Jonah Patel
While the US Constitution does not explicitly mention health, it does include the notion to promote the general welfare, which has been interpreted as an indication that the federal government can pass laws pertaining to healthcare. The Supreme Court has also held that the Due Process Clause of the Fourteenth Amendment provides constitutional protection for certain rights related to privacy, such as the right to procreate, use contraception, have an abortion, and maintain bodily integrity. Congress has enacted statutes such as Medicare, Medicaid, and the Children's Health Insurance Program, which establish specific rights for individuals to receive healthcare services from the government. The Affordable Care Act, enacted in 2010, includes a requirement for most individuals to purchase health insurance. State constitutions may also provide constitutional rights relating to health and healthcare services, which can be more expansive than federal rights.
| Characteristics | Values |
|---|---|
| Health care policy | Congress has enacted statutes such as Medicare, Medicaid, and the Children's Health Insurance Program, which establish and define specific rights to receive healthcare services from the government |
| Congress has provided funding for these health services | |
| Congress has used its constitutional powers to regulate interstate commerce and levy taxes to enact legislation relating to health insurance and healthcare | |
| The Affordable Care Act was enacted in 2010, requiring most individuals to purchase health insurance | |
| State constitutions may provide constitutional rights that are more expansive than those in the federal Constitution | |
| The Supreme Court has held that the Constitution implicitly confers a fundamental right to privacy, but has not elevated healthcare to the status of a fundamental right | |
| The US Supreme Court's Medicaid Decision in NFIB v Sebelius had consequences for the poorest Americans, particularly in Kentucky and Tennessee |
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What You'll Learn
The right to privacy
The US Constitution has been interpreted in various ways to address the right to privacy, particularly in the context of healthcare. While the Constitution does not explicitly mention a right to privacy, the Supreme Court has held that the Due Process Clause of the Fourteenth Amendment provides constitutional protection for certain rights or "liberty interests" related to privacy.
The Fourth Amendment, ratified on December 15, 1791, is often cited as a key element of the right to privacy. It protects US citizens from unreasonable searches and seizures, stating that:
> "The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized."
The creation of the Fourth Amendment was in response to increasing infringements on privacy in the colonies and England, where "general warrants" and "writs of assistance" allowed officials to conduct warrantless searches. The Fourth Amendment requires that any search or seizure be authorized by a judge and be based on probable cause. This amendment has been invoked in modern times to address mass surveillance and the collection of personal data, with critics arguing that these practices are too invasive to be justified under the Fourth Amendment.
In the context of healthcare, the Supreme Court has held that the right to privacy includes the right to procreate, use contraception, have an abortion, and maintain bodily integrity. In Griswold v. Connecticut (1965), the Supreme Court first recognized the "right to privacy," finding that the Constitution creates a "zone of privacy" derived from the personal protections expressly stated in the First, Third, Fourth, Fifth, and Ninth Amendments. In Eisenstadt v. Baird (1971), the Court extended the right to purchase contraceptives to unmarried couples, asserting that "the constitutionally protected right of privacy inheres in the individual, not the marital couple."
The Affordable Care Act, enacted in 2010, has also been a subject of debate regarding the right to privacy. While the Act expanded access to health insurance and healthcare services, the Supreme Court's ruling in NFIB v. Sebelius (2012) derailed the nationwide Medicaid expansion, making it an option rather than a mandate. This ruling impacted the poorest residents in states that chose not to expand Medicaid, raising questions about equal access to healthcare and health equity.
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Health care as a fundamental right
While the US Constitution does not explicitly mention health, health care, medical care, or medicine, health care policy is related to the US Constitution in several ways. The Supreme Court has found rights to privacy, bodily integrity, and the refusal of medical care within the vague right to "due process" in the Constitution. The Supreme Court has also ruled that the government has no obligation to subsidize abortions, despite having constructed a right to decide to terminate a pregnancy.
Despite the lack of discussion of health care rights in the Constitution, arguments have been made that the denial by the federal government of a minimal level of health care to poor persons transgresses the equal protection guarantees under the Constitution. While the equal protection clause of the Fourteenth Amendment applies only to the states, similar equal protection principles are applicable to the federal government through the Due Process Clause of the Fifth Amendment. The standard of review used in cases involving fundamental rights is called "strict scrutiny". Using this heightened standard of review, if the Court determines that a fundamental right has been unduly burdened, the governmental action will only be upheld if the government can demonstrate that the action is necessary to achieve a compelling governmental interest.
In 1976, the Supreme Court found a right to adequate medical care for prisoners grounded in the Eighth Amendment of the Constitution in a landmark decision in Estelle v. Gamble. Congress has also enacted numerous statutes, such as Medicare, Medicaid, and the Children's Health Insurance Program, that establish and define specific statutory rights of individuals to receive health care services from the government. As a major component of many health care entitlement statutes, Congress has provided funding to pay for the health services provided under law. Most of these statutes have been enacted pursuant to Congress's authority to "make all Laws which shall be necessary and proper" to carry out its mandate "to ... provide for the ... general Welfare."
The health care reform debate raises many complex issues, including coverage, accessibility, cost, accountability, and quality of health care. Underlying these policy considerations are issues regarding the status of health or health care as a moral, legal, or constitutional right. It may be useful to distinguish between a right to health and a right to health care. The World Health Organization describes health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." "Health care" connotes the means for the achievement of this state.
The right to health and other health-related human rights are legally binding commitments enshrined in international human rights instruments. WHO’s Constitution also recognizes the right to health. Every human being has the right to the highest attainable standard of physical and mental health. Countries have a legal obligation to develop and implement legislation and policies that guarantee universal access to quality health services and address the root causes of health disparities, including poverty, stigma, and discrimination. The right to health is indivisible from other human rights, including the rights to education, participation, food, housing, work, and information. Universal health coverage (UHC) grounded in primary health care helps countries realize the right to health by ensuring all people have affordable, equitable access to health services. Quality health services should be safe, effective, people-centred, timely, equitable, integrated, and efficient.
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Health care reform
The US Constitution does not specifically mention health or healthcare. However, the "promote the general welfare" notion in the Constitution's preamble has been interpreted as an indication that the federal government can pass laws pertaining to healthcare. Congress has enacted statutes such as Medicare, Medicaid, and the Children's Health Insurance Program, which establish and define specific statutory rights for individuals to receive healthcare services from the government.
Healthcare reform is a complex issue that raises questions about coverage, accessibility, cost, accountability, and quality of healthcare. The underlying policy considerations involve the status of health or healthcare as a moral, legal, or constitutional right. While the Supreme Court has held that the Constitution implicitly guarantees a fundamental right to privacy, it has not elevated healthcare to the status of a fundamental right. Instead, the Court has evaluated governmental actions involving healthcare using a "rational basis" standard of review, upholding actions that bear a rational relationship to legitimate governmental interests.
In 2010, Congress enacted the Affordable Care Act, a comprehensive healthcare reform law. A centerpiece of this Act was the expansion of Medicaid to cover low-income, nonelderly adults, most of whom had been excluded from the traditional program. However, in 2012, the US Supreme Court derailed the nationwide Medicaid expansion, turning this pathway to health insurance for the nation's poorest from a mandate to an option. This decision had a significant impact on the poorest Americans, especially in states such as Kentucky and Tennessee, which had previously had similar coverage rates.
To address the growing health crisis in America, there is a need to refocus national efforts on understanding and reducing chronic disease rates and ending childhood chronic disease. This includes rethinking nutrition, physical activity, healthy lifestyles, over-reliance on medication, technological habits, environmental impacts, and food and drug quality and safety. Additionally, federally funded health research should be transparent and open-sourced, empowering Americans to make informed decisions about their health. Agencies must work together to ensure that US food is the healthiest, most abundant, and most affordable globally, and that expanded treatment options and flexible health insurance coverage are available to support beneficial lifestyle changes and disease prevention.
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State constitutions and health care
The US Constitution does not set forth an explicit right to health care, and the Supreme Court has never interpreted the Constitution as guaranteeing a right to health care services from the government for those who cannot afford it. However, several state constitutions contain provisions relating to health and the provision of health care services, and these may provide constitutional rights that are more expansive than those found under the federal Constitution. As of April 2014, 15 state constitutions specifically mentioned health and health care, either as a programmatic statement, public concern, individual right, or government duty beyond the federal minimum.
State constitutions may bind and restrict state government initiatives to offer more equitable health care to their citizens. The introduction of a stronger constitutional commitment that obligates state legislatures to provide health care has been associated with a subsequent reduction in infant mortality rates. For example, in 2012, as part of a landmark legal ruling upholding the constitutionality of the Affordable Care Act's individual mandate, the US Supreme Court effectively turned the crucial pathway to health insurance coverage for the nation's poorest residents from a mandate to an option. This decision had a significant impact on the poorest Americans, especially in states like Kentucky, which embraced Medicaid expansion as a fundamental population health reform, and its bordering state, Tennessee, which rejected the expansion.
Congress has also enacted statutes such as Medicare, Medicaid, and the Children's Health Insurance Program, which establish and define specific statutory rights of individuals to receive health care services from the government. These statutes have been enacted pursuant to Congress's authority to "make all Laws which shall be necessary and proper" to carry out its mandate to "provide for the general Welfare". Congress has also used its power to regulate interstate commerce and its power to levy taxes to enact legislation relating to health insurance and health care.
While the Supreme Court has held that the Constitution implicitly confers a fundamental right to privacy, it has not elevated health care to the status of a fundamental right. The Court has evaluated governmental actions involving health care using the "rational basis" standard of review, upholding governmental actions that bear a rational relationship to a legitimate governmental interest.
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The Affordable Care Act
The Patient Protection and Affordable Care Act, also known as the Affordable Care Act or ACA, was enacted in March 2010 as a comprehensive health care reform law. The ACA has two parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.
The ACA was established to make affordable health insurance available to more people. It provides consumers with subsidies, or "premium tax credits", that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL). The ACA also expands the Medicaid program to cover all adults with income below 138% of the FPL, although not all states have expanded their Medicaid programs.
The ACA's impact on Medicaid is a crucial aspect of the legislation. Medicaid plays a significant role in determining who has access to healthcare, and studies suggest that it improves healthcare access and positively impacts certain health outcomes. The ACA's initial aim was to expand Medicaid to cover low-income, nonelderly adults, most of whom were excluded from the traditional program. However, in 2012, the US Supreme Court derailed the nationwide Medicaid expansion, making it an option rather than a mandate. This decision had significant implications for the poorest Americans, particularly in states that rejected the expansion, such as Tennessee.
The ACA also includes a requirement that most individuals purchase health insurance, which falls under Congress's authority to "make all Laws which shall be necessary and proper" to carry out its mandate to "provide for the general Welfare." This mandate has been a subject of debate, with some arguing that it exceeds Congress's constitutional powers.
The ACA's enactment raised complex issues surrounding the right to health care and its relation to constitutional rights. While the Supreme Court has held that the Constitution implicitly confers a fundamental right to privacy, it has not elevated health care to the status of a fundamental right. Instead, the Court evaluates governmental actions related to health care using a "rational basis" standard, upholding actions that bear a rational relationship to legitimate governmental interests.
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Frequently asked questions
No, the US Constitution does not specifically mention health or healthcare. However, the "promote the general welfare" notion from the Constitution's Preamble has been interpreted as an indication that the federal government can pass laws pertaining to healthcare.
The US Supreme Court has held that the Due Process Clause of the Fourteenth Amendment provides constitutional protection for certain rights or "liberty interests" related to privacy. This includes the right to procreate, use contraception, have an abortion, and maintain bodily integrity. While the Court has not elevated healthcare to the status of a fundamental right, it has reviewed governmental actions involving healthcare under the "rational basis" standard, upholding actions that bear a rational relationship to a legitimate governmental interest.
Congress has enacted statutes such as Medicare, Medicaid, and the Children's Health Insurance Program, which establish and define specific statutory rights to receive healthcare services from the government. Congress has provided funding for these programs and used its constitutional powers to regulate interstate commerce and levy taxes to enact legislation related to health insurance and healthcare. In 2010, Congress passed the Affordable Care Act, which included a requirement for most individuals to purchase health insurance.
