So far, the constitutional debate over the Patient Protection and Affordable Care Act has centered on Congress's power to require individuals to purchase health insurance. Opponents have argued that the individual mandate is a regulation of inactivity, and therefore beyond the scope of the Commerce Clause. This Comment argues that Congress should pass a statute conditioning federal Medicaid funding for each state on that state's adoption of an individual mandate. This alternative arrangement shifts the debate from the scope of Congress's commerce power to the scope of its spending power. The controlling framework for evaluating the constitutionality of conditional-funding statutes was articulated by Chief Justice William Rehnquist in South Dakota v. Dole. After designing such a statute, this Comment demonstrates that the arrangement is not barred by any of the four Spending Clause limitations announced in Dole, or by the requirement that Congress not "coerce" the state into adopting regulations. The spending is for the general welfare. The condition imposed on the states is unambiguous. The condition is related to a federal interest. And finally, there is no independent constitutional bar precluding the arrangement. The current form of the individual mandate has created constitutional uncertainty because it presses against the boundaries of the Supreme Court's Commerce Clause jurisprudence. The form of the individual mandate proposed by this Comment, however, falls squarely within the bounds of the Court's Spending Clause jurisprudence.
