The Individual Mandate: Implications for Public Health Law
Posted: 26 Oct 2011 Last revised: 12 Dec 2011
Date Written: October 22, 2011
No provision of the Patient Protection and Affordable Care Act (PPACA) has been more contentious than the so-called “individual mandate.” Critics claim that the mandate represents an unprecedented attempt by the federal government to compel individual action. Yet, states frequently employ similar mandates to protect the public’s health. These public health mandates have also often aroused deep opposition. This essay situates PPACA’s mandate, and the opposition to it, in that broader context. The article reviews the arguments that public health’s population perspective provides in support of mandates, as well as the reasons why mandates often ignite intense legal and political opposition. Most importantly, by holding individuals accountable for population-based problems, mandates may undercut the public health arguments that justify them. The article concludes by arguing that public health policymakers need to know more about the unintended political and legal costs of mandates. The article appears in a symposium entitled “Public Health Reform: Patient Protection and Affordable Care Act Implications for the Public’s Health” edited by Elizabeth Weeks Leonard.
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