On the losing end of a 5-4 decision, Justices Anthony Kennedy, Antonin Scalia, Clarence Thomas and Samuel Alito say that the entire health care reform law should have been struck down. They write: “The Act before us here exceeds federal power both in mandating the purchase of health insurance and in denying nonconsenting states all Medicaid funding. These parts of the Act are central to its design and operation, and all the Act’s other provisions would not have been enacted without them. In our view it must follow that the entire statute is inoperative.”