Medina v. Planned Parenthood (2025)

(Slip Opinion) OCTOBER TERM, 2024 1 Syllabus NOTE: Where it is feasible, a syllabus (headnote) will be released, as is being done in connection with this case, at the time the opinion is issued. The syllabus constitutes no part of the opinion of the Court but has been prepared by the Reporter of Decisions for the convenience of the reader. See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337 . SUPREME COURT OF THE UNITED STATES Syllabus MEDINA, DIRECTOR, SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES v. PLANNED PARENTHOOD SOUTH ATLANTIC ET AL. CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 23–1275. Argued April 2, 2025—Decided June 26, 2025 Congress created Medicaid in 1965 to subsidize state healthcare for fam- ilies and individuals “whose income and resources are insufficient to meet the costs of necessary medical services.” §1396–1. Medicaid of- fers States “a bargain”: federal funds in exchange for compliance with congressionally imposed conditions. To participate in Medicaid, States must submit a “plan for medical assistance” satisfying over 80 condi- tions in §1396a(a). If a State fails “to comply substantially” with any condition, the Secretary of Health and Human Services may withhold federal funding. §1396c. This case involves the any-qualified-provider provision in §1396a(a)(23)(A), which requires States to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. The provision does not define “qualified,” leaving that to States’ traditional authority over health and safety matters. The ques- tion is whether individual Medicaid beneficiaries may sue state offi- cials under 42 U. S. C. §1983 for failing to comply with the any-quali- fied-provider provision. Planned Parenthood South Atlantic operates two clinics in South Carolina, offering a wide range of services to Medicaid and non-Medi- caid patients. It also performs abortions. Citing state law prohibiting public funds for abortion, South Carolina in July 2018 determined that Planned Parenthood could no longer participate in the State’s Medi- caid program. At the same time, the State took steps that, it said, 2 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Syllabus would help ensure that other providers would continue offering neces- sary medical care and family planning services. Planned Parenthood and patient Julie Edwards sued, claiming the exclusion of Planned Parenthood violated the any-qualified-provider provision. Edwards al- leged she preferred Planned Parenthood for gynecological care but needed Medicaid coverage. They brought a §1983 class action “to vin- dicate rights secured by the federal Medicaid statutes.” Section 1983 allows private parties to sue state actors who violate their “rights” under the federal “Constitution and laws.” But federal statutes do not automatically confer §1983-enforceable “rights.” This is especially true of spending-power statutes like Medicaid, where “the typical remedy” for violations is federal funding termination, not pri- vate suits. Gonzaga Univ. v. Doe, 536 U. S. 273, 280 . The district court granted summary judgment for plaintiffs and en- joined the exclusion. The Fourth Circuit affirmed. This Court then granted certiorari, vacated, and remanded in light of Health and Hos- pital Corporation of Marion Cty. v. Talevski, 599 U. S. 166 , which ad- dressed whether another spending-power statute created §1983-en- forceable rights. On remand, the Fourth Circuit reaffirmed. Held: Section 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under §1983. Pp. 5–24. (a) Congress sometimes allows private enforcement through §1983, which authorizes suits against state actors who deprive individuals of federal “rights, privileges, or immunities.” But statutes create indi- vidual rights only in “atypical case[s].” Talevski, 599 U. S., at 183 . Section 1983 provides causes of action for deprivation of “ ‘rights,’ ” not mere “ ‘benefits’ or ‘interests.’ ” Gonzaga, 536 U. S., at 283 . To prove an enforceable right, plaintiffs must show the statute “clear[ly] and unambiguous[ly]” uses “rights-creating terms” with “an unmistakable focus” on individuals. Id., at 284, 290 . This is a “strin- gent” and “demanding” test. Talevski, 599 U. S., at 180, 186 . Even qualifying statutes may be unenforceable if Congress provided alter- native remedies. These rules vindicate separation of powers. Courts once assumed authority to provide whatever remedies seemed necessary for statu- tory purposes. But statutes do not pursue single purposes “at all costs,” American Express Co. v. Italian Colors Restaurant, 570 U. S. 228, 234 , and Congress may not wish to authorize private suits, Her- nández v. Mesa, 589 U. S. 93 , 100. Deciding whether to permit private enforcement poses delicate policy questions involving competing costs and benefits—decisions for elected representatives, not judges. Pp. 6– 7. (b) Spending-power statutes are especially unlikely to confer en- forceable rights. Unlike Commerce Clause or other regulatory powers, Cite as: 606 U. S. ____ (2025) 3 Syllabus Congress’s spending authority rests on the “Taxing Clause” (Art. I, §8, cl. 1), which does not expressly authorize regulating conduct or issuing direct orders to States. Early courts described federal grants as contracts, not commands. Federal-state agreements resemble treaties “between two sovereign- ties.” Neil, Moore & Co. v. Ohio, 3 How. 720, 742 . Treaties may benefit citizens but generally do not confer individually enforceable rights against sovereigns, instead depending on the contracting governments for enforcement. Thus, “Congress alone has the power to enforce” grant conditions. Emigrant Co. v. County of Adams, 100 U. S. 61, 69 . Pp. 8–10. (c) In Pennhurst State School and Hospital v. Halderman, 451 U. S. 1 , the Court established that spending-power legislation is “much in the nature of a contract.” Id., at 17 . The “typical remedy for state noncompliance” is federal funding termination. Id., at 28 . Private en- forcement requires showing States “voluntarily and knowingly” con- sented to private suits, meaning Congress must “clearly” and “unam- biguously” alert States that private enforcement was a funding condition. Id., at 17 . Gonzaga held that spending-power legislation cannot support §1983 suits unless Congress “speaks with a clear voice, and manifests an un- ambiguous intent to confer individual rights.” 536 U. S., at 280 . Only “unmistakable” notice suffices. Id., at 286–287, and n. 5 Talevski reaffirmed that Gonzaga “sets forth [the] established method.” 599 U. S., at 183 . Statutory provisions must “unambigu- ously confer individual federal rights”—a “demanding bar” cleared only in “atypical” cases. Id., at 180 , 183–184. The statutes there qual- ified because they “expressly” used clear “rights-creating language.” Id., at 184, 186 (internal quotation marks omitted). Earlier cases like Wilder v. Virginia Hospital Assn., 496 U. S. 498 , Wright v. Roanoke Redevelopment and Housing Authority, 479 U. S. 418 , and Blessing v. Freestone, 520 U. S. 329 , suggested less demand- ing standards, but Gonzaga “reject[ed]” any approach permitting “an- ything short of an unambiguously conferred right.” 536 U. S., at 283 . Lower courts should not rely on these repudiated precedents. Pp. 10– 15. (d) Section 1396a(a)(23)(A) lacks the required clear rights-creating language. Since Pennhurst, only three sets of spending-power statutes have been found to confer §1983 rights: those in Wright, Wilder, and Talevski. Given this Court’s repudiation of Wright and Wilder’s rea- soning, Talevski provides the only reliable measure. Talevski addressed Federal Nursing Home Reform Act provisions requiring facilities to “protect and promote” residents’ “right to be free from” restraints and provisions titled “[t]ransfer and discharge rights” 4 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Syllabus in a subsection called “[r]equirements relating to residents’ rights.” §1396r(c) (emphasis added). The any-qualified-provider provision looks nothing like these. Sec- tion 1396a(a)(23)(A) states that Medicaid plans must “provide that . . . any individual eligible for medical assistance . . . may obtain such as- sistance from any . . . qualified” provider. This language addresses state duties and may benefit providers and patients, but lacks FNHRA’s clear “rights-creating language,” Talevski, 599 U. S., at 186 (internal quotation marks omitted). Congress knows how to create clear rights, as FNHRA shows by giv- ing nursing-home residents “the right to choose a personal attending physician.” §1396r(c)(1)(A)(i) (emphasis added). But that is not the law here. The provision’s exceptions confirm this reading. States may exclude providers “convicted of a felony” and “determin[e]” which convictions qualify. §1396a(a)(23)(B). This makes sense if the provision addresses state duties to the federal government, but creates problems if it also confers individual rights—Congress would grant rights in one breath while letting States control their scope in the next. The statutory context supports this conclusion. The Medicaid Act requires only “substantia[l]” compliance, §1396c, suggesting focus on “ ‘aggregate’ ” compliance with federal obligations rather than rights “ ‘of any particular person.’ ” Gonzaga, 536 U. S., at 288 . The provision appears as paragraph 23 of 87 plan requirements directed to the Sec- retary, without discernible organizational principle. If §1396a(a)(23)(A) created individual rights, many similar Medicaid provisions would too, making rights-creating provisions the rule ra- ther than “atypical” exceptions. Pp. 15–19. (e) Four counterarguments are offered. First, the claim that Con- gress modeled §1396a(a)(23)(A) on a Medicare provision titled “ ‘Free choice by patient guaranteed.’ ” 79 Stat. 291 , 42 U. S. C. §1395a. But no court has addressed whether that Medicare provision creates §1983 rights. Moreover, while the Medicare provision “guarantee[s]” patient “free choice,” the Medicaid provision never uses “guarantee” or “free choice”—Congress omitted the very language claimed to create rights. Second, the appeal to legislative history suggesting Congress intended individual rights. But statutory interpretation focuses on what Con- gress enacted, not speculated intentions. For spending-power stat- utes, “the key is not what a majority of the Members . . . intend but what the States are clearly told.” Arlington Central School Dist. Bd. of Ed. v. Murphy, 548 U. S. 291, 304 . Third, the proposal to remodel the established test by arguing that “individual-centric, mandatory language” is necessarily “rights-creating” without requiring the “ex- Cite as: 606 U. S. ____ (2025) 5 Syllabus plicit rights-creating terms” this Court has long required. This stand- ard lacks foundation in precedent and obliterates the distinction be- tween mere benefits and enforceable rights. It would make rights-cre- ating provisions the rule rather than “atypical” exceptions and leave States guessing about their obligations. Fourth, the policy argument that only §1983 litigation can effectively enforce the provision, claim- ing the federal government lacks capacity or appetite for funding cut- offs. This Court has rejected the notion that funding cutoffs are “too massive” to be realistic relief. Armstrong v. Exceptional Child Center, Inc., 575 U. S. 320 , 331. Alternative enforcement exists—States have administrative processes for provider challenges, reviewable by state courts. If existing remedies prove insufficient, Congress can create new ones. But balancing enforcement costs and benefits is a policy question for Congress, not courts. Pp. 19–24. 95 F. 4th 152 , reversed and remanded. GORSUCH, J., delivered the opinion of the Court, in which ROBERTS, C. J., and THOMAS, ALITO, KAVANAUGH, and BARRETT, JJ., joined. THOMAS, J., filed a concurring opinion. JACKSON, J., filed a dissenting opinion, in which SOTOMAYOR and KAGAN, JJ., joined. Cite as: 606 U. S. ____ (2025) 1 Opinion of the Court NOTICE: This opinion is subject to formal revision before publication in the United States Reports. Readers are requested to notify the Reporter of Decisions, Supreme Court of the United States, Washington, D. C. 20543, [email protected], of any typographical or other formal errors. SUPREME COURT OF THE UNITED STATES _________________ No. 23–1275 _________________ EUNICE MEDINA, DIRECTOR, SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES, PETITIONER v. PLANNED PARENTHOOD SOUTH ATLANTIC, ET AL. ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT [June 26, 2025] JUSTICE GORSUCH delivered the opinion of the Court. Medicaid offers States “a bargain.” Armstrong v. Excep- tional Child Center, Inc., 575 U. S. 320 , 323 (2015). In re- turn for federal funds, States agree “to spend them in ac- cordance with congressionally imposed conditions.” Ibid. Should a State fail to comply substantially with those con- ditions, the Secretary of Health and Human Services can withhold some or all of its federal Medicaid funding. This case poses the question whether, in addition to that remedy, individual Medicaid beneficiaries may sue state officials for failing to comply with one funding condition spelled out in 42 U. S. C. §1396a(a)(23)(A). I Congress created Medicaid in 1965 to subsidize state ef- forts to provide healthcare to families and individuals “ ‘whose income and resources are insufficient to meet the costs of necessary medical services.’ ” Armstrong, 575 U. S., at 323 (quoting §1396–1). Today, all 50 States participate 2 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court in Medicaid. Congressional Research Service, Medicaid: An Overview 1 (2025) (CRS). In order to do so, a State must submit to the Secretary a “plan for medical assistance.” §1396a(a); see also §1396–1. To win the Secretary’s ap- proval, that plan must satisfy more than 80 separate condi- tions Congress has set out in §1396a(a). Once the Secretary approves a plan, federal funds begin flowing to help the State execute it. Of course, States must contribute their own money, too. See §1396d(b). Historically, the federal government has provided on average about 57% of the funds required to implement Medicaid, and States have supplied the balance. CRS 21. This case concerns one of the conditions state plans must meet. Located in §1396a(a)(23)(A), Medicaid’s any- qualified-provider provision, as it is sometimes called, re- quires States to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to pro- vide” it. The provision does not define the term “qualified,” perhaps because States have traditionally exercised pri- mary responsibility over “matters of health and safety,” in- cluding the regulation of the practice of medicine. De Buono v. NYSA–ILA Medical and Clinical Services Fund, 520 U. S. 806, 814 (1997); see also Linder v. United States, 268 U. S. 5, 18 (1925); 42 CFR §431.51 (c)(2) (2024). But every- one acknowledges that, if a State fails “to comply substan- tially” with this (or any) congressionally specified condition, the Secretary may withhold some or all of the State’s fed- eral funding until he is “satisfied that there will no longer be any such failure to comply.” §1396c. The parties’ dispute concerns whether, in addition to that remedy, the law recognizes another. The dispute arose this way. Planned Parenthood South Atlantic operates two clin- ics in South Carolina, one in each of the State’s two most populous cities. Planned Parenthood South Atlantic v. Kerr, 95 F. 4th 152 , 156–157 (CA4 2024). At both locations, Cite as: 606 U. S. ____ (2025) 3 Opinion of the Court the group offers “a wide range” of services to Medicaid and non-Medicaid patients. Ibid. It also performs abortions. Ibid. Citing a state law prohibiting the use of its own public funds for abortion, South Carolina announced in July 2018 that Planned Parenthood could no longer participate in the State’s Medicaid program. App. to Pet. for Cert. 157a–162a. At the same time, the State took steps that, it said, would help ensure that a “variety of other nongovernmental enti- ties and governmental agencies” would continue to provide “access to necessary medical care and important women’s health and family planning services.” Id., at 158a. Accord- ing to the State, it has “140 [other] federally qualified health clinics and pregnancy centers, not counting the nu- merous private health providers who accept Medicaid.” Brief for Petitioner 9. In response to the State’s announcement, Planned Parenthood and one of its patients, Julie Edwards, sued the director of the State’s Department of Health and Human Services. They argued that South Carolina’s exclusion of Planned Parenthood from its Medicaid program violated the any-qualified-provider provision. Specifically, Ms. Ed- wards alleged that, while she regularly visits other medical care providers, she has had especially positive experiences with Planned Parenthood and would like “to shift all [her] gynecological and reproductive health care there.’’ App. 32, 33. But none of that will be possible, she continued, unless Medicaid covers those services. Ibid. Based on these alle- gations, Ms. Edwards and Planned Parenthood brought a putative class action “pursuant to 42 U. S. C. §1983 to vin- dicate rights secured by the federal Medicaid statutes.” Id., at 1 . First enacted as part of the Civil Rights Act of 1871, §1983 allows private parties to sue state actors who violate their “rights” under “the Constitution and laws” of the United States. But federal statutes do not confer “rights” enforceable under §1983 “as a matter of course.” Health 4 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court and Hospital Corporation of Marion Cty. v. Talevski, 599 U. S. 166, 183 (2023). That is particularly true of statutes, like Medicaid, enacted pursuant to Congress’s spending power. The spending power allows Congress to offer funds to States that agree to certain conditions. See, e.g., South Dakota v. Dole, 483 U. S. 203 , 207–208 (1987). But when a State violates those conditions, “ ‘the typical remedy’ ” is not a private enforcement suit “ ‘but rather action by the Fed- eral Government to terminate funds to the State.’ ” Gon- zaga Univ. v. Doe, 536 U. S. 273, 280 (2002) (quoting Pennhurst State School and Hospital v. Halderman, 451 U. S. 1, 28 (1981)). Appreciating all this, the plaintiffs argued that their case implicated an exception to the usual rule. The any- qualified-provider provision, they said, is among those rare federal spending-power statutes that confer individual rights enforceable under §1983. And, they submitted, South Carolina violated Ms. Edwards’s rights under that provision when it denied her the opportunity to select Planned Parenthood as her healthcare provider. Agreeing with the plaintiffs’ assessment, the district court granted summary judgment to them and entered a permanent in- junction preventing the State from excluding Planned Parenthood from its Medicaid program. Planned Parenthood South Atlantic v. Baker, 487 F. Supp. 3d 443 , 448 (SC 2020). On appeal, the Fourth Circuit affirmed the district court’s decision. Planned Parenthood South Atlantic v. Kerr, 27 F. 4th 945 (2022). Writing separately, Judge Richardson expressed “confusion and uncertainty” about this Court’s directions addressing when spending-power legislation cre- ates enforceable rights under §1983. Id., at 959 (opinion concurring in judgment). And he voiced “hop[e]” that we might provide “clarity . . . soon.” Ibid. Seeking review of the Fourth Circuit’s decision, the State filed a petition for certiorari in this Court. In light of our Cite as: 606 U. S. ____ (2025) 5 Opinion of the Court intervening decision in Talevski, 599 U. S. 166 , in which we addressed whether another spending-power statute created §1983-enforceable rights, we granted the State’s petition, vacated the decision of the court of appeals, and remanded the case for further proceedings. Kerr v. Planned Parenthood South Atlantic, 599 U. S. ___ (2023). On remand, the court of appeals reaffirmed its earlier de- cision. 95 F. 4th, at 153. And, once more, Judge Richardson wrote separately. Even after Talevski, he said, lower courts “continue[d] to lack the guidance” they need from this Court to determine when a federal spending-power statute cre- ates a right that private parties can enforce under §1983. 95 F. 4th, at 170 (opinion concurring in judgment). Other circuit judges have expressed similar concerns. See, e.g., Saint Anthony Hospital v. Whitehorn, 132 F. 4th 962 , 971 (CA7 2025) (en banc); id., at 982 (Hamilton, J., dissenting); New York State Citizens’ Coalition for Children v. Poole, 935 F. 3d 56, 60 (CA2 2019) (Livingston, J., dissenting from denial of rehearing en banc). In response to the Fourth Circuit’s latest decision, the State filed another petition for certiorari. In it, South Car- olina noted that other lower courts have disagreed with the Fourth Circuit regarding whether §1396a(a)(23)(A) confers an individually enforceable right. Cf. Planned Parenthood of Greater Tex. Family Planning & Preventative Health Servs., Inc. v. Kauffman, 981 F. 3d 347 , 350 (CA5 2020) (en banc); Does v. Gillespie, 867 F. 3d 1034, 1037 (CA8 2017). We agreed to hear the case. 604 U. S. ___ (2024). II To resolve the circuits’ disagreement and address our lower court colleagues’ calls for clarification, we begin by outlining how to determine whether a statute confers an in- dividually enforceable right under §1983. 6 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court A The Constitution charges the Executive Branch with en- forcing federal law. Art. II, §3. But sometimes Congress also allows private parties to enforce the law through civil litigation. In §1983, Congress did just that, authorizing in- dividuals to sue anyone who, under color of state law, de- prives them of “rights, privileges, or immunities secured by the Constitution and laws” of the United States. Historically, individuals brought §1983 suits to vindicate rights protected by the Constitution. But, in 1980, this Court recognized that §1983 also authorizes private parties to pursue violations of their federal statutory rights. Maine v. Thiboutot, 448 U. S. 1 . Still, this Court has emphasized, statutes create individual rights only in “atypical case[s].” Talevski, 599 U. S., at 183 . Routinely, of course, federal leg- islation seeks to benefit one group or another. (Why pass legislation otherwise?) But §1983 provides a cause of action “only for the deprivation of ‘rights, privileges, or immuni- ties,’ ” not “ ‘benefits’ or ‘interests.’ ” Gonzaga, 536 U. S., at 283 . To prove that a statute secures an enforceable right, priv- ilege, or immunity, and does not just provide a benefit or protect an interest, a plaintiff must show that the law in question “clear[ly] and unambiguous[ly]” uses “rights- creating terms.” Id., at 284, 290 . In addition, the statute must display “ ‘an unmistakable focus’ ” on individuals like the plaintiff. Id., at 284 (emphasis deleted); accord, Talev- ski, 599 U. S., at 183 . We have described this as a “strin- gent” and “demanding” test. Id., at 180, 186 ; accord, post, at 9 (JACKSON, J., dissenting) (describing Gonzaga as set- ting forth “a restrictive test”). And even for the rare statute that satisfies it, this Court has said, a §1983 action still may not be available if Congress has displaced §1983’s general cause of action with a more specific remedy. Rancho Palos Verdes v. Abrams, 544 U. S. 113, 120 (2005). These rules seek to “vindicat[e] the separation of powers.” Cite as: 606 U. S. ____ (2025) 7 Opinion of the Court Talevski, 599 U. S., at 183 . To be sure, there was a time in the mid-20th century when “the Court assumed it to be a proper judicial function to provide” whatever “remedies” it deemed “necessary to make effective a statute’s purpose.” Ziglar v. Abbasi, 582 U. S. 120 , 131–132 (2017) (internal quotation marks omitted). But, as this Court has since come to appreciate, no statute pursues any single “pur- pos[e ] at all costs.” American Express Co. v. Italian Colors Restaurant, 570 U. S. 228, 234 (2013) (internal quotation marks omitted). And, often enough, Congress may “not wish to pursue [a] provision’s purpose to the extent of au- thorizing private suits.” Hernández v. Mesa, 589 U. S. 93 , 100 (2020). After all, the decision whether to let private plaintiffs enforce a new statutory right poses delicate ques- tions of public policy. New rights for some mean new duties for others. And private enforcement actions, meritorious or not, can force governments to direct money away from pub- lic services and spend it instead on litigation. See ibid. The job of resolving how best to weigh those competing costs and benefits belongs to the people’s elected representatives, not unelected judges charged with applying the law as they find it. See Alexander v. Sandoval, 532 U. S. 275, 286 (2001); Gonzaga, 536 U. S., at 285 .1 —————— 1 Cannon v. University of Chicago, 441 U. S. 677, 691 (1979), and its aftermath illustrate the shift in this Court’s approach. In Cannon, the Court inferred new private causes of action from the terms of Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972. Though Congress later “ratified Cannon’s holding,” Sandoval, 532 U. S., at 280 , the Court has retreated from Cannon’s reasoning, which “exemplified” an “expansive rights-creating approach” that later decisions “abandoned,” Franklin v. Gwinnett County Public Schools, 503 U. S. 60, 77 (1992) (Scalia, J., concurring in judgment); see also Ston- eridge Investment Partners, LLC v. Scientific-Atlanta, Inc., 552 U. S. 148 , 164–165 (2008) (quoting Justice Powell’s Cannon dissent). So while this Court has said it remains bound by Cannon’s “holdin[g],” it has empha- sized that the decision’s “language” no longer controls. Sandoval, 532 U. S., at 282 . 8 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court B Though it is rare enough for any statute to confer an en- forceable right, spending-power statutes like Medicaid are especially unlikely to do so. The reasons why take a little unpacking. When Congress passes a law, say, regulating commerce between the States or outlawing piracy, it can point for au- thority to the Commerce Clause, U. S. Const., Art. I, §8, cl. 3, or the Piracies Clause, cl. 10. In enumerated areas like those, the Constitution vests Congress with the power to regulate conduct. But when Congress distributes money, its authority rests on a different footing. The Constitution has no “Spending Clause,” strictly speaking. Instead, we usually trace Congress’s spending power to Article I, section eight, clause one, which gives Congress the “Power To lay and collect Taxes, Duties, Im- posts and Excises, to pay the Debts and provide for the com- mon Defence and general Welfare of the United States.” Unlike other enumerated powers, this provision does not expressly endow Congress with the power to regulate con- duct. Nor does it include “the power to issue direct orders to the governments of the States.” Murphy v. National Col- legiate Athletic Assn., 584 U. S. 453 , 471 (2018). As the Court observed in United States v. Butler, the meaning of Article I’s “general welfare” language provoked fierce debate right from the start. 297 U. S. 1 , 65–67 (1936). At one extreme, Gouverneur Morris thought it authorized Congress to tax, spend, and regulate broadly in pursuit of the “general Welfare.” D. Schwartz, Mr. Madison’s War on the General Welfare Clause, 56 U. C. D. L. Rev. 887, 915 (2022). Alexander Hamilton took a more modest view. He thought the language gave Congress the power to raise and “appropriate money” for “objects” of “General” (as opposed to “local”) importance. Report on the Subject of Manufac- tures (Dec. 5, 1791), in 10 Papers of Alexander Hamilton 230, 303–304 (H. Syrett ed. 1966) (emphasis deleted). But Cite as: 606 U. S. ____ (2025) 9 Opinion of the Court he denied that those powers included as well “a power to do whatever else should appear to Congress conducive to the General Welfare.” Ibid. James Madison advanced a nar- rower position still. As he saw it, the language authorized Congress to spend money only in support of its other enu- merated powers. A. LaCroix, The Interbellum Constitu- tion: Federalism in the Long Founding Moment, 67 Stan. L. Rev. 397 , 407 (2015) (LaCroix). Over time, Hamilton’s view gained ground. So, for exam- ple, as Justice Story saw it, Congress may raise and “appro- priat[e] . . . money” to advance the “general welfare.” 3 J. Story, Commentaries on the Constitution of the United States §1269, p. 150 (1833). But nothing in Article I, section eight, clause one endows Congress with a power to regulate, for if it did, the “enumeration of specific powers” elsewhere in Article I would be rendered largely pointless, and the Na- tion would trade a limited federal government for “an un- limited” one. 2 id., §§904, 906, pp. 367, 369; see also Butler, 297 U. S., at 66 (Justice Story’s “reading . . . is the correct one”); J. Monroe, Message From the President of the United States 32–33 (1822); E. Corwin, The Spending Power of Congress—Apropos the Maternity Act, 36 Harv. L. Rev. 548 , 564–566 (1923). Consistent with this understanding, early courts de- scribed federal grants not as commands but as contracts. Consider, for example, how this Court approached a dispute concerning the first major federal highway. The Cumber- land Road once supplied a vital link between the East Coast and the old Northwest. LaCroix 420. Starting in the 1830s, the federal government gradually transferred control of the road to several States. J. Young, A Political and Constitu- tional Study of the Cumberland Road 78–98 (1902). One transfer to Ohio came with a condition: The State could not charge tolls on wagons carrying federal property. Id., at 96–98. When a disagreement arose about the scope of that toll exemption, this Court looked to “the expectations of the 10 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court parties,” a familiar feature of contract law, to resolve it. Neil, Moore & Co. v. Ohio, 3 How. 720, 741 (1845). In doing so, the Court emphasized that it was enforcing require- ments “well known” to the parties when the “compact was made.” Ibid.; see also McGee v. Mathis, 4 Wall. 143, 155 (1866) (“It is not doubted that the grant by the United States to the State upon conditions, and the acceptance of the grant by the State, constituted a contract”). At the same time, the Court recognized that agreements between state and federal governments are not exactly the same as contracts “between individuals.” Searight v. Stokes, 3 How. 151, 167 (1845). In many respects, the Court suggested, federal-state agreements are really more like treaties “between two sovereignties.” See Neil, Moore & Co., 3 How., at 742. And, while treaties may seek to benefit the citizens of the compacting nations, they generally do not confer individually enforceable rights against a sovereign, but “depen[d ] for the enforcement of [their] provisions on . . . the governments which are parties to” them. Head Money Cases, 112 U. S. 580, 598 (1884).2 Adapting this logic to the context of federal grants, the Court concluded that, as a rule, “Congress alone has the power to enforce” the conditions it attaches to its grants. Emigrant Co. v. County of Adams, 100 U. S. 61, 69 (1879); see also Mills County v. Railroad Cos., 107 U. S. 557, 566 (1883). C For much of the Nation’s history, the Court had little oc- casion to employ these ideas. Congress rarely granted money to States and, when it did, those grants rarely came —————— 2 Much the same holds true today. While treaties may benefit individ- uals or groups, this Court has said, “the background presumption” is that treaties “ ‘do not create private rights or provide for a private cause of action.’ ” Medellín v. Texas,