ZIPPED
NFIB v. Sebelius
567 U.S. 519 (2012) · 2012
2.2 million Americans have a legal right to healthcare that activates only in certain states.
“The Court today limits the power of Congress to offer the States a deal they cannot refuse, imposing an offer they cannot accept.”
The Ruling
The Court upheld the ACA but ruled 7–2 that states cannot be required to expand Medicaid — making expansion optional. Twelve states still refuse.
The Personhood Argument Not Made
The Court treated this as federalism — the balance of state and federal power. The actual question: does the Constitution permit states to toggle off their residents' right to survive? A person who cannot access medical care when ill is not exercising personhood. They are dying in possession of rights they cannot use. State 'sovereignty' cannot constitutionally include the power to deactivate the personhood of the state's poorest residents.
The Execution Gap Created
The right to healthcare exists in federal law. Whether it activates depends on the state. Personhood has a zip code. 2.2 million people fall into the coverage gap — too poor for subsidies, too 'wealthy' for existing Medicaid.
Primary sources & research
Related cases
Part of The Personhood Prism, the companion to The Execution Gap by Thomas William Hornig. See all personhood cases →