ACA, which they claim is thus invalid in its entirety.
Am. Compl., Dkt. No. 27, ¶¶ 55–57; Complaint-in-Intervention, Dkt. No. 81-1, ¶¶ 54–66. In
Count 2, Plaintiffs claim that if Section 5000A is unconstitutional, then “the rest of the ACA is
irrational” and thus violates due process. Am. Compl. ¶ 65; Complaint-in-Intervention ¶¶ 71. In
Count 3, they claim that if Section 5000A is unconstitutional, then the rest of the ACA “is outside
the powers delegated to the United States by the Constitution” and thus violates the Tenth
Amendment. Am. Compl. ¶ 73; Complaint-in-Intervention ¶ 79. In Count 4, Plaintiffs assert that
if the ACA is invalid in its entirety, then “all regulations” issued under its authority must be
declared invalid. Am. Compl. ¶ 81; Complaint-in-Intervention ¶ 87. In Count 5, Plaintiffs assert
an entitlement to injunctive relief. Am. Compl. ¶ 85; Complaint-in-Intervention ¶ 91. Because
Plaintiffs’ preliminary injunction brief solely relies (pp. 21–40) on their Count 1 claim that Section
5000A as amended by the TCJA is unconstitutional and inseverable from the rest of the ACA, that
is the only claim to which Defendants respond here.
LEGAL STANDARDS
“A preliminary injunction is an extraordinary remedy never awarded as of right.” Winter
v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 24 (2008). A party seeking a preliminary injunction
must show: “(1) a substantial likelihood of success on the merits, (2) a substantial threat of
irreparable injury if the injunction is not issued, (3) that the threatened injury if the injunction is
denied outweighs any harm that will result if the injunction is granted, and (4) that the grant of an
injunction will not disserve the public interest.” Jordan v. Fisher, 823 F.3d 805, 809 (5th Cir.
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2016). Due to its “extraordinary” nature, no preliminary injunction should be “granted unless the
party seeking it has clearly carried the burden of persuasion on all four requirements.” Id. at 221
(citation omitted).
ARGUMENT
The United States agrees with Plaintiffs that the ACA’s individual mandate, as amended
by the TCJA, is unconstitutional. Because Section 5000A(a) can no longer fairly be described as
a tax after the TCJA amendment takes effect in 2019, the saving construction adopted by NFIB
will no longer be available. Instead, Section 5000A(a) must be interpreted per its plain text as a
freestanding legal mandate to maintain insurance, which NFIB squarely held exceeds the powers
of Congress. And as the United States explained in NFIB, the individual mandate cannot be
severed from the guaranteed-issue and community-rating provisions, though those three provisions
can be severed from the rest of the ACA. Nonetheless, as explained below, preliminary injunctive
relief should not be issued; instead, this Court should simply enter a declaratory judgment.
I.

THE INDIVIDUAL MANDATE IS UNCONSTITUTIONAL AFTER THE TCJA.
Starting in 2019, the TCJA will eliminate the individual mandate’s tax penalty under

Section 5000A(b)‒(c), but it will not alter the mandate’s plain-text “[r]equirement to maintain
minimum essential coverage” under Section 5000A(a). The individual mandate will continue to
provide that applicable individuals “shall . . . ensure” that they are “covered under minimum
essential coverage.” 26 U.S.C. § 5000A(a). Yet the only available interpretation of that plain text
will be that it mean what it says: there is a legal mandate to obtain insurance; the mandate can no
longer instead fairly be interpreted as a tax because it will raise no revenue as Congress has
eliminated the monetary penalty.
This plain-text interpretation is confirmed by the Supreme Court’s decision in NFIB. The
Chief Justice’s controlling opinion repeatedly acknowledged—and the four Justices in the joint
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dissent asserted even more emphatically—that “[t]he most straightforward reading of the mandate
is that it commands individuals to purchase insurance. After all, it states that individuals ‘shall’
maintain health insurance.” NFIB, 567 U.S. at 562 (quoting § 5000A(a)); see also id. at 574 (“the
statute reads more naturally as a command to buy insurance than as a tax”); id. at 662–63 (joint
dissent) (describing Section 5000A(a) as “unquestionably” a “mandate . . . enforced by a penalty”
rather than a tax).

Although the Chief Justice concluded at the time that it was “fairly possible”

to interpret the mandate as merely “establishing a condition—not owning health insurance—that
triggers a tax—the required payment to the IRS,” id. at 563, that saving construction is no longer
available because, post-TCJA, the mandate no longer “yields the essential feature of any tax,”
which is that it must “produce[] at least some revenue for the Government.” Id. at 564 (opinion
of the Court); see also id. at 574 (opinion of Roberts, C.J.) (“Congress’s authority under the taxing
power is limited to requiring an individual to pay money into the Federal Treasury, no more.”).
This plain-text interpretation is further confirmed by established canons of construction.
First, it is “a cardinal principle” that a statute should be construed so that “no clause, sentence, or
word shall be superfluous, void, or insignificant.” TRW Inc. v. Andrews, 534 U.S. 19, 31 (2001).
Here, in light of the elimination of the Section 5000A(b) penalty, Section 5000A(a) would be
utterly meaningless unless it imposes a legal requirement that covered individuals shall maintain
insurance, as would Section 5000A(d)’s exemption from that requirement.

See 26 U.S.C.

§ 5000A(d) (setting forth certain categories of individuals who are not subject to Section
5000A(a)’s “[r]equirement to maintain minimum essential coverage”). Second, “Congress is
presumed to act with full awareness of existing judicial interpretations.” United States v. Fausto,
484 U.S. 439, 460 n.6 (1987) (citing Rodriguez v. United States, 480 U.S. 522, 525 (1987) (per
curiam)). Here, Congress was indisputably aware of NFIB’s saving construction of Section

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5000A(a)’s individual mandate, and that it rested on the revenue raised by Section 5000A(b)’s
penalty. Yet Congress eliminated the linchpin of that saving construction—the revenue-raising
penalty—without altering the unambiguous language of the mandate itself. Cf. Harris v. United
States, 536 U.S. 545, 556 (2002) (refusing to apply the canon of constitutional avoidance where
doing so would contradict the “respect for Congress” upon which “[t]he avoidance canon rests”).
This plain-text interpretation is also shared by at least some members of the public. See
App’x in Support of Application for Preliminary Injunction at App.004 (“I value compliance with
my legal obligations, and believe that following the law is the right thing to do. The repeal of the
associated health insurance tax penalty did not relieve me of the requirement to purchase health
insurance. I continue to maintain minimum essential health insurance coverage because I am
obligated to comply with the Affordable Care Act’s individual mandate, even though doing so is
a burden to me.”); App.008 (same).
In sum, once the associated financial penalty is gone, the “tax” saving construction will no
longer be fairly possible and thus the individual mandate will be unconstitutional. As a majority
of the Supreme Court held in NFIB, “[t]he Federal Government does not have the power to order
people to buy health insurance. Section 5000A would therefore be unconstitutional if read as a
command.” NFIB, 567 U.S. at 575 (opinion of Roberts, C.J.); see also id. at 706‒07 (joint dissent);
id. at 572 (opinion of the Court). Because Section 5000A(a) must be read as a command once the
TCJA’s elimination of the penalty takes effect in 2019, it will exceed Congress’s enumerated
powers.

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II.

Page 17 of 27 PageID 1514

THE INDIVIDUAL MANDATE IS NOT SEVERABLE FROM THE
GUARANTEED-ISSUE AND COMMUNITY-RATING PROVISIONS, BUT
THOSE THREE PROVISIONS ARE SEVERABLE FROM THE REST OF THE
ACA.
In addition to claiming that the individual mandate is unconstitutional in light of the TCJA,

Plaintiffs claim that the rest of the ACA is not severable from the unconstitutional mandate. A
plaintiff seeking to invalidate provisions of a statute as inseverable must show that it is “evident
that Congress would not have enacted those provisions which are within its power, independently
of those which are not.” Murphy v. NCAA, 138 S. Ct. 1461, 1482 (2018); see also Alaska Airlines,
Inc. v. Brock, 480 U.S. 678, 684–85 (1987). This inquiry reflects the fact that under our
Constitution, the Judiciary “cannot rewrite a statute and give it an effect altogether different from
that sought by the measure viewed as a whole.” Murphy, 138 S. Ct. at 1482 (quoting R.R.
Retirement Bd. v. Alton R. Co., 295 U.S. 330, 362 (1935)). Although the Supreme Court’s test for
severability is “essentially an inquiry into legislative intent,” Minnesota v. Mille Lacs Band of
Chippewa Indians, 526 U.S. 172, 191 (1999), “the enacted text is the best indicator of intent,”
Nixon v. United States, 506 U.S. 224, 232 (1993). 3

3

In addition, plaintiffs may only seek to invalidate statutory provisions as inseverable if those provisions themselves
injure them. The Supreme Court has held that it “ha[s] no business answering” questions about the inseverability of
provisions that concern only “the rights and obligations of parties not before the court.” Printz v. United States, 521
U.S. 898, 935 (1997); see also Murphy, 138 S. Ct. at 1485–87 (Thomas, J. concurring). And that holding is consistent
with basic limitations on Article III standing and equitable remedies. See, e.g., Town of Chester v. Laroe Estates, Inc.,
137 S. Ct. 1645, 1650 (2017) (“[S]tanding is not dispensed in gross,” and “a plaintiff must demonstrate standing . . .
for each form of relief that is sought.” (citations omitted)); Madsen v. Women’s Health Ctr., Inc., 512 U.S. 753, 765
(1994) (explaining that equitable relief must “be no more burdensome to the defendant than necessary to provide
complete relief to the plaintiffs” (citation omitted)). Here, the individual plaintiffs have adequately alleged injury
from the ACA’s guaranteed-issue and community-rating provisions. See, e.g., App’x in Support of Application for
Preliminary Injunction at App.004 (“My preference would be to purchase reasonably-priced insurance coverage that
is consumer-driven in accordance with my actuarial risk.”). By contrast, Plaintiffs have not argued and cannot argue
that each and every other provision in the ACA also injures them. Accordingly, regardless of whether other provisions
of the ACA are inseverable and whether this Court may consider that question in analyzing the inseverability of the
guaranteed-issue and community-rating provisions, it would be improper for this Court to enter judgment on the
inseverability of any of the many ACA provisions that do not injure Plaintiffs.

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Here, as the United States has consistently maintained, the individual mandate is not
severable from the ACA’s guaranteed-issue and community-rating requirements, but it is severable
from the ACA’s other provisions.
A.

The Guaranteed-Issue and Community-Rating Requirements Are Not
Severable

The United States contended in NFIB that “Congress’s findings establish that the
guaranteed-issue and community-rating provisions are inseverable from the minimum coverage
provision.” Br. for Resp. (Severability) at 45, NFIB, No. 11-393. And the Supreme Court has
since essentially agreed, noting that these “three reforms are closely intertwined” and that
“Congress found that the guaranteed issue and community rating requirements would not work
without the coverage requirement.” King v. Burwell, 135 S. Ct. 2480, 2487 (2015).
That finding, set forth at 42 U.S.C. § 18091(2)(I), specifically and expressly explains why
Congress believed that the individual mandate requirement is “essential” to the operation of the
guaranteed-issue and community-rating provisions. Namely, “if there were no requirement, many
individuals would wait to purchase health insurance until they needed care.” Id. But “[b]y
significantly increasing health insurance coverage,” the mandate, “together with the other
provisions of this Act, will minimize this adverse selection and broaden the health insurance risk
pool to include healthy individuals, which will lower health insurance premiums.”

Id.

Accordingly, the individual mandate “is essential to creating effective health insurance markets in
which improved health insurance products that are guaranteed issue and do not exclude coverage
of pre-existing conditions can be sold.” Id. In short, Congress found that enforcing guaranteedissue and community-rating requirements without an individual mandate would allow individuals
to game the system by waiting until they were sick to purchase health insurance, thereby increasing

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the price of insurance for everyone else—the polar opposite of what Congress sought in enacting
the ACA.
Indeed, Congress’s conclusions regarding the linkage between the individual mandate,
guaranteed-issue, and community-rating requirements were agreed upon by all of the Justices in
NFIB. See 567 U.S. at 548 (opinion of Roberts, C.J.) (“The guaranteed-issue and communityrating reforms … exacerbate” the “problem” of “healthy individuals who choose not to purchase
insurance to cover potential health care needs,” and “threaten to impose massive new costs on
insurers[.] … The individual mandate was Congress’s solution to these problems.”); id. at 597–98
(Ginsburg, J., concurring in part and dissenting in part) (“[T]hese two provisions, Congress
comprehended, could not work effectively unless individuals were given a powerful incentive to
obtain insurance. … [G]uaranteed-issue and community-rating laws alone will not work.”); id. at
695–96 (joint dissent) (“Insurance companies bear new costs imposed by a collection of insurance
regulations and taxes, including ‘guaranteed issue’ and ‘community rating’ requirements . . . but
the insurers benefit from the new, healthy purchasers who are forced by the Individual Mandate to
buy the insurers’ product.”).
In expressly finding this link between these three provisions, Congress looked to
experiences from prior state experiments in restructuring their laws governing health insurance.
In some States, insurers were forced to cover everyone and charge the same rates regardless of
health status, and chose to raise premiums for healthy individuals. See Br. of America’s Health
Insurance Plans and the Blue Cross Blue Shield Association as Amici Curiae in Support of
Reversal of the Court of Appeals’ Severability Judgment at 8‒11, NFIB, No. 11-393. For example,
after imposing guaranteed-issue and community-rating requirements without an individual
mandate, New Hampshire experienced an increase in premiums and, ultimately, all but two

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insurers withdrew from the State. See Br. for Resp’t (Severability) at 49, NFIB, No. 11-393; see
also id. at 48‒51 (collecting examples). Thus, Congress acted on the assumption that severing the
individual mandate from the guaranteed-issue and community-rating provisions “necessarily
would impose significant risks and real uncertainties on insurance companies, their customers, all
other major actors in the system, and the government treasury.” NFIB, 567 U.S. at 699 (joint
dissent). Although the empirical assumptions underlying this connection may be subject to dispute
(see, e.g., Br. for Court-Appointed Amicus Curiae Supporting Complete Severability at 35‒41,
NFIB, No. 11-393), what is indisputable is that Congress believed that these three provisions were
interdependent in enacting the ACA.
That conclusion is not affected by the fact that the TCJA eliminated the mandate’s penalty.
It still remains the case that, in the complete absence of the mandate, retention of the guaranteedissue and community-rating requirements would expose health insurers (and their customers) to
unfettered adverse selection by individuals who can game the system by waiting until they are sick
to purchase insurance, contrary to Congress’s express intent. 42 U.S.C. § 18091(2)(I). Nor is this
conclusion undermined by the fact that the TCJA did not itself eliminate the guaranteed-issue and
community-rating requirements at the same time it eliminated the mandate’s penalty and thereby
rendered the mandate unconstitutional. The best evidence of Congress’s intent is found in the
legislative findings, which continue to remain part of the ACA after the TCJA. These express
findings continue to describe the mandate as “essential” to the operation of the guaranteed-issue
and community-rating provisions. See EEOC v. Hernando Bank, Inc., 724 F.2d 1188, 1190–91
(5th Cir. 1984) (noting that in determining “whether Congress would have enacted the remainder
of the statute in the absence of the invalid provision[,] … [c]ongressional intent and purpose are
best determined by an analysis of the language of the statute in question”). Those findings cannot

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be deemed to have been impliedly repealed by Congress’s mere elimination of the financial
penalty. See Nat’l Ass’n of Home Builders v. Defs. of Wildlife, 551 U.S. 644, 662 (2007)
(explaining that “‘repeals by implication are not favored’ and will not be presumed unless the
‘intention of the legislature to repeal is clear and manifest’” (citation omitted)). 4
B.

The ACA’s Other Provisions Are Severable

As the United States also contended in NFIB, the remainder of the ACA is severable from
the individual mandate and the guaranteed-issue and community-rating requirements. Br. for
Resp’t (Severability) at 44‒54, NFIB, No. 11-393.
1. The ACA’s other major provisions—concerning various insurance regulations, health
insurance exchanges and associated subsidies, the employer mandate and Medicaid expansion, and
reduced federal healthcare reimbursement rates for hospitals—are severable from the individual
mandate. Although Congress made clear its belief that the mandate is not severable from the
guaranteed-issue and community-rating requirements, see 42 U.S.C. § 18091(2)(I), Congress did
not do so with respect to the ACA’s other major provisions.
The ACA contains numerous mechanisms designed to expand health insurance coverage
through federal regulation. Each of these provisions can independently operate “consistent with
Congress’ basic objectives in enacting the statute,” and therefore, this Court “must retain” them.
United States v. Booker, 543 U.S. 220, 258‒59 (2005). Although Plaintiffs speculate (Br. at 35‒
39) as to a chain reaction of failed policymaking that could occur once the individual mandate is
struck down, they cannot show that striking down the individual mandate, guaranteed-issue, and

4
That is especially true given that Congress passed the TCJA by a majority vote under the restrictive reconciliation
process, which limits congressional action to generally fiscal matters. See H.R.1, 115th Cong., “An Act to provide
for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018”; Cong.
Research Serv., Bill Heniff Jr., The Budget Reconciliation Process: The Senate’s “Byrd Rule” (Nov. 22, 2016),
https://fas.org/sgp/crs/misc/RL30862.pdf (last visited June 7, 2018). Although Congress was able to revoke the tax
penalty, it could not have revoked the guaranteed-issue or community-rating provisions through reconciliation.

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community-rating requirements means that the ACA necessarily “ceases to implement any
coherent federal policy.” Murphy, 138 S. Ct. at 1483. Congress’s other legislative findings in 42
U.S.C. § 18091(2) demonstrate that, instead, these other provisions are severable from the
mandate. See 42 U.S.C. § 18091(2)(C), (E), (F) (finding that the “individual responsibility
requirement,” “together with the other provisions of this Act,” will accomplish Congress’s
objectives of “increas[ing] the number and share of Americans who are insured” and “significantly
reducing the number of the uninsured”). The other major provisions still serve the objectives that
Congress had when enacting the ACA notwithstanding the elimination of the mandate (plus
guaranteed-issue and community-rating)—especially given that Congress itself reduced the effect
of the mandate by eliminating its penalty in the TCJA, and yet did not repeal the rest of the ACA
despite repeated attempts to do so.
For example, Congress has repeatedly expanded the scope of Medicaid since the inception
of the program over half a century ago. There is no reason why the ACA’s particular expansion
of Medicaid hinges on the individual mandate. The same can be said about the health insurance
exchanges, which likewise can operate as functioning “marketplace[s] for the purchase of health
insurance” without the individual mandate. H.R. Rep. No. 443, 111th Cong., 2d Sess. Pt. 2, at 976
(2010) (citation omitted); see also 42 U.S.C. § 18091(2)(J) (“By significantly increasing health
insurance coverage and the size of purchasing pools, which will increase economies of scale, the
requirement, together with the other provisions of this Act, will significantly reduce administrative
costs and lower health insurance premiums.”). This is not a case like Murphy in which the Court
concluded that finding one provision severable from another would inherently bring about “a weird
result.” 138 S. Ct. at 1483–84 (“If the people of a State support the legalization of [an activity],
federal law would make the activity illegal.”). Instead, Plaintiffs rely on a chain of speculative

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hypotheticals, which are not strong enough to justify invalidating these other parts of the ACA’s
insurance market regulations.
Congress has provided further proof of its intent that the bulk of the ACA would remain in
place by amending the ACA on numerous occasions after the TCJA invalidated the individual
mandate.

See Pub. L. No. 115-120, § 3002(g)(2), 132 Stat. at 35 (amending 26 U.S.C.

§ 5000A(f)(1) (revising definition of “minimum essential coverage,” which is relevant to various
insurance reforms besides the mandate, see supra at 7–8 n.2)); id. § 4002, 132 Stat. at 38
(amending ACA § 9001(c) (delaying implementation date of excise tax on high cost employersponsored health coverage)); id. § 4003 (amending ACA § 9010(j) (suspending annual fee on
health insurance providers)); see also Pub. L. No. 115-123, §§ 50207, 50208, 50901(a), (c), 52001,
53103, 53119, 132 Stat. 64, 186–89, 283–88, 298, 300–01, 308–13 (2018); Pub. L. No. 115-96,
§§ 3101, 3103, 131 Stat. 2044, 2048–49 (2017). Congress likely would not have sought to amend
a statute that it believed had been invalidated in total.
2. If the ACA’s major provisions besides guaranteed-issue and community-rating are
severable from the mandate, then it follows that the remaining provisions are as well. But even if
some or all of the other major provisions were inseverable, this Court still should not hold
“inseverable all other minor provisions scattered throughout the ACA.” Pltfs. Br. 39. Many, if
not all, of these “minor” provisions serve purposes far removed from the individual mandate, the
guaranteed-issue and community-rating requirements, and the purchase of health insurance in
general, as Plaintiffs appear to acknowledge. Cf. id. at 40 (arguing that the “minor provisions”
“only (if at all) tangentially further the law’s main purpose of near-universal affordable care”).
Thus, the presence or absence of three provisions of the ACA would not affect the functioning of,

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for example, “regulations on the display of nutritional content at restaurants.” Id. at 40 (citing 21
U.S.C. § 343(q)(5)(H)).
The cases that Plaintiffs cite, moreover, confirm that the tangential nature of these “minor”
provisions weighs in favor of their severability. For example, in Williams v. Standard Oil Co. of
Louisiana, 278 U.S. 235 (1929), after holding a law fixing gasoline prices unconstitutional, the
Supreme Court concluded that several other provisions (including a provision requiring permits to
sell gasoline and providing for the issuing of the permits) were inseverable because they were
“adjuncts” with the sole purpose of enabling the problematic price-fixing provision. Id. at 242–
43. Here, in contrast, the “minor” provisions are not “adjuncts” with the sole purpose of
effectuating Section 5000A—rather, they operate in a completely different sphere.
Plaintiffs also suggest (Br. at 40) that the “minor” provisions would not have garnered the
requisite votes in Congress if they were not attached to the rest of the ACA. But the severability
analysis should be one of statutory construction, not parliamentary probabilities. A court should
not hypothesize about the motivations of individual legislators, or speculate about the number of
votes available for any number of alternatives. To the contrary, in New York v. United States, 505
U.S. 144 (1992), the Supreme Court recognized that the statute before it, “like much federal
legislation, embodies a compromise among the States,” but nonetheless held that the invalidated
provision of the statute was severable from other provisions. See id. at 183, 186–87.
Accordingly, this Court should hold that the individual mandate is severable from all but
the ACA’s guaranteed-issue and community-rating requirements.

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III.

Page 25 of 27 PageID 1522

PRELIMINARY INJUNCTIVE RELIEF IS NOT WARRANTED AT THIS TIME,
BUT A DECLARATORY JUDGMENT WOULD BE APPROPRIATE.
Although Plaintiffs have demonstrated a substantial likelihood of success on the merits, at

least in part, preliminary relief is nevertheless unwarranted here. The individual mandate will not
become unconstitutional under NFIB until the TCJA’s elimination of the mandate’s tax penalty
goes into effect in 2019. An injunction may “be issued only if future injury is ‘certainly
impending.’” Aransas Project v. Shaw, 775 F.3d 641, 664 (5th Cir. 2014) (quoting Babbitt v.
United Farm Workers Nat’l Union, 442 U.S. 289, 298 (1979)). Here, the injury imposed by the
individual mandate is not sufficiently imminent to warrant preliminary injunctive relief, especially
where final adjudication would be possible before that injury occurs.
Because Plaintiffs agree that the mandate will not become unconstitutional until the tax is
eliminated in 2019, immediate relief is not warranted at this time. That said, because this is a pure
question of law on which the Plaintiffs and Defendants do not disagree, this Court should consider
construing Plaintiffs’ motion as a request for summary judgment and then entering a declaratory
judgment that the ACA’s provisions establishing the individual mandate as well as the guaranteedissue and community-rating requirements will all be invalid as of January 1, 2019. That would be
adequate relief against the government. See, e.g., Fla. ex rel. Bondi v. U.S. Dep’t of Health &
Human Servs., 780 F. Supp. 2d 1256, 1305 (N.D. Fla. 2011).

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CONCLUSION
For these reasons, this Court should hold that the ACA’s individual mandate will be
unconstitutional as of January 1, 2019, and that the ACA’s guaranteed-issue and community-rating
provisions are inseverable from the mandate.

Dated: June 7, 2018

Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
BRETT A. SHUMATE
Deputy Assistant Attorney General
BRENNA E. JENNY
Counsel to the Assistant Attorney General
/s/ Daniel D. Mauler
.
DANIEL D. MAULER
Virginia State Bar No. 73190
Trial Attorney
U.S. Department of Justice
Civil Division, Federal Programs Branch
20 Massachusetts Ave. NW
Washington, DC 20530
[phone]
[phone] (fax)
[e-mail]
Counsel for the Federal Defendants

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CERTIFICATE OF SERVICE
I certify that on June 7, 2018, I filed the foregoing document with the Clerk of Court via
the CM/ECF system, causing it to be served electronically on all counsel of record.
/s/ Daniel D. Mauler
.
DANIEL D. MAULER
Virginia State Bar No. 73190
Trial Attorney
U.S. Department of Justice
Civil Division, Federal Programs Branch
20 Massachusetts Ave. NW
Washington, DC 20530
[phone]
[phone] (fax)
[e-mail]
Counsel for the Federal Defendants

22