In 2010, few anticipated the fate of health care reform would rest with the Supreme Court. Yet National Federation of Independent Business v. Sebelius emerged as a watershed case that could remake the constitutional landscape. NFIB presented a conflict between two constitutional visions of federal power, and the role of the courts in policing such limits – an unconstrained vision, under which limits on federal power are enforced primarily through the political process, and a constrained vision, under which constitutional limits on federal power are enforced by the courts. The contrasting views of the constitutionality of the individual mandate and the Medicaid expansion did not reflect different applications of settled principles so much as allegiance to competing visions of federal power. This essay, prepared for Drake University Constitutional Law Center’s 2014 Symposium on “The U.S. Supreme Court’s Obamacare Decision and Its Significance for the 50th Anniversary of LBJ’s Great Society,” details this conflict, its resolution by the NFIB, and possible future implications.


NFIB v. Sebelus, National Federation of Independent Business v. Sebelius, Federalism, Medicaid, Obamacare, Great Society, commerce clause, individual mandate

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62 Drake Law Review 937 (2014)


COinS Jonathan H. Adler Faculty Bio