The Affordable Care Act and Health Promotion: The Role of Insurance in Defining Responsibility for Health Risks and Costs

Abstract

The Affordable Care Act has three different approaches to promoting health. Two are uncontroversial: supporting education, research and community projects; and requiring insurance coverage of preventive services. The third, encouraging wellness programs within public and private health plans, reintroduces risk rating, which the ACA otherwise largely eliminates, back into insurance pools, although primarily for conditions most prevalent among disadvantaged populations. This article critiques the use of insurance to achieve health outcomes. Insurance influences what we find socially acceptable, which risks we are willing to share, and which risks remain the personal responsibility of individuals. It can transform prejudices based on questionable evidence into socially acceptable discrimination, in both employment and access to public benefits.

Keywords: health law, wellness programs, discrimination, Affordable Care Act