Personal Networks: Health Coverage Status and the Invisible Burden on Family and Friends

Abstract

Traditionally, debates over American health coverage institutions have relied on vocabulary and concepts from the world of insurance. Policymakers, scholars, and commentators emphasize the interests of parties with direct financial or legal ties to the health insurance contract. Missing from that conversation are the interests of each individual’s friends and family. This group, which I term the “personal network,” bears diverse and potentially devastating burdens relating to the individual’s health coverage status, illnesses, and medical interventions. These burdens undermine equality of opportunity and reinforce existing social hierarchies. Turning to feminist scholarship on domesticity and care, I explain why the interests of personal networks are wrongly presumed to be coextensive with those of individuals, if they are even mentioned at all.

I then examine personal network burden through the interdisciplinary lenses of microeconomic externalities, classical liberalism, and sociocultural risk studies. Each of these analytical frameworks sheds new light on ways in which the Affordable Care Act (ACA) benefited personal networks, even if only incidentally, thereby providing a novel, independent justification for the ACA’s reforms and for America’s long-term trend toward a social insurance model for health coverage. I conclude by offering a normative framework for considering future developments that would more fully account for personal networks’ stake in the health coverage conversation.

As the early years of the ACA continue to generate controversy and discord, this Article offers a novel perspective on what the ACA did well, what problems remain to be solved, and what political messaging may be helpful in solving them.

Keywords: health insurance, health coverage, healthcare, health care, ACA, Affordable Care Act, care, caregiving, care giving, domesticity, family, feminism, externalities, classical liberalism, classic liberalism

JEL Classification: A12, A13, A14, D62, D63, I1, I10, I18, K32