Sissel v. United States Department of Health & Human Services , 760 F.3d 1 ( 2014 )


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  •  United States Court of Appeals
    FOR THE DISTRICT OF COLUMBIA CIRCUIT
    Argued May 8, 2014                       Decided July 29, 2014
    No. 13-5202
    MATT SISSEL,
    APPELLANT
    v.
    UNITED STATES DEPARTMENT OF HEALTH AND HUMAN
    SERVICES, ET AL.,
    APPELLEES
    Appeal from the United States District Court
    for the District of Columbia
    (No. 1:10-cv-01263)
    Timothy M. Sandefur argued the cause for appellant. With
    him on the briefs were Paul J. Beard II and Daniel A.
    Himebaugh. Theodore Hadzi-Antich entered an appearance.
    John C. Eastman and Anthony T. Caso were on the brief for
    amicus curiae Center for Constitutional Jurisprudence in support
    of appellant.
    Lawrence J. Joseph was on the brief for amicus curiae
    Association of American Physicians and Surgeons in support of
    appellant.
    Joseph E. Schmitz and Paul D. Kamenar were on the brief
    2
    for amici curiae U.S. Representatives Trent Franks, et al. in
    support of appellant.
    Alisa B. Klein, Attorney, U.S. Department of Justice,
    argued the cause for appellees. With her on the brief were
    Stuart F. Delery, Assistant Attorney General, Ronald C. Machen
    Jr., U.S. Attorney, Beth S. Brinkmann, Deputy Assistant
    Attorney General, and Mark B. Stern, Attorney.
    Before: ROGERS, PILLARD and WILKINS, Circuit Judges.
    Opinion for the Court filed by Circuit Judge ROGERS.
    ROGERS, Circuit Judge: Section 5000A of the Patient
    Protection and Affordable Care Act, 26 U.S.C. § 5000A,
    mandates that as of January 2014, non-exempt individuals
    maintain minimum health care coverage or, with limited
    exceptions, pay a penalty. Matt Sissel, who is an artist and
    small-business owner who serves from time to time on active
    duty with the National Guard, appeals the dismissal of his
    complaint alleging that the mandate violates the Commerce
    Clause, U.S. CONST. art. I, § 8, cl. 3, and the Origination Clause,
    U.S. CONST. art. I, § 7, cl. 1. We affirm, because his contention
    that the mandate obligating him to buy government-approved
    health insurance violates the Commerce Clause fails under the
    Supreme Court’s interpretation of the mandate in National
    Federation of Independent Business v. Sebelius, 
    132 S. Ct. 2566
    ,
    2598 (2012) (“NFIB”), and his contention that the mandate’s
    shared responsibility payment was enacted in violation of the
    Origination Clause fails under Supreme Court precedent
    interpreting that Clause.
    3
    I.
    A.
    Section 5000A of the Affordable Care Act imposes a
    “[r]equirement to maintain minimum essential [health
    insurance] coverage.” 26 U.S.C. § 5000A. Subsection (a)
    provides that “[a]n applicable individual” — that is, an
    individual subject to the requirement — “shall for each month
    beginning after 2013 ensure that the individual, and any
    dependent of the individual who is an applicable individual, is
    covered under minimum essential coverage for such month.” Id.
    § 5000A(a). Subsection (b) provides that if an applicable
    individual “fails to meet the requirement of subsection (a),”
    there shall be “imposed on the taxpayer a penalty,” id.
    § 5000A(b)(1), denominated the “[s]hared responsibility
    payment,” id., which “shall be included with a taxpayer’s
    [federal income tax] return,” id. § 5000A(b)(2). These
    requirements are subject to several exceptions.
    Subsection (d) limits who is an “applicable individual”
    subject to the coverage requirement. See id. § 5000A(d)(2)–(4).
    The “[r]eligious conscience exemption,” id. § 5000A(d)(2)(A),
    exempts from the minimum coverage requirement a “member of
    a recognized religious sect” whose beliefs oppose the acceptance
    of insurance benefits and an “adherent of established tenets or
    teachings of such sect.” See also id. § 1402(g)(1) (criteria for
    religious exemption). Also exempt is a “member of a
    [qualifying] health care sharing ministry” whose members
    “share a common set of ethical or religious beliefs and share
    medical expenses among members in accordance with those
    beliefs.” Id. § 5000A(d)(2)(B)(i) & (ii)(II). “Individuals not
    lawfully present” in the United States, id. § 5000A(d)(3), and
    “[i]ncarcerated individuals,” id. § 5000A(d)(4), are likewise
    exempt from the insurance purchase requirement.
    4
    Subsection (e) enumerates when “[n]o penalty shall be
    imposed” for failure to obtain required health coverage. Id.
    § 5000A(e). Exempt are “[i]ndividuals who cannot afford
    coverage,” that is, individuals whose “required contribution
    (determined on an annual basis) for coverage for the month
    exceeds 8 percent of such individual’s household income for the
    taxable year.” Id. § 5000A(e)(1) (emphasis added). The
    “required contribution” is the cost of obtaining minimum
    essential coverage, either through an employer-sponsored
    insurance plan or by purchasing in an insurance exchange “the
    lowest cost bronze plan available in the individual market . . .
    in which the individual resides.” Id. § 5000A(e)(1)(B). Also
    exempt are “[t]axpayers with income below [the] filing
    threshold [for federal income taxes],” id. § 5000A(e)(2),
    “[m]embers of Indian tribes,” id. § 5000A(e)(3), and individuals
    experiencing a “short . . . gap[]” in coverage of less than three
    months, id. § 5000A(e)(4). Individuals who “have suffered a
    hardship with respect to the capability to obtain coverage under
    a qualified health plan,” as determined by the Secretary of
    Health and Human Services, are also exempt.                   Id.
    § 5000A(e)(5).
    B.
    According to the complaint filed October 11, 2012, Matt
    Sissel is an “artist who works out of his studio” in Iowa and
    “also works part-time . . . for the National Guard.” First Am.
    Compl. (“Compl.”) ¶ 5. “He is financially stable, has an annual
    income that requires him to file federal tax returns, and could
    afford health insurance if he wanted to obtain such coverage.”
    Id. He “does not have, need, or want health insurance.” Id.
    Further, “he is able to and does pay for any and all of his
    medical expenses out of pocket.” Id. Because “he cannot claim
    any of the exemptions,” id. ¶ 15, the Affordable Care “Act
    obligates [him] to purchase, at his own expense and against his
    will, federally approved health insurance, or pay the ‘shared
    5
    responsibility payment,’” id. Sissel seeks declaratory and
    injunctive relief against the mandate and the Affordable Care
    Act in toto.
    First, Sissel alleges that the Affordable Care Act’s
    “purchase requirement,” commonly known as the individual
    mandate, “is not a regulation of commerce, but purports to
    compel affected Americans, like [himself], to engage in
    commerce.” Id. ¶ 34. Citing NFIB, 
    132 S. Ct. at 2600
    , where
    Chief Justice Roberts stated that “the Commerce Clause does
    not authorize such a command,” he alleges that Section 5000A
    violates the Commerce Clause. See 
    id.
     Second, he alleges that
    Section 5000A’s “‘shared responsibility payment’ is a tax that
    raises revenue to support Government generally,” id. ¶ 39, and
    violates the Origination Clause because it “originated in the
    Senate, not the House,” id. ¶ 40.
    The district court dismissed the complaint pursuant to
    Federal Rule of Civil Procedure 12(b)(6), ruling that Sissel’s
    Commerce Clause claim was premised on a misreading of the
    NFIB decision, the Origination Clause did not apply because
    Section 5000A was not a bill for raising revenue, and, in any
    event, it satisfied the Origination Clause because there was a
    valid Senate amendment to a bill that originated in the House of
    Representatives. See Sissel v. U.S. Dep’t of Health & Human
    Servs., 
    951 F. Supp. 2d 159
    , 166–74 (D.D.C. 2013). Sissel
    appeals, and our review of the dismissal of the complaint is de
    novo. See English v. Dist. of Columbia, 
    717 F.3d 968
    , 971 (D.C.
    Cir. 2013). “To survive a motion to dismiss, a complaint must
    contain sufficient factual matter, accepted as true, to ‘state a
    claim to relief that is plausible on its face.’” Ashcroft v. Iqbal,
    
    556 U.S. 662
    , 678 (2009) (quoting Bell Atl. Corp. v. Twombly,
    
    550 U.S. 544
    , 570 (2007)). The court assumes the truth of all
    well-pleaded factual allegations in the complaint and construes
    reasonable inferences from those allegations in the plaintiff’s
    6
    favor, see, e.g., Doe v. Rumsfeld, 
    683 F.3d 390
    , 391 (D.C. Cir.
    2012), but is not required to accept the plaintiff’s legal
    conclusions as correct, see 
    id.
    II.
    As a threshold matter, we must determine whether or not
    Sissel has standing under Article III of the Constitution in order
    to assure ourselves that this court has jurisdiction over his
    appeal. See Lujan v. Defenders of Wildlife, 
    504 U.S. 555
    ,
    559–60 (1992); U.S. Telecom Ass’n v. FCC, 
    295 F.3d 1326
    ,
    1330 (D.C. Cir. 2002). Standing must be shown at each stage of
    the judicial proceedings. See Hollingsworth v. Perry, 
    133 S. Ct. 2652
    , 2661 (2013). The district court concluded Sissel had
    standing because he claimed to have had to sell property and
    curtail his professional activities in order to raise funds to pay
    for the required health insurance coverage. See Sissel, 951 F.
    Supp. 2d at 164 n.7. Sissel’s complaint, however, does not
    demonstrate that as of the time of his appeal, he would be
    subject to the Affordable Care Act’s individual mandate and
    shared responsibility payment. Although he alleged that in
    January 2008 he left the National Guard where he did have
    health insurance during his active service, see Compl. ¶ 24, his
    counsel advised during oral argument before this court that
    Sissel was currently on active duty with the National Guard. See
    Oral Arg. Tr. 5:14–17 (May 8, 2014). It also was unclear from
    the complaint whether the circumstances relating to Sissel’s
    annual income and relied on by the district court had changed.
    See id. at 7:8–20.
    Upon review of the requested supplementation, see Order
    (May 22, 2014), we hold that Sissel has Article III standing. By
    signed affidavit, Sissel attests that he does not fall within any of
    the exemptions under the Affordable Care Act, 26 U.S.C.
    § 5000A(d)(2)–(4), (e)(3). For example, he avers that he has no
    7
    religious objection to purchasing health insurance, he is not a
    member of an Indian tribe, he is not incarcerated, and he has not
    been determined ineligible for Medicaid or had an individual
    insurance plan cancelled. See Sissel Aff. ¶¶ 3–13 (June 2,
    2014); 26 U.S.C. § 5000A(d)(2) & (4), (e)(3) & (5).
    Additionally, he avers that as of June 2, 2014, he was no longer
    on active duty with the National Guard, and that he has not
    purchased health insurance through the National Guard, and is
    not eligible for any kind of insurance coverage or continuing
    care through the National Guard. See Sissel Aff. ¶¶ 14–15.
    According to Sissel, the National Guard would provide
    emergency care for any injuries or illnesses he might suffer
    while on active duty, but the Guard has no such “limited
    medical-emergency” obligation when he is not on active duty.
    Id. ¶ 15.
    Sissel’s counsel has further attested that based on available
    information from the “Washington Healthplanfinder” website,
    the cost of the least expensive qualifying health plan in the
    region of the country where Sissel now lives is less than 8
    percent of Sissel’s projected 2014 income. See Sandefur Aff.
    ¶ 2 (June 2, 2014), Ex. A; Sissel Aff. ¶ 10. In his complaint and
    affidavit, Sissel states that the two sources of his annual income
    are his work as an artist and his part-time service as a Public
    Affairs Specialist for the National Guard. See Compl. ¶ 5; Sissel
    Aff. ¶ 10. Consequently, Sissel maintains he does not qualify
    for a low-income exemption under the Affordable Care Act, 26
    U.S.C. § 5000A(e)(1)(a). See Appellant’s Supp. Br. 3–4.
    Taking these factual representations as true, as we must for
    purposes of Article III standing, see Defenders of Wildlife, 
    504 U.S. at 561
    , and absent any basis to question Sissel’s view of the
    legal obligation of the National Guard with respect to health care
    coverage, it appears certain that Sissel is subject to the Section
    5000A mandate requiring him to purchase minimum essential
    8
    health insurance coverage or else to pay the shared
    responsibility payment. The government does not challenge the
    affiants’ representations or otherwise claim that Sissel lacks
    Article III standing. See Appellees’ Supp. Br. 1. Even though
    Sissel is still a member of the National Guard and from time to
    time may be called to active duty, providing him temporary
    health insurance coverage by the Guard, the government has not
    suggested this circumstance would render exempt an individual
    otherwise subject to the requirements of Section 5000A, and we
    agree. Congress has included limited, specific exemptions from
    Section 5000A, and, absent reason to conclude otherwise,
    exemptions are to be construed narrowly. See, e.g., A.H.
    Phillips, Inc. v. Walling, 
    324 U.S. 490
    , 493 (1945). This court
    is aware of no countervailing considerations inasmuch as the
    Affordable Care Act seeks “to increase the number of
    Americans covered by health insurance and decrease the cost of
    health care.” NFIB, 
    132 S. Ct. at 2580
    . We therefore turn to the
    merits of Sissel’s complaint.
    III.
    The Constitution authorizes the Congress to “regulate
    Commerce . . . among the several States,” U.S. CONST. art. I,
    § 8, cl. 3, and to “make all Laws which shall be necessary and
    proper for carrying into Execution” that authority, id. art. I, § 8,
    cl. 18. In NFIB, several States and private parties challenged the
    Section 5000A individual mandate on the ground, among others,
    that the Commerce Clause did not empower Congress to require
    individuals to purchase health insurance. See State Resp’ts Br.
    on Minimum Coverage Provision 15–51; Private Resp’ts Br. on
    Individual Mandate 15–62, in U.S. Dep’t of Health & Human
    Servs. v. Florida, No. 11-398, decided sub. nom. NFIB, 
    132 S. Ct. 2566
    . Five Justices would have held that if the individual
    mandate commanded individuals to purchase insurance, then its
    enactment would have exceeded Congress’s authority under the
    9
    Commerce Clause, U.S. CONST. art. I, § 8, cl. 3; see NFIB, 
    132 S. Ct. at 2593
     (separate opinion of Roberts, C.J.), 2650 (Scalia,
    Kennedy, Thomas, and Alito, JJ., dissenting), but the Court
    understood that Section 5000A gives individuals the choice of
    purchasing insurance or paying a tax, and sustained it as a valid
    exercise of Congress’s taxing power, U.S. CONST. art. I,
    § 8, cl.1; see NFIB, 
    132 S. Ct. at 2598
    .
    Sissel seeks to “enjoin[] the government from enforcing the
    individual mandate against him,” Reply Br. 3, because “the
    Commerce Clause does not authorize Congress to impose” the
    mandate, Appellant’s Br. 6. He maintains that in NFIB the
    Supreme Court “did not sustain the individual mandate under
    the taxing power.” Id. at 7. “[I]ndeed,” he suggests, “the
    Supreme Court did not sustain the individual mandate at all.”
    Id. In Sissel’s view, “[t]he NFIB opinion makes an essential
    constitutional distinction between the individual mandate —
    which compels people to buy health insurance — and the shared
    responsibility payment — which imposes a tax on people who
    choose not to purchase health insurance,” and he maintains that
    only the latter was upheld by the Court. Id. at 7, 10. Unless this
    court declares the individual mandate invalid, he contends the
    mandate will “render[] [him] a violator of federal law if he fails
    to buy the prescribed insurance.” Id. at 12.
    Sissel’s Commerce Clause claim rests on a flawed
    understanding of the Supreme Court’s decision in NFIB. See
    Appellees’ Br. 7–8. In NFIB, the government “ask[ed] [the
    Court] to read the mandate not as ordering individuals to buy
    insurance, but rather as imposing a tax on those who do not buy
    that product.” NFIB, 
    132 S. Ct. at 2593
     (emphasis added); see
    also 
    id. at 2584
     (separate opinion of Roberts, C.J.). Although
    Chief Justice Roberts stated that “[t]he most straightforward
    reading of the mandate is that it commands individuals to
    purchase insurance,” 
    id.,
     he concluded, in an opinion joined by
    10
    four other Justices, that “it need not be read to declare that
    failing to [purchase insurance] is unlawful,” 
    id. at 2597
     (opinion
    of Roberts, C.J., joined by Ginsburg, Breyer, Sotomayor, and
    Kagan, JJ.) (emphasis added). Rather, the Court held that
    Section 5000A can be read to do nothing “more than impose a
    tax,” and “[t]hat is sufficient to sustain it” under the
    Constitution. 
    Id. at 2598
    .
    Sissel’s contention that the individual mandate “compels
    [him] to buy health insurance,” Appellant’s Br. 7, is thus
    foreclosed under the Supreme Court’s interpretation of the
    mandate; in the Court’s opinion, the mandate provision “leaves
    [Sissel] with a lawful choice” to purchase health insurance or
    not, “so long as he is willing to pay a tax levied on that choice,”
    NFIB, 
    132 S. Ct. at 2600
    . Although the Chief Justice stated that
    the individual mandate “would . . . be unconstitutional if read as
    a command,” he concluded that it is not unconstitutional as
    beyond the scope of Congressional authority because it “can
    reasonably be read” as not imposing a command. 
    Id. at 2601
    (separate opinion of Roberts, C.J.) (emphasis added). The
    Court’s decision to sustain the constitutionality of the whole of
    Section 5000A under the taxing power necessarily disposes of
    Sissel’s Commerce Clause claim. His reliance on later opinions
    in the circuits is misplaced as none denies that the Supreme
    Court upheld the individual mandate as a valid exercise of the
    taxing power. See Liberty Univ., Inc. v. Lew, 
    733 F.3d 72
    , 97
    (4th Cir. 2013); United States v. Rose, 
    714 F.3d 362
    , 371 (6th
    Cir. 2013); United States v. Roszkowski, 
    700 F.3d 50
    , 58 (1st
    Cir. 2012).
    IV.
    The Origination Clause, U.S. CONST. art. I, § 7, cl. 1, states
    that “[a]ll Bills for raising Revenue shall originate in the House
    of Representatives; but the Senate may propose or concur with
    11
    Amendments as on other Bills.” Sissel contends that “the shared
    responsibility payment is a bill for raising revenue” and that it
    “originated in the Senate, not the House” in violation of the
    Origination Clause. Appellant’s Br. 20. He states in his
    complaint that “[i]n September, 2009, the House [of
    Representatives] passed H.R. 3590, entitled the ‘Service
    Members Home Ownership Tax Act of 2009,’” to “‘amend[] the
    Internal Revenue Code of 1986 to modify [the] first-time
    homebuyers credit in the case of members of the Armed Forces
    and certain other Federal employees.’” Compl. ¶ 40. He alleges
    this bill “had nothing to do with health insurance reform,” and
    yet “[i]n November of [2009], the Senate purported to ‘amend’
    the House bill by gutting its contents, replacing them with
    health-insurance reforms (including the purchase requirement
    and associated payment), and renaming the bill the ‘Patient
    Protection and Affordable Care Act.’” Id. The “substitute
    legislation,” he alleges, was “a revenue-raising tax bill,” id., and
    the enactment of the Act violated the Origination Clause
    “[b]ecause the tax originated in the Senate, and not in the
    House,” id. ¶ 41.        Because we conclude that the shared
    responsibility payment in Section 5000A is not a “Bill[] for
    raising Revenue” within the Supreme Court’s accepted meaning
    of that phrase, and thus was not subject to the Origination
    Clause, this court has no occasion to determine whether it
    originated in the House or the Senate.
    In interpreting the Origination Clause, the Supreme Court
    has held from the early days of this Nation that “revenue bills
    are those that levy taxes in the strict sense of the word, and are
    not bills for other purposes which may incidentally create
    revenue.” Twin City Bank v. Nebeker, 
    167 U.S. 196
    , 202 (1897)
    (citing 1 J. STORY, COMMENTARIES ON THE CONSTITUTION
    § 880). The Court has adhered to this “strict” interpretation.
    See United States v. Munoz-Flores, 
    495 U.S. 385
    , 397 (1990);
    Millard v. Roberts, 
    202 U.S. 429
    , 436 (1906); United States v.
    12
    Norton, 
    91 U.S. 566
    , 569 (1875). Necessarily, this court has
    followed suit. See Rural Cellular Ass’n v. FCC, 
    685 F.3d 1083
    ,
    1090 (D.C. Cir. 2012). Under this “strict” interpretation, the
    Supreme Court has upheld as not subject to the Origination
    Clause a tax on circulating bank notes, see Nebeker, 
    167 U.S. at 202
    , a tax to fund railway construction in the District of
    Columbia, see Millard, 
    202 U.S. at
    436–37, and a “special
    assessment” levied on federal criminal offenders for a victims’
    fund, see Munoz-Flores, 
    495 U.S. at 401
    . In each case,
    consistent with its “strict” interpretation of the phrase “Bills for
    raising Revenue,” the Court’s analysis focused on the purpose
    of the challenged measure: Because the revenue raised was
    merely incidental to the main object or aim of the challenged
    measure, the requirements of the Origination Clause were held
    not to apply. In Nebeker, for example, the issue was whether “a
    tax upon the average amount of the notes of a national banking
    association in circulation[] was a revenue bill within the
    [Origination] [C]lause.” 
    167 U.S. at 202
    . The Court observed
    that “[t]he main purpose that Congress had in view was to
    provide a national currency based upon United States bonds, and
    to that end it was deemed wise to impose the tax in question.”
    
    Id. at 203
     (emphasis added). Similarly, in Millard, involving the
    use of property taxes to fund railway construction in the District
    of Columbia, the Court reasoned that “[w]hatever taxes are
    imposed are but means to the purposes provided by the act.”
    
    202 U.S. at 437
     (emphasis added). And in Munoz-Flores, the
    Court noted that “[a]ny revenue for the general Treasury that
    [the provision imposing a special assessment on defendants]
    creates is . . . ‘incidental’ to that provision’s primary purpose,”
    which was to provide money for a crime victims’ fund. 
    495 U.S. at 399
     (emphasis added; alterations omitted). In each
    instance, the Court underscored that unless a bill is aimed at
    “levy[ing] taxes in the strict sense,” it does not fall within the
    limited scope of the Origination Clause. Munoz-Flores, 
    495 U.S. at 397
    ; Millard, 
    202 U.S. at 436
    ; Nebeker, 
    167 U.S. at 202
    .
    13
    The purposive approach embodied in Supreme Court
    precedent necessarily leads to the conclusion that Section 5000A
    of the Affordable Care Act is not a “Bill[] for raising Revenue”
    under the Origination Clause. The Supreme Court’s repeated
    focus on the statutory provision’s “object,” Nebeker, 
    167 U.S. at 203
    , and “primary purpose,” Munoz-Flores, 
    495 U.S. at 399
    ,
    makes clear, contrary to Sissel’s position, that the purpose of a
    bill is critical to the Origination Clause inquiry. And after the
    Supreme Court’s decision in NFIB, it is beyond dispute that the
    paramount aim of the Affordable Care Act is “to increase the
    number of Americans covered by health insurance and decrease
    the cost of health care,” NFIB, 
    132 S. Ct. at 2580
    , not to raise
    revenue by means of the shared responsibility payment. The
    Supreme Court explained: “Although the [Section 5000A]
    payment will raise considerable revenue, it is plainly designed
    to expand health insurance coverage.” 
    Id. at 2596
     (emphasis
    added); see 
    id.
     at 2596–97. This court noted in Seven-Sky v.
    Holder, 
    661 F.3d 1
    , 6 (D.C. Cir. 2012), abrogated by NFIB, 
    132 S. Ct. 2566
     (2012), that the “congressional findings never
    suggested that Congress’s purpose was to raise revenue.” See
    
    42 U.S.C. § 18091
    (2) (congressional findings). To the contrary,
    “the aim of the shared responsibility payment is to encourage
    everyone to purchase insurance; the goal is universal coverage,
    not revenues from penalties.” Seven-Sky, 661 F.3d at 6. The
    Supreme Court acknowledged that the Section 5000A shared
    responsibility payment may ultimately generate substantial
    revenues — potentially $4 billion in annual income for the
    government by 2017, see NFIB, 
    132 S. Ct. at
    2594 — if people
    do not “sign up” for coverage, but those revenues are a by-
    product of the Affordable Care Act’s primary aim to induce
    participation in health insurance plans. Successful operation of
    the Act would mean less revenue from Section 5000A payments,
    not more.
    14
    Sissel contends, however, that the Supreme Court cases
    rejecting Origination Clause challenges merely embody “two
    exceptions” to the general “presumpt[ion]” that “[a]ll taxes” are
    subject to the Clause. Appellant’s Br. 14; Reply Br. 6–7. He
    maintains that the Affordable Care Act does not fall within
    either exception because the Section 5000A payment neither
    funds a particular governmental program, as was true in Munoz-
    Flores, 
    495 U.S. at
    397–98, nor enforces compliance with a
    statute passed under some other (non-taxing) constitutional
    power, as in Millard, 
    202 U.S. at 433
    . Yet even assuming Sissel
    is correct that the precedent can be classified in one or both of
    his categories, neither the Supreme Court nor this court has held
    that a statute must be so classifiable to avoid the requirements of
    the Origination Clause. All Sissel has demonstrated is that the
    Affordable Care Act’s mandate does not fall squarely within the
    fact patterns of prior unsuccessful Origination Clause
    challenges, not that his challenge should succeed.
    Sissel’s interpretation of the taxing power also fails to
    adhere to Supreme Court precedent. In emphasizing that in
    NFIB the Court upheld Section 5000A solely as an exercise of
    Congress’s taxing power, see NFIB, 
    132 S. Ct. at 2600
    , Sissel
    contends that the Section 5000A tax is presumptively subject to
    the Origination Clause because it “serves no constitutional
    purpose other than to raise revenue pursuant to Congress’s
    taxing power.” Reply Br. 7. This implicitly assumes that all
    exercises of the taxing power are necessarily aimed at raising
    revenue. In fact, “the taxing power is often, very often, applied
    for other purposes[] than revenue.” 2 JOSEPH STORY,
    COMMENTARIES ON THE CONSTITUTION OF THE UNITED STATES
    § 962, p. 434 (1833), cited in NFIB, 
    132 S. Ct. at 2596
    . In
    United States v. Sanchez, 
    340 U.S. 42
     (1950), the Supreme
    Court stated:
    It is beyond serious question that a tax does not cease
    15
    to be valid [under the taxing power] merely because it
    regulates, discourages, or even definitely deters the
    activities taxed. The principle applies even though the
    revenue obtained is obviously negligible, or the
    revenue purpose of the tax may be secondary. Nor
    does a tax statute necessarily fall because it touches on
    activities which Congress might not otherwise regulate.
    
    Id. at 44
     (emphasis added; citations omitted). That view was
    reiterated in United States v. Kahriger, 
    345 U.S. 22
     (1953),
    where the Court upheld “a tax on persons engaged in the
    business of accepting wagers,” 
    id. at 23
    , notwithstanding the
    argument that “the sole purpose of the statute is to penalize . . .
    illegal gambling in the states through the guise of a tax
    measure,” 
    id. at 28
    , abrogated on other grounds by Marchetti v.
    United States, 
    390 U.S. 39
     (1968). Because not all of
    Congress’s exercises of the taxing power are primarily aimed at
    raising revenue, and a measure is a “Bill[] for raising Revenue”
    only if its primary purpose is to raise general revenues, some
    exercises of the taxing power are not subject to the Origination
    Clause. The Supreme Court’s decisions in Nebeker and Millard
    confirm this point: Not all “taxes” are “Bills for raising
    Revenue.” See Nebeker, 
    167 U.S. at 202
    ; Millard, 
    202 U.S. at
    436–37.
    Sissel’s attempts to distinguish the Supreme Court’s “tax”
    cases confirm that the Origination Clause inquiry does not hinge
    on the existence (or absence) of another source of constitutional
    authority. For instance, Sissel contends that the tax on
    circulating notes in Nebeker was not a “Bill[] for raising
    Revenue” because, among other things, it was enacted “in
    furtherance of Congress’s Article I power to coin money.”
    Reply Br. 6; see U.S. CONST. art I, § 8, cl. 5. But many taxes are
    imposed to raise revenue in furtherance of the federal
    government’s enumerated powers, and some of those taxes may
    16
    well be “Bills for raising Revenue.” The mere existence of
    another source of Congressional power, then, cannot be what
    insulates a measure from the Origination Clause. Conversely,
    a measure that would not be a “Bill[] for raising Revenue” does
    not become one simply because Congress lacks an independent
    basis (apart from the taxing power) to enact it. For example,
    Sissel contends that the tax to finance railroad projects in
    Millard was not a “Bill[] for raising Revenue” because, among
    other things, Congress possessed exclusive constitutional
    jurisdiction over the District of Columbia. Reply Br. 7; see U.S.
    CONST. art. I, § 8, cl. 17. Yet nothing in Millard hints that
    Congress’s authority over the District of Columbia affected the
    Origination Clause inquiry in that case. See Millard, 
    202 U.S. at
    436–37.
    In sum, under Supreme Court precedent, the presence of
    another constitutional power does not suggest that a provision is
    not a “Bill[] for raising Revenue,” and the absence of another
    constitutional power does not, in itself, suggest that it is.
    Because the existence of another power is not necessary (or
    sufficient) to exempt a bill from the Origination Clause, the
    mere fact that Section 5000A may have been enacted solely
    pursuant to Congress’s taxing power does not compel the
    conclusion that the entire Affordable Care Act is a “Bill[] for
    raising Revenue” subject to the Origination Clause. Where, as
    here, the Supreme Court has concluded that a provision’s
    revenue-raising function is incidental to its primary purpose, see
    NFIB, 
    132 S. Ct. at 2596
    , the Origination Clause does not apply.
    The analysis is not altered by the fact that the shared
    responsibility payment may in fact generate substantial
    revenues.     In light of the Supreme Court’s historical
    commitment to a narrow construction of the Origination Clause,
    this court can only hold that the challenged measure — whose
    primary purpose “plainly” was not to raise revenue, 
    id.
     at 2596
    — falls outside the scope of the Clause.
    17
    Accordingly, we affirm the dismissal of the complaint for
    failure to state a cause of action.