NFIB V. Sebelius -- Putting Enforceable Limits on Federal Leveraging: The Contract Paradigm, the Clear Notice Rule, and the Coercion Principle

Abstract

One of the Supreme Court’s most anticipated and highly charged cases of the October 2011 Term and, indeed of any Term, NFIB v. Sebelius, involved the challenge by twenty-six states, led by Florida, to two core provisions of the Patient Protection and Affordable Care Act (ACA) – (a) the requirement that most individuals without medical insurance purchase federally qualifying medical insurance or pay a penalty and (b) the requirement that states mandatorily expand their pre-existing Medicaid programs to cover all persons with incomes under 133% of the federal poverty level or face the threat of loss of all pre-existing federal Medicaid support.