In the 2000 case of Board of Trustees of the University of Alabama v. Patricia Garrett, the U.S. Supreme Court ruled that state employees cannot sue their employers for money damages in federal court under Title I (employment provisions) of the Americans with Disabilities Act (ADA). The case involved two plaintiffs: Patricia Garrett, a nurse who was demoted after returning from cancer treatment, and Milton Ash, an asthmatic security officer whose requests for reasonable accommodation were denied by his employer. Both sued their respective state employers under ADA's Title I but were dismissed by lower courts on grounds that states have Eleventh Amendment immunity against such suits in federal court. On appeal to the Supreme Court, it upheld these dismissals in a 5-4 decision led by Chief Justice William Rehnquist stating that Congress overstepped its Fourteenth Amendment enforcement powers when it abrogated states' sovereign immunity through ADA's employment provisions.

In the dissenting opinion for Board of Trustees of the University of Alabama v. Patricia Garrett, Justice Breyer, joined by Justices Stevens, Souter and Ginsburg argued that Congress had sufficient evidence to justify its conclusion that states were unconstitutionally discriminating against disabled individuals in violation of the Fourteenth Amendment's Equal Protection Clause when it enacted Americans with Disabilities Act (ADA). The dissenters believed that this case was not about whether Congress can enact legislation under Section 5 but rather if there is a reasonable basis for their decision. They pointed out numerous instances where state governments had discriminated against disabled employees or potential employees based on prejudice or stereotypes. Therefore, they disagreed with the majority’s view that these cases did not constitute a pattern of unconstitutional discrimination by states. In their view, ADA was an appropriate response to this history and pattern of unequal treatment.