Full opinion text
ORDER AND MEMORANDUM OPINION ROGER VINSON, Senior District Judge. Now pending is the defendants’ motion to dismiss (doc. 55). This motion seeks dismissal of Counts One, Two, Three, and Six of the plaintiffs’ amended complaint for lack of subject matter jurisdiction (pursuant to Rule 12(b)(1), Fed.R.Civ.P.), and dismissal of all counts in the amended complaint for failure to state a claim upon which relief can be granted (pursuant to Rule 12(b)(6), Fed.R.Civ.P.). The plaintiffs have filed a response in opposition, and the defendants have filed a reply to that response. A hearing was held in this matter on September 14, 2010. I. INTRODUCTION This litigation—one of many filed throughout the country—raises a facial Constitutional challenge to the federal healthcare reform law, Patient Protection and Affordable Care Act, Pub. L. No. Ill— 148, 124 Stat. 119 (2010), amended by Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) (the “Act”). It has been filed by sixteen state Attorneys General and four state Governors (the “state plaintiffs”); two private citizens, Mary Brown and Kaj Ahlburg (the “individual plaintiffs”); and the National Federation of Independent Business (“NFIB”) (together, the “plaintiffs”). The defendants are the United States Department of Health and Human Services, Department of Treasury, Department of Labor, and their respective secretaries (together, the “defendants”). Before addressing the plaintiffs’ allegations, and the arguments in support of the defendants’ motion to dismiss, I will take a moment to emphasize preliminarily what this case is, and is not, about. The Act is a controversial and polarizing law about which reasonable and intelligent people can disagree in good faith. There are some who believe it will expand access to medical treatment, reduce costs, lead to improved care, have a positive effect on the national economy, and reduce the annual federal budgetary deficit, while others expect that it will do exactly the opposite. Some say it was the product of an open and honest process between lawmakers sufficiently acquainted with its myriad provisions, while others contend that it was drafted behind closed doors and pushed through Congress by parliamentary tricks, late night weekend votes, and last minute deals among members of Congress who did not read or otherwise know what was in it. There are some who believe the Act is designed to strengthen the private insurance market and build upon free market principles, and others who believe it will greatly expand the size and reach of the federal government and is intended to create a socialized government healthcare system. While these competing arguments would make for an interesting debate and discussion, it is not my task or duty to wade into the thicket of conflicting opinion on any of these points of disagreement. For purposes of this case, it matters not whether the Act is wise or unwise, or whether it will positively or negatively impact healthcare and the economy. Nor (except to the limited extent noted in Part III.A(7) infra) am I concerned with the manner in which it was passed into law. My review of the statute is not to question or second guess the wisdom, motives, or methods of Congress. I am only charged with deciding if the Act is Constitutional. If it is, the legislation must be upheld—even if it is a bad law. United States v. Butler, 297 U.S. 1, 79, 56 S.Ct. 312, 80 L.Ed. 477 (1936) (“For the removal of unwise laws from the statute books appeal lies, not to the courts, but to the ballot and to the processes of democratic government”) (Stone, J., dissenting). Conversely, if it is unconstitutional, the legislation must be struck down—even if it is a good law. Bailey v. Drexel Furniture Co. (Child Labor Tax Case), 259 U.S. 20, 37, 42 S.Ct. 449, 66 L.Ed. 817 (1922) (reviewing court must strike down unconstitutional law even though that law is “designed to promote the highest good. The good sought in unconstitutional legislation is an insidious feature, because it leads citizens and legislators of good purpose to promote it, without thought of the serious breach it will make in the ark of our covenant, or the harm which will come from breaking down recognized standards.”). At this stage in the case, however, my job is much simpler and more narrow than that. In ruling on the defendants’ motion to dismiss, I must only decide if this court has jurisdiction to consider some of the plaintiffs’ claims, and whether each of the counts of the amended complaint states a plausible claim for relief. II. BACKGROUND As Congress has recognized: “By most measures, we have the best medical care system in the world.” H.R.Rep. No. 111— 443, pt. 1, U.S.Code Cong. & Admin.News 2010, p. 123. However, at the same time, no one can deny that there are significant and serious problems. Costs are high and millions do not have insurance. Lack of health insurance can preclude the uninsured from accessing preventative care. If and when the uninsured are injured or become ill, they receive treatment, as the defendants acknowledge, because in this country medical care is generally not denied due to lack of insurance coverage or inability to pay. However, the costs that are incurred to treat the uninsured are sometimes left unpaid—to the tune of $43 billion in 2008 (which is less than 2% of all national healthcare expenditures for that year). The costs of uncompensated care are passed along to market participants in the form of higher costs and raised premiums, which, in turn, can help perpetuate the cycle (or the “premium spiral,” as the defendants call it) and add to the number of uninsured. It was against this backdrop that Congress passed the Act. A. The Legislative Scheme At nearly 2,700 pages, the Act is very lengthy and includes many provisions, only a few of which are specifically at issue in this litigation. Chief among them is Section 1501, which, beginning in 2014, will require that all citizens (with stated exceptions) obtain federally-approved health insurance, or pay a monetary penalty (the “individual mandate”). This provision is necessary, according to Congress and the defendants, to lower premiums (by spreading risks across a much larger pool) and to meet “a core objective of the Act,” which is to expand insurance coverage to the uninsured by precluding the insurance companies from refusing to cover (or charging exorbitant rates to) people with pre-existing medical conditions. Without the individual mandate and penalty in place, the argument goes, people would simply “game the system” by waiting until they get sick or injured and only then purchase health insurance (that insurers must by law now provide), which would result in increased costs for the insurance companies. This is known as “the moral hazard.” The increased costs would ultimately be passed along to consumers in the form of raised premiums, thereby creating market pressures that would (arguably) inevitably drive the health insurance industry into extinction. The plaintiffs allege that regardless of whether the individual mandate is well-meaning and essential to the Act, it is unconstitutional and will have both a “profound and injurious impact” on the states, individuals, and businesses. The plaintiffs object to several interrelated portions of the Act as well. First, the Act significantly alters and expands the Medicaid program. Created in 1965, Medicaid is a cooperative federal-state program that provides for federal financial assistance (in the form of matching funds) to states that elect to provide medical care to needy persons. The Act will add millions of new enrollees to the states’ Medicaid rolls by expanding the program to include all individuals under the age of 65 with incomes up to 133% of the federal poverty line. Second, the Act provides for creation of “health benefit exchanges” designed to allow individuals and small businesses to leverage their buying power to obtain competitive prices. The Act contemplates that these exchanges will be set up and operated by the states, or by the federal government if the states elect not to do so. And lastly, the Act requires that the states (along with other “large employers”) provide their employees with a prescribed minimum level of health insurance coverage (the “employer mandate”). The plaintiffs allege that these several provisions violate the Constitution and state sovereignty by coercing and commandeering the states and depriving them of their “historic flexibility” to run their state government, healthcare, and Medicaid programs. The plaintiffs anticipate that these and various other provisions in the Act will cost Florida (and the other states similarly) billions of dollars between now and the year 2019, not including the administrative costs it will take to implement the Act, and that these costs will only increase in the subsequent years. In short, the plaintiffs contend that the legislation is coercive, intrusive, and could bankrupt the states. B. This Lawsuit and the Motion to Dismiss The plaintiffs advance six causes of action in their amended complaint, and they seek declaratory and injunctive relief with respect to each. They contend that the Act violates the Constitution in the following ways: (1) the individual mandate and concomitant penalty exceed Congress’s authority under the Commerce Clause and violate the Ninth and Tenth Amendments (Count I); (2) the individual mandate and penalty violate substantive due process under the Fifth Amendment (Count II); (3) “alternatively,” if the penalty imposed for failing to comply with the individual mandate is found to be a tax, it is an unconstitutional unapportioned capitation or direct tax in violation of U.S. Const, art. I, § 9, cl. 4, and the Ninth and Tenth Amendments (Count III); (4) the Act coerces and commandeers the states with respect to Medicaid by altering and expanding the program in violation of Article I and the Ninth and Tenth Amendments (Count IV); (5) it coerces and commandeers with respect to the health benefit exchanges in violation of Article I and the Ninth and Tenth Amendments (Count V); and (6) the employer mandate interferes with the states’ sovereignty as large employers and in the performance of government functions in violation of Article I and the Ninth and Tenth Amendments (Count VI). See generally Amended Complaint (“Am. Compl.”) (doc. 42). The defendants seek to have the complaint dismissed on numerous grounds; four of the counts for lack of jurisdiction (under Rule 12(b)(1)), and all six of them for failure to state a claim upon which relief can be granted (under Rule 12(b)(6)). With respect to jurisdiction, the defendants contend that for the challenges to the individual mandate and employer mandate (Counts I, II, and VI), the plaintiffs lack standing; the claims are not ripe; and the claims are barred by the Anti-Injunction Act. (By not raising similar arguments for Counts IV and V, the defendants appear to impliedly concede that those counts allege injuries that are immediately ripe for review). As for the plaintiffs’ “alternative” cause of action contending that, if the individual mandate penalty is deemed to be a tax, then it is an impermissible and unconstitutional one (Count III), the defendants maintain that, too, is precluded by the Anti-Injunction Act. If the foregoing jurisdictional challenges fail, the defendants go on to assert that those causes of action, and all others, fail to state a claim for which relief can be granted. III. DISCUSSION A. Is the “Penalty” for Non-Compliance with the Individual Mandate Actually a “Tax” for Constitutional Analysis? A fundamental issue overlaps the defendants’ challenges to several of the plaintiffs’ claims, and that is whether the individual mandate penalty is a “tax” within Congress’s broad taxing power and thus subject to the Anti-Injunction Act, or instead, a “penalty” that must be authorized, if at all, by Congress’s narrower Commerce Clause power. Because of the importance of this issue, I will analyze it first and at some length. The defendants contend that the individual mandate penalty is a tax that is sustainable under Congress’s expansive power to tax for the general welfare. U.S. Const, art. I, § 8, cl. 1 (“The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the ... general Welfare”). The plaintiffs urge that, if it is a tax, it is an unconstitutional one. The defendants maintain that the plaintiffs have no standing to raise the claim at this point in time because of the Anti-Injunction Act. The Anti-Injunction Act [26 U.S.C. § 7421(a) ] provides that “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person....” The remedy for challenging an improper tax is a post-collection suit for refund. As the Supreme Court has explained: The Anti-Injunction Act ... could scarcely be more explicit—“no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court ...” The Court has interpreted the principal purpose of this language to be the protection of the Government’s need to assess and collect taxes as expeditiously as possible with a minimum of pre-enforcement judicial interference, “and to require that the legal right to the disputed sums be determined in a suit for refund.” The Court has also identified “a collateral objective of the Act—protection of the collector from litigation pending a suit for refund.” Bob Jones Univ. v. Simon, 416 U.S. 725, 736-37, 94 S.Ct. 2038, 40 L.Ed.2d 496 (1974) (citations omitted); accord, e.g., United States v. Clintwood Elkhorn Min. Co., 553 U.S. 1, 10, 128 S.Ct. 1511, 170 L.Ed.2d 392 (2008) (“[The Anti-Injunction Act] commands that (absent certain exceptions) ‘no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court,’ ” even if the tax is alleged to be unconstitutional, which means “the taxpayer must succumb to an unconstitutional tax, and seek recourse only after it has been unlawfully exacted”); Enochs v. Williams Packing & Navigation Co., 370 U.S. 1, 7, 82 S.Ct. 1125, 8 L.Ed.2d 292 (1962) (explaining that the “manifest purpose” of the Anti-Injunction Act “is to permit the United States to assess and collect taxes alleged to be due without judicial intervention, and to require that the legal right to the disputed sums be determined in a suit for refund. In this manner the United States is assured of prompt collection of its lawful revenue.”). The Anti-Injunction Act, in short, applies to “truly revenue-raising tax statutes,” see Bob Jones Univ., supra, 416 U.S. at 743, 94 S.Ct. 2038, and seeks “protection of the revenues” pending a suit for refund. See id. at 737, 740, 94 S.Ct. 2038. Because the individual mandate does not go into effect until 2014, which means the penalty for non-compliance could not be assessed until that time, the Anti-Injunction Act, if it applies, could render much of this case premature and inappropriate as any injunctive or declaratory relief in favor of the plaintiffs could hinder collection of tax revenue. See id. at 732 n. 7, 738-39, 94 S.Ct. 2038 (where the outcome of a suit seeking injunctive or declaratory relief will prevent assessment and collection of tax revenue, the case “falls within the literal scope and the purposes of the [Anti-Injunction Act]”). Consequently, whether the individual mandate penalty is a tax is an important question that not only implicates jurisdiction (vis-a-vis the Anti-Injunction Act), and is not only the specific basis of one of the plaintiffs’ causes of action, but it also goes to the merits of the individual mandate-related challenges of Counts One and Two (that is, whether the penalty can be justified by, and enforced through, Congress’s indisputably broad taxing power), or whether, instead, the penalty must pass Constitutional muster, if at all, under the more limited Commerce Clause authority. As noted, I should, and will, consider this significant issue at the outset. (1) Revenue-raising vs. regulatory The plaintiffs contend that the individual mandate penalty is not a “true tax” because, among other things, it will (at most) “generate only ‘some revenue,’ and then only as an incident to some persons’ failure to obey the law.” See Plaintiffs’ Memorandum in Opposition to Defendants’ Motion to Dismiss (“PI. Mem.”), at 19 (doc. 68). In other words, because its primary purpose is regulatory—and will only raise “little” revenue—it is not a tax as the term is generally understood. It is true, as held in certain of the early tax cases to which the plaintiffs cite, see, e.g., Lipke v. Lederer, 259 U.S. 557, 42 S.Ct. 549, 66 L.Ed. 1061 (1922); Hill v. Wallace, 259 U.S. 44, 42 S.Ct. 453, 66 L.Ed. 822 (1922), that the Supreme Court once drew distinctions between regulatory and revenue-raising taxes. However, those holdings had a very short shelf-life. As noted in Bob Jones Univ., supra, which cited to Lipke and Hill for that position, “the Court ... subsequently abandoned such distinctions.” 416 U.S. at 741 n. 12, 94 S.Ct. 2038; see also id. at 743, 94 S.Ct. 2038 (further stating that the cases were “of narrow scope” and “produced a prompt correction in course”). Succeeding case law recognized that “[e]very tax is in some measure regulatory. To some extent it interposes an economic impediment to the activity taxed as compared with others not taxed. But a tax is not any the less a tax because it has a regulatory effect.” Sonzinsky v. United States, 300 U.S. 506, 513, 57 S.Ct. 554, 81 L.Ed. 772 (1937); see also id. (“it has long been established that an Act of Congress which on its face purports to be an exercise of the taxing power is not any the less so because the tax ... tends to restrict or suppress the thing taxed”). Thus, as the law currently exists, “[i]t is beyond serious question that a tax does not cease to be valid 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.” United States v. Sanchez, 340 U.S. 42, 44, 71 S.Ct. 108, 95 L.Ed. 47 (1950); accord United States v. Kahriger, 345 U.S. 22, 27 n. 3, 28, 73 S.Ct. 510, 97 L.Ed. 754 (1953) (holding same and sustaining federal gambling tax even though its proponents sought to hinder the activity at issue and “ ‘indulge^] the hope that the imposition of this type of tax would eliminate that kind of activity’ ”), overruled on other grounds, Marchetti v. United States, 390 U.S. 39, 88 S.Ct. 697, 19 L.Ed.2d 889 (1968). The elimination of the “regulatory vs. revenue-raising” test does not necessarily mean, however, that the exaction at issue in this case is a “tax.” (2) The Court’s role in ascertaining what Congress intended In deciding this specific question, I will start from the assumption (only for the analysis of whether it is a tax) that Congress could have used its broad taxing power to impose the exaction and that, if it had clearly (or even arguably) intended to do so, then the exaction would have been sustainable under its taxing authority. See Kahriger, supra, 345 U.S. at 28, 31, 73 S.Ct. 510 (“As is well known, the constitutional restraints on taxing are few,” and courts are generally “without authority to limit the exercise of the taxing power”); see also United States v. Ptasynski, 462 U.S. 74, 103 S.Ct. 2239, 76 L.Ed.2d 427 (1983) (observing that “Congress’s power to tax is virtually without limitation”). However, that is not what happened here. Although factually dissimilar, on this point I find instructive the early case of Hekwig v. United States, 188 U.S. 605, 23 S.Ct. 427, 47 L.Ed. 614 (1903). At issue in that case was a federal law that required importers to pay a duty on imported items based on their declared value, plus “a further sum” for any item subsequently found to have been inadequately valued. The sole question the Supreme Court was called upon to decide was whether, for jurisdictional purposes, the so-called “further sum” was “revenue from imports or tonnage” (i.e., a tax), or whether it was in the nature of a penalty. The Court stated: Although the statute, under § 7, supra, terms the money demanded as ‘a further sum,’ and does not describe it as a penalty, still the use of those words does not change the nature and character of the enactment. Congress may enact that such a provision shall not be considered as a penalty or in the nature of one, ... and it is the duty of the court to be governed by such statutory direction, but the intrinsic nature of the provision remains, and, in the absence of any declaration by Congress affecting the manner in which the provision shall be treated, courts must decide the matter in accordance with their views of the nature of the act. Id. at 612-13, 23 S.Ct. 427 (emphasis added). In concluding that the provision was a penalty, the Court stated that, based on the statutory language and its application to the facts of the case, it was “impossible ... to hold this provision to be other than penal in its nature.” Id. at 613, 23 S.Ct. 427. To be clear, it is not necessarily significant for our purposes that Helwig found the “further sum” to be in the nature of a penalty and not a tax; rather, what is significant is what the Supreme Court said along the way to getting there. In reaching its conclusion, the Court made it a point to stress—as it did in the emphasized portion quoted above—that regardless of the “ordinary or general meaning of the words” in the statute, and regardless of the “nature and character of the enactment,” the exaction would not have been found a penalty if Congress intended otherwise. Thus, “[i]f it clearly appear that it is the will of Congress that the provision shall not be regarded as in the nature of a penalty, the court must be governed by that will.” Id. (emphasis added). As applied to the facts of this case, Helwig can be interpreted as concluding that, regardless of whether the exaction could otherwise qualify as a tax (based on the dictionary definition or “ordinary or general meaning of the word”), it cannot be regarded as one if it “clearly appears” that Congress did not intend it to be. In this case, there are several reasons (perhaps none dispositive alone, but convincing in total) why it is inarguably clear that Congress did not intend for the exaction to be regarded as a tax. (3) Congress did not call it a tax, despite knowing how to do so In addition to the Act, there were several healthcare reform bills introduced and debated during the 111th Congress. For example, “America’s Affordable Health Choices Act of 2009” (H.R. 3200) was introduced in the House of Representatives on July 14, 2009. Like the Act, it contained an individual mandate and concomitant penalty. However, it called the penalty a tax. Section 401 was unambiguously titled “Tax on Individuals Without Acceptable Health Care Coverage,” and went on to refer to the exaction as a “tax” no less than fourteen times in that section alone. See, e.g., id. (providing that with respect to “any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax”). H.R. 3200 was thereafter superseded by a similar bill, “Affordable Health Care for America Act” (H.R. 3962), which was actually passed in the House of Representatives on November 7, 2009. That second House bill also included an individual mandate and penalty, and it repeatedly referred to the penalty as a “tax.” See, e.g., Section 501 (providing that for any person who does not comply with the individual mandate “there is hereby imposed a tax,” and referring to that “tax” multiple times); Section 307(c)(1)(A) (further referring to the penalty as a “tax[ ] on individuals not obtaining acceptable coverage”). While the above bills were being considered in the House, the Senate was working on its healthcare reform bills as well. On October 13, 2009, the Senate Finance Committee passed a bill, “America’s Healthy Future Act” (S. 1796). A precursor to the Act, this bill contained an individual mandate and accompanying penalty. In the section titled “Excise Tax on Individuals Without Essential Health Benefits Coverage,” the penalty was called a “tax.” See Section 1301 (“If an applicable individual fails to [obtain required insurance] there is hereby imposed a tax”). In contrast to the foregoing, the Act—which was the final version of the healthcare legislation later passed by the Senate on December 24, 2009—did not call the failure to comply with the individual mandate a tax; it was instead called a “penalty.” The Act reads in pertinent part: “If an applicable individual fails to meet the requirement of subsection (a) ... there is hereby imposed a penalty.” Act § 1501(b)(1). Congress’s conspicuous decision to not use the term “tax” in the Act when referring to the exaction (as it had done in at least three earlier incarnations of the legislation) is significant. “ ‘Few principles of statutory construction are more compelling than the proposition that Congress does not intend sub silentio to enact statutory language that it has earlier discarded in favor of other language.’ ” INS v. Cardoza-Fonseca, 480 U.S. 421, 442, 107 S.Ct. 1207, 94 L.Ed.2d 434 (1987). Thus, “[w]here Congress includes [certain] language in an earlier version of a bill but deletes it prior to enactment, it may be presumed that the [omitted text] was not intended.” Russello v. United States, 464 U.S. 16, 23-24, 104 S.Ct. 296, 78 L.Ed.2d 17 (1983); see also United States v. NEC Corp., 931 F.2d 1493, 1502 (11th Cir.1991) (changes in statutory language “generally indicate! ] an intent to change the meaning of the statute”); Southern, Pac. Transportation Co. v. Usery, 539 F.2d 386, 390-91 (5th Cir.1976) (rejecting the interpretation of a statute that was based on language in an earlier House version that the Senate changed prior to passing into law, and attaching “weight to the [Senate’s] conscious and deliberate substitution of [the House’s] language”) (binding under Bonner v. City of Prichard, Alabama, 661 F.2d 1206, 1207 (11th Cir.1981) (en banc)). Congress’s failure to call the penalty a “tax” is especially significant in light of the fact that the Act itself imposes a number of taxes in several other sections (see, e.g., Excise Tax on Medical Device Manufacturers, § 1405 (“There is hereby imposed on the sale of any taxable medical device by the manufacturer, producer, or importer a tax”); Excise Tax on High Cost Employer-Sponsored Health Coverage, § 9001 (“there is hereby imposed a tax”); Additional Hospital Insurance Tax on High-Income Taxpayers, § 9015 (“there is hereby imposed a tax”); Excise Tax on Indoor Tanning Services, § 10907 (“There is hereby imposed on any indoor tanning service a tax”)). This shows beyond question that Congress knew how to impose a tax when it meant to do so. Therefore, the strong inference and presumption must be that Congress did not intend for the “penalty” to be a tax. See generally Hodge v. Muscatine County, 196 U.S. 276, 25 S.Ct. 237, 49 L.Ed. 477 (1905) (noting that “[i]t is not easy to draw an exact line of demarcation between a tax and a penalty,” but where the statute uses “tax” in one section and “penalty” in another, courts “cannot go far afield” in treating the exaction as it is called; to do otherwise “would be a distortion of the words employed”); see also Duncan v. Walker, 533 U.S. 167, 173, 121 S.Ct. 2120, 150 L.Ed.2d 251 (2001) (“It is well settled that ‘[w]here Congress includes particular language in one section of a statute but omits it in another section of the same Act, it is generally presumed that Congress acts intentionally and purposely in the disparate inclusion or exclusion.’ ”) (citations omitted); Freemanville Water Sys., Inc. v. Poarch Band of Creek Indians, 563 F.3d 1205, 1209 (11th Cir.2009) (“[W]here Congress knows how to say something but chooses not to, its silence is controlling”); DIRECTV, Inc. v. Brown, 371 F.3d 814, 818 (11th Cir.2004) (“[W]hen Congress uses different language in similar sections, it intends different meanings.”). The defendants assert in their memorandum, see Memorandum in Support of Defendants’ Motion to Dismiss (“Def. Mem.”), at 33, 50 n. 23 (doc. 56-1), as they did during oral argument, that in deciding whether the exaction is a penalty or tax, “it doesn’t matter” what Congress called it because the label “is not conclusive.” See Transcript of Oral Argument (“Tr.”), at 27-29 (doc. 77). As a general rule, it is true that the label used is not controlling or dispositive because Congress, at times, may be unclear and use inartful or ambiguous language. Therefore, as the Supreme Court recognized more than 100 years ago in Helwig, supra, the use of a particular word “does not change the nature and character of the [exaction],” and it is the ultimate duty of the court to decide the issue based on “the intrinsic nature of the provision” irrespective of what it is called. See 188 U.S. at 612-13, 23 S.Ct. 427; accord Cooley v. Bd. of Wardens, 53 U.S. (12 How.) 299, 314, 13 L.Ed. 996 (1851) (“it is the thing, and not the name, which is to be considered”). However, as also noted in Helwig, this rule must be set aside when it is clear and manifest that Congress intended the exaction to be regarded as one and not the other. For that reason, the defendants are wrong to contend that what Congress called it “doesn’t matter.” To the extent that the label used is not just a label, but is actually indicative of legislative purpose and intent, it very much does matter. By deliberately changing the characterization of the exaction from a “tax” to a “penalty,” but at the same time including many other “taxes” in the Act, it is manifestly clear that Congress intended it to be a penalty and not a tax. Quoting the Third Circuit in Penn Mut. Indem. Co. v. C.I.R, 277 F.2d 16, 20 (3d Cir.1960), the defendants maintain that “ ‘Congress has the power to impose taxes generally, and if the particular imposition does not run afoul of any constitutional restrictions then the tax is lawful, call it what you will.’ ” Def. Mem. at 50 n. 23. I do not necessarily disagree with this position, at least not when it is quite clear that Congress intends to impose a tax and is acting pursuant to its taxing power. However, as will be discussed in the next section, that is not the situation here. In the Penn Mutual Indemnity case, for example, it was clear and undisputed that Congress had exercised its taxing authority to impose the exaction; it was inarguably a “tax,” and the only question was whether it was an excise tax, an income tax, or some other type of tax. It was in that particular context that the Third Circuit’s analysis included the quoted statement, and further elaborated that: “It is not necessary to uphold the validity of the tax imposed by the United States that the tax itself bear an accurate label.” See 271 F.2d at 20. That is obviously a very different situation front the one presented here, where the precise label of an acknowledged tax is not being disputed, but rather whether it is even a tax at all. (4) Congress did not state that it was acting under its taxing authority, and, in fact, it treated the penalty differently than traditional taxes Congress did not state in the Act that it was exercising its taxing authority to impose the individual mandate and penalty; instead, it relied exclusively on its power under the Commerce Clause. U.S. Const, art. I, § 8, cl. 3 (“[Congress shall have Power] To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes”). The Act recites numerous (and detailed) factual findings to show that the individual mandate regulates commercial activity important to the economy. Specifically, it states that: “The [individual mandate] is commercial and economic in nature, and substantially affects interstate commerce” in that, inter alia, “[h]ealth insurance and health care services are a significant part of the national economy” and the mandate “will add millions of new consumers to the health insurance market, increasing the supply of, and demand for, health care services.” Act § 1501(a)(l)-(2)(B)(C). It further states that health insurance “is in interstate commerce,” and the individual mandate is “essential to creating effective health insurance markets.” Id. § 1501(a)(2)(F), (H). The Act contains no indication that Congress was exercising its taxing authority or that it meant for the penalty to be regarded as a tax. Although the penalty is to be placed in the Internal Revenue Code under the heading “Miscellaneous Excise Taxes,” the plain language of the Code itself states that this does not give rise to any inference or presumption that it was intended to be a tax. See United States v. Reorganized CF & I Fabricators of Utah, Inc., 518 U.S. 213, 222-23, 116 S.Ct. 2106, 135 L.Ed.2d 506 (1996) (citing to 26 U.S.C. § 7806(b), which provides that: “No inference, implication, or presumption of legislative construction shall be drawn or made by reason of the location or grouping of any particular section or provision or portion of this title”). In fact, while the penalty is placed under the “Excise Taxes” heading of the Code, at the same time Congress specifically exempted and divorced the penalty from all the traditional enforcement and collection methods used by the Internal Revenue Service, such as tax liens, levies, and criminal proceedings. See Act § 1501(b). These exemptions from normal tax attributes—coupled with Congress’s failure to identify its taxing authority—belie the claim that, simply because it is mentioned in the Internal Revenue Code, the penalty must be a tax. (5) Lack of statutorily-identiñed revenue-generating purpose Perhaps most significantly, the Act does not mention any revenue-generating purpose that is to be served by the individual mandate penalty, even though such a purpose is required. See Rosenberger v. Rector and Visitors of Univ. of Virginia, 515 U.S. 819, 841, 115 S.Ct. 2510, 132 L.Ed.2d 700 (1995) (“ ‘A tax, in the general understanding of the term, and as used in the Constitution, signifies an exaction for the support of the Government’ ”). In this circuit, the ultimate test of tax validity “is whether on its face the tax operates as a revenue generating measure and the attendant regulations are in aid of a revenue purpose.” United States v. Ross, 458 F.2d 1144, 1145 (5th Cir.1972) (emphasis added) (binding under Bonner, supra, 661 F.2d at 1207). The revenue-generating provisions in the Act were an important part of the legislation as they were necessary under current Congressional procedure to score its final cost. To be sure, much of the debate within and outside Congress focused on the bill’s final price tag and whether it would exceed the threshold of $1 trillion over the course of the first ten years; and while the legislation was being debated, Congress worked closely and often with the Congressional Budget Office (“CBO”) to ensure that it did not. Obviously, if the penalty had been intended by Congress to be a true revenue-generating tax (that could be used to keep the Act’s final cost down) then it would have been treated as a tax “on its face.” During oral argument, defense counsel stated that “[t]he purpose of the [penalty] is ... to raise revenue to offset expenditures of the federal government that it makes in connection, for example, with the Medicaid expansion.” See Tr. at 9. However, there is absolutely no support for that statement in the statute itself. On its face, the Act lists seventeen “Revenue Offset Provisions” (including the several taxes described supra), and, as reconciled, it further includes a section entitled “Provisions Relating to Revenue” (which also references those taxes and other revenue offsetting provisions). However, the individual mandate penalty is not listed anywhere among them. Nowhere in the statute is the penalty provision identified or even mentioned as raising revenue and offsetting the Act’s costs. It is especially noteworthy that the Act does not identify revenue to be generated from the penalty (which the defendants now maintain would raise about $1 billion each year), but the statute identifies the tanning salon tax as revenue-raising (even though that tax is expected to raise a significantly smaller $300 million annually). See Joint Committee on Taxation, Estimated Revenue Effects of the Manager’s Amendment to the Revenue Provisions Contained in the “Patient Protection and Affordable Care Act,” as Passed by the Senate on December 24, 2009 (JCX-10-10), March 11, 2010, at 2. If Congress had intended and understood the penalty to be a tax that would raise revenue for the government, which could in turn be used to partially finance the Act’s budgetary effect and help keep its ten-year cost below the $1 trillion threshold by offsetting its expenditures, it makes little sense that Congress would ignore a “tax” that could be expected to raise almost $20 billion in revenue between the years 2015-2019, yet mention another tax that was expected to raise less than one-tenth of that revenue annually during the same time period. To the extent there is statutory ambiguity on this issue, both sides ask that I look to the Act’s legislative history to determine if Congress intended the penalty to be a tax. Ironically, they rely on the same piece of legislative history in making their respective arguments, to wit, the 157-page “Technical Explanation” of the Act that was prepared by the Staff of the Joint Committee on Taxation on March 21, 2010 (the same day the House voted to approve and accept the Senate bill and two days before the bill was signed into law). The plaintiffs highlight the fact that the report “consistently” refers to the penalty as a penalty and not a tax, see PI. Mem. at 19 (as compared, for example, with the tanning salon tax that is consistently referred to as a “tax” in that same report, see JCT, Technical Explanation of the Revenue Provisions of the “Reconciliation Act of 2010,” as amended, in Combination with the “Patient Protection and Affordable Care Act” (JCX-18-10), March 21, 2010, at 108). The defendants, on the other hand, highlight the fact that the JCT referred to the penalty as an “excise tax” in a single heading in that report. See Def. Mem. at 51. As the Supreme Court has repeatedly held, “the authoritative statement is the statutory text, not the legislative history or any other extrinsic material. Extrinsic materials have a role in statutory interpretation only to the extent they shed a reliable light on the enacting Legislature’s understanding of otherwise ambiguous terms.” Exxon Mobil Corp. v. Allapattah Services, Inc., 545 U.S. 546, 568, 125 S.Ct. 2611, 162 L.Ed.2d 502 (2005) (emphasis added). On the facts of this case, “penalty” is not an ambiguous term, but rather was a carefully and intentionally selected word that has a specific meaning and carries a particular import (discussed infra). Moreover, even if the term was ambiguous, the Supreme Court has pointed out two “serious criticisms” of attempting to rely on legislative history: Not all extrinsic materials are reliable sources of insight into legislative understandings ..., and legislative history in particular is vulnerable to two serious criticisms. First, legislative history is itself often murky, ambiguous, and contradictory. Judicial investigation of legislative history has a tendency to become, to borrow Judge Leventhal’s memorable phrase, an exercise in “ ‘looking over a crowd and picking out your friends.’ ” See Wald, Some Observations on the Use of Legislative History in the 1981 Supreme Court Term, 68 Iowa L.Rev. 195, 214 (1983). Second, judicial reliance on legislative materials like committee reports, which are not themselves subject to the requirements of Article I, may give unrepresentative committee members—or, worse yet, unelected staffers and lobbyists—both the power and the incentive to attempt strategic manipulations of legislative history to secure results they were unable to achieve through the statutory text. Id. In this case, both criticisms are directly on the mark. The report is ambiguous and contradictory, as evidenced by the simple fact that both sides claim it supports their position. Should I look to the heading (that calls the exaction an “excise tax”), or should I look to the actual body of the report (that calls it a penalty no less than twenty times with no mention of it being a tax)? It is, as Judge Leventhal said, like “looking over a crowd and picking out your friends.” Further, a strong argument could be (and has been) made that the staffers who drafted the report were merely engaging in last minute “strategic manipulation” to secure results they were unable to achieve through the Act itself. See, e.g., The Insurance Mandate in Peril, Wall St. J., Apr. 29, 2010, at A19 (opining that the “excise tax” heading in the JCT report should not be used to convert the penalty into a tax because the Supreme Court “will not allow staffers and lawyers to change the statutory cards that Congress already dealt when it adopted the Senate language”). For these reasons, as recognized by the Supreme Court, resort to, or reliance upon, the JCT staffs Technical Explanation would be inappropriate on the facts of this case—even if the term “penalty” was ambiguous (which it is not). To summarize the foregoing, it “clearly appears” from the statute itself, see Helwig, supra, 188 U.S. at 613, 23 S.Ct. 427, that Congress did not intend to impose a tax when it imposed the penalty. To hold otherwise would require me to look beyond the plain words of the statute. I would have to ignore that Congress: (i) specifically changed the term in previous incarnations of the statute from “tax” to “penalty;” (ii) used the term “tax” in describing the several other exactions provided for in the Act; (iii) specifically relied on and identified its Commerce Clause power and not its taxing power; (iv) eliminated traditional IRS enforcement methods for the failure to pay the “tax;” and (v) failed to identify in the legislation any revenue that would be raised from it, notwithstanding that at least seventeen other revenue-generating provisions were specifically so identified. The defendants have not pointed to any reported case decided by any court of record that has ever found and sustained a tax in a situation such as the one presented here, and my independent research has also revealed none. At bottom, the defendants are asking that I divine hidden and unstated intentions, and despite considerable evidence to the contrary, conclude that Congress really meant to say one thing when it expressly said something else. The Supreme Court confronted the inverse of this situation in Sonzinsky, supra, and I believe the rationale of that case forecloses the defendants’ argument. The issue in Sonzinsky was whether a levy on the sale of firearms was a tax. The exaction was called a tax on its face, and it was undisputed that it had been passed pursuant to Congress’s taxing power. Nonetheless, the petitioner sought to invalidate the tax because it was “prohibitive in effect and [disclosed] unmistakably the legislative purpose to regulate rather than to tax.” The petitioner argued that it was not “a true tax, but a penalty.” In rejecting this argument, the Supreme Court explained: Inquiry into the hidden motives which may move Congress to exercise a power constitutionally conferred upon it is beyond the competency of courts. They will not undertake, by collateral inquiry as to the measure of the regulatory effect of a tax, to ascribe to Congress an attempt, under the guise of taxation, to exercise another power. Stated somewhat differently, reviewing courts cannot look beyond a statute and inquire as to whether Congress meant something different than what it said. If an exaction says “tax” on its face and was imposed pursuant to Congress’s taxing power, courts “are not free to speculate as to the motives which moved Congress to impose it, or as to the extent to which it may [be a penalty intended] to restrict the activities taxed.” See generally Sonzinsky, supra, 300 U.S. at 511-14, 57 S.Ct. 554; accord Kahriger, supra, 345 U.S. at 22, 73 S.Ct. 510 (similarly declining invitation to hold that “under the pretense of exercising” a particular power, Congress was, in fact, exercising another power). The holding of Sonzinsky cuts both ways, and applying that holding to the facts here, I have no choice but to find that the penalty is not a tax. Because it is called a penalty on its face (and because Congress knew how to say “tax” when it intended to, and for all the other reasons noted), it would be improper to inquire as to whether Congress really meant to impose a tax. I will not assume that Congress had an unstated design to act pursuant to its taxing authority, nor will I impute a revenue-generating purpose to the penalty when Congress specifically chose not to provide one. It is “beyond the competency” of this court to question and ascertain whether Congress really meant to do and say something other than what it did. As the Supreme Court held by necessary implication, this court cannot “undertake, by collateral inquiry as to the measure of the [revenue-raising] effect of a [penalty], to ascribe to Congress an attempt, under the guise of [the Commerce Clause], to exercise another power.” See Sonzinsky, supra, 300 U.S. at 514, 57 S.Ct. 554. This conclusion is further justified in this case since President Obama, who signed the bill into law, has “absolutely” rejected the argument that the penalty is a tax. See supra note 5. To conclude, as I do, that Congress imposed a penalty and not a tax is not merely formalistic hair-splitting. There are clear, important, and well-established differences between the two. See Dep’t of Revenue of Montana v. Kurth Ranch, 511 U.S. 767, 779-80, 114 S.Ct. 1937, 128 L.Ed.2d 767 (1994) (“Whereas [penalties] are readily characterized as sanctions, taxes are typically different because they are usually motivated by revenue-raising, rather than punitive, purposes.”); Reorganized CF & I Fabricators of Utah, Inc., supra, 518 U.S. at 224, 116 S.Ct. 2106 (“ ‘a tax is a pecuniary burden laid upon individuals or property for the purpose of supporting the Government,’ ” whereas, “if the concept of penalty means anything, it means punishment for an unlawful act or omission”); United States v. La Franca, 282 U.S. 568, 572, 51 S.Ct. 278, 75 L.Ed. 551 (1931) (“A ‘tax’ is an enforced contribution to provide for the support of government; a ‘penalty,’ as the word is here used, is an exaction imposed by statute as punishment for an unlawful act.’ ”). Thus, as the Supreme Court has said, “[t]he two words are not interchangeable one for the other ...; and if an exaction be clearly a penalty it cannot be converted into a tax by the simple expedient of calling it such.” La Franca, supra, 282 U.S. at 572, 51 S.Ct. 278. (6) Does the Anti-Injunction Act apply anyway? The defendants insist that the Anti-Injunction Act should still preclude the individual mandate challenges even if the penalty is not a tax. For this argument, the defendants rely on Title 26, United States Code, Section 6671, which states that the “penalties” provided under subchapter B of chapter 68 of the IRS Code (a classification that includes the individual mandate penalty) “shall be assessed and collected in the same manner as taxes.” If the penalty is intended to be assessed and collected in the same manner as a tax, the defendants contend, then the Anti-Injunction Act should apply. I do not agree. First of all, the penalty is obviously not to be collected and treated “in the same manner as taxes” in light of the fact that Congress specifically divorced the penalty from the tax code’s traditional collection and enforcement mechanisms. Further, and more significantly, as noted supra, the whole point of the Anti-Injunction Act is to protect the government in the collection of its lawful tax revenues, and thus it applies to “truly revenue-raising tax statutes,” which Congress plainly did not understand and intend the penalty to be. The Eleventh Circuit has recognized (albeit by implication) that the Anti-Injunction Act does not reach penalties that are, as here, “imposed for substantive violations of laws not directly related to the tax code” and which are not good-faith efforts to enforce the technical requirements of the tax law. Cf. Mobile Republican Assembly v. United States, 353 F.3d 1357, 1362 n. 5 (11th Cir.2003). The defendants have cited two out-of-circuit cases in support of their contention that Section 6671(a) requires penalties to be treated the same as taxes for Anti-Injunction Act purposes, Barr v. United States, 736 F.2d 1134 (7th Cir.1984); Warren v. United States, 874 F.2d 280 (5th Cir.1989). Although those cases did indeed hold that the penalties at issue fell under the Anti-Injunction Act, they do not really support the defendants’ position. As the plaintiffs note, the penalties in both those cases were imposed for failing to pay an undisputed tax, that is, falsely claiming an exemption in Barr, and refusing to sign a tax return in Warren. In other words, the penalties were “directly related to the tax code.” Cf. Mobile Republican Assembly, supra, 353 F.3d at 1362 n. 5. Allowing IRS penalties such as those to qualify as a tax for Anti-Injunction Act purposes “is simply a means for ensuring that the [underlying] tax is paid.” See Botta v. Scanlon, 314 F.2d 392, 393 (2d Cir.1963). That is not the situation here. It would be inappropriate to give tax treatment under the Anti-Injunction Act to a civil penalty that, by its own terms, is not a tax; is not to be enforced as a tax; and does not bear any meaningful relationship to the revenue-generating purpose of the tax code. Merely placing a penalty (which virtually all federal statutes have) in the IRS Code, even though it otherwise bears no meaningful relationship thereto, is not enough to render the Anti-Injunction Act (which only applies to true revenue-raising exactions) applicable to this case. (7) Accountability I will say one final thing on the tax issue, which, although I believe it to be important, is not essential to my decision. For purposes of this discussion, I will assume that the defendants are correct and that the penalty is (and was always intended to be) a tax. In Virginia v. Sebelius, one of the twenty or so other lawsuits challenging the Act, the federal government’s lead counsel (who is lead defense counsel in this litigation, as well) urged during oral argument in that case that the penalty is proper and sustainable under the taxing power. Although that power is broad and does not easily lend itself to judicial review, counsel stated, “there is a check. It’s called Congress. And taxes are scrutinized. And the reason we don’t have all sorts of crazy taxes is because taxes are among the most scrutinized things we have. And the elected representatives in Congress are held accountable for taxes that they impose.” See Transcript of Oral Argument (Virginia case), at 45 (emphasis added). This foregoing statement highlights one of the more troubling aspects of the defendants’ “newfound” tax argument. As noted at the outset of this order, and as anyone who paid attention to the healthcare reform debate already knew, the Act was very controversial at the time of passage. Irrespective of the merits of the arguments for or against it, the legislation required lawmakers in favor of the bill to cast politically difficult and tough votes. As it turned out, the voting was extremely close. Because by far the most publicized and controversial part of the Act was the individual mandate and penalty, it would no doubt have been even more difficult to pass the penalty as a tax. Not only are taxes always unpopular, but to do so at that time would have arguably violated pledges by politicians (including the President) to not raise taxes, which could have made it that much more difficult to secure the necessary votes for passage. One could reasonably infer that Congress proceeded as it did specifically because it did not want the penalty to be “scrutinized” as a $4 billion annual tax increase, and it did not want at that time to be “held accountable for taxes that they imposed.” In other words, to the extent that the defendants are correct and the penalty was intended to be a tax, it seems likely that the members of Congress merely called it a penalty and did not describe it as revenue-generating to try and insulate themselves from the potential electoral ramifications of their votes. Regardless of whether the members of Congress had this specific motivation and intent (which, once again, is not my place to say), it is obvious that Congress did not pass the penalty, in the version of the legislation that is now “the Act,” as a tax under its taxing authority, but rather as a penalty pursuant to its Commerce Clause power. Those two exactions, as previously noted, are not interchangeable. And, now that it has passed into law on that basis, government attorneys have come into this court and argued that it was a tax after all. This rather significant shift in position, if permitted, could have the consequence of allowing Congress to avoid the very same accountability that was identified by the government’s counsel in the Virginia case as a check on Congress’s broad taxing power in the first place. In other words, the members of Congress would have reaped a political advantage by calling and treating it as a penalty while the Act was being debated, see Virginia v. Sebelius, 702 F.Supp.2d 598, 612 (E.D.Va.2010) (referring to “preenactment representations by the Executive and Legislative branches” that the penalty was not “a product of the government’s power to tax for the general welfare”), and then reap a legal advantage by calling it a tax in court once it passed into law. See Def. Mem. at 33-34, 49 (arguing that the Anti-Injunction Act bars any challenge to the penalty which, in any event, falls under Congress’s “very extensive” authority to tax for the general welfare). This should not be allowed, and I am not aware of any reported case where it ever has been. Congress should not be permitted to secure and cast politically difficult votes on controversial legislation by deliberately calling something one thing, after which the defenders of that legislation take an “Alice-in-Wonderland” tack and argue in court that Congress really meant something else entirely, thereby circumventing the safeguard that exists to keep their broad power in check. If Congress intended for the penalty to be a tax, it should go back and make that intent clear (for example, by calling it a tax, relying on Congress’s Constitutional taxing power, allowing it to be collected and enforced as a tax, or identifying revenue to be raised) so it can be “scrutinized” as a tax and Congress can accordingly be held accountable. They cannot, however, use a different linguistic with a perhaps secret understanding between themselves that the word, in fact, means something else entirely. As the First Circuit has explained, the integrity of the process must be guaranteed by the judiciary: In our republican form of government, legislators make laws by wilting statutes—an exercise that requires putting words on paper in a way that conveys a reasonably definite meaning. Once Congress has spoken, it is bound by what it has plainly said, notwithstanding the nods and winks that may have been exchanged____And the judiciary must stand as the ultimate guarantor of the integrity of an enacted statute’s text. State of Rhode Island v. Narragansett Indian Tribe, 19 F.3d 685, 699-700 (1st Cir.1994). (8) For Constitutional purposes, it is a penalty, and must be analyzed under Congress’s Commerce Clause power For all the above reasons, I conclude that the individual mandate penalty is not a “tax.” It is (as the Act itself says) a penalty. The defendants may not rely on Congress’s taxing authority under the General Welfare Clause to try and justify the penalty after-the-fact. If it is to be sustained, it must be sustained as a penalty imposed in aid of an enumerated power, to wit, the Commerce Clause power. See Sunshine Anthracite Coal Co. v. Adkins, 310 U.S. 381, 393, 60 S.Ct. 907, 84 L.Ed. 1263 (1940) (“Congress may impose penalties in aid of the exercise of any of its enumerated powers”). Therefore, the Anti-Injunction Act does not deprive this court of jurisdiction. See Lipke, supra, 259 U.S. at 562, 42 S.Ct. 549 (“The collector demanded payment of a penalty, and [thus the Anti-Injunction Act], which prohibits suits to restrain assessment or collection of any tax, is without application.”). I will next consider the rest of the defendants’ jurisdictional challenges. B. Rule 12(b)(1) (“Lack of Subject Matter Jurisdiction”) Challenges The defendants raise two additional jurisdictional arguments: first, that the individual plaintiffs and the NFIB do not have standing to pursue Counts One and Two, and the state plaintiffs do not have standing with respect to Count Six; and second, that those same causes of action are not ripe. (1) Standing The Constitution limits the subject matter of the federal courts to “cases” and “controversies.” U.S. Const, art. Ill, § 2. “[T]he core component of standing is an essential and unchanging part of the case-or-eontroversy requirement of Article III.” Lujan v. Defenders of Wildlife, 504 U.S. 555, 560, 112 S.Ct. 2130, 119 L.Ed.2d 351 (1992). The “irreducible constitutional minimum of standing” contains three elements: “(1) an injury in fact, meaning an injury that is concrete and particularized, and actual or imminent, (2) a causal connection between the injury and the causal conduct, and (3) a likelihood that the injury will be redressed by a favorable decision.” Granite State Outdoor Advertising Inc. v. City of Clearwater, 351 F.3d 1112, 1116 (11th Cir.2003). The defendants appear to concede that (2) and (3) are present in this litigation, but contend that the plaintiffs cannot establish an injury-in-fact. Accordingly, only element (1) is at issue here. For purposes of ruling on the defendants’ motion to dismiss, I simply need to examine the plaintiffs’ factual allegations: At the pleading stage, general factual allegations of injury resulting from defendant’s conduct may suffice, for on a motion to dismiss we “presum[e] that general allegations embrace those specific facts that are necessary to support the claim.” Lujan, supra, 504 U.S. at 561, 112 S.Ct. 2130 (quoting Lujan v. Nat’l Wildlife Federation, 497 U.S. 871, 889, 110 S.Ct. 3177, 111 L.Ed.2d 695 (1990)). Thus, “mere allegations of injury” are sufficient to withstand a motion to dismiss based on lack of standing. Dep’t of Commerce v. U.S. House of Representatives, 525 U.S. 316, 329, 119 S.Ct. 765, 142 L.Ed.2d 797 (1999); accord Miccosukee Tribe of Indians of Florida v. Southern Everglades Restoration Alliance, 304 F.3d 1076, 1081 (11th Cir.2002) (noting “at the motion to dismiss stage [the plaintiff] is only required to generally allege a redressable injury caused by the actions of [the defendant] about which it complains”). The individual plaintiffs make numerous allegations in the amended complaint that are relevant to the standing issue. According to those allegations, Mary Brown is a small business owner and current member of the NFIB. She has not had health insurance for the last four years. She devotes her available resources to maintaining her b