; (B) its powers under the commerce clause of section 8, article 1 of the Constitution of the United States; (C) its powers to tax and spend for the general welfare under section 8, article 1 of the Constitution of the United States; and (D) its powers to enforce section 1 of the Fourteenth Amendment under section 5 of the Fourteenth Amendment to the Constitution of the United States. (20) Congress has exercised these constitutional powers to create, expand, and insure health care access for people in the United States for decades. Pursuant to this constitutional authority, Congress has enacted, and subsequently reauthorized, numerous health care programs including but not limited to title XVIII of the Social Security Act of 1965 (Medicare); title XIX of the Social Security Act of 1965 (Medicaid)