Malcolm Rivera
The United States Constitution does not explicitly guarantee a right to health care. However, the Supreme Court has found rights to privacy, bodily integrity, and the refusal of medical treatment within the vague right to due process. While the Constitution does not contain the words health, health care, medical care, or medicine, Congress and the Supreme Court have incrementally crafted an incomplete web of health care rights. In 2017, Congresswoman Betty McCollum introduced an amendment to the Constitution to guarantee all Americans access to health care.
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What You'll Learn
- The US Constitution does not explicitly mention health care
- The Supreme Court has never interpreted the Constitution as guaranteeing a right to health care
- State constitutions may provide more expansive health care rights than the federal Constitution
- The Supreme Court's NFIB v. Sebelius decision upheld the Affordable Care Act
- Congress has the power to enact and fund health care programs
The US Constitution does not explicitly mention health care
The Supreme Court has also ruled that the government has no obligation to subsidize the right to decide to terminate a pregnancy. When considering these cases together, it appears that the US Constitution does not provide an affirmative obligation to provide health care. Despite this, Congress and the Supreme Court have incrementally crafted an incomplete web of healthcare rights. For example, in 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), guaranteeing a basic level of medical attention for all who arrive at a hospital emergency department that accepts Medicare.
EMTALA is a federal program, while other programs, such as Medicaid, are federally subsidized and state-based. However, Medicaid has dramatic variations from state to state and between different needy groups. Additionally, it does not include nursing home care or other long-term care. Courts have interpreted EMTALA to allow for varying levels of care in different hospitals, which contributes to the inconsistency in US healthcare policymaking.
Some states have passed laws, amended their constitutions, or entered into interstate compacts to "nullify" or "opt out" of the federal individual health insurance mandate and other federal healthcare provisions. Direct conflicts between federal laws and state nullification statutes or state constitutional amendments would likely be resolved in favor of federal law under the Supremacy Clause of the US Constitution. State constitutions may provide more expansive constitutional rights than those found under the federal Constitution, as federal rights set the minimum standards for the states.
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The Supreme Court has never interpreted the Constitution as guaranteeing a right to health care
The United States Constitution does not set forth an explicit right to health care. 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. The words "health" or "medical care" do not appear anywhere in the text of the Constitution. The provisions in the Constitution indicate that the framers were more concerned with guaranteeing freedom from government rather than providing for specific rights to governmental services such as health care.
While the Supreme Court has never interpreted the Constitution as guaranteeing a right to health care, it has held that the government has an obligation to provide medical care in certain limited circumstances. For example, in the 1976 landmark decision in Estelle v. Gamble, the Supreme Court found a right to adequate medical care for prisoners grounded in the Eighth Amendment of the Constitution. The Supreme Court has also held that involuntarily confined mentally disabled patients have a right to safe conditions, including food, shelter, and medical care, as part of their substantive liberty interests guaranteed by the Due Process Clause of the Fourteenth Amendment.
In addition to these limited circumstances, the Supreme Court has upheld the constitutionality of various federal and state health care programs. For example, in the 2012 case NFIB v. Sebelius, the Supreme Court upheld most of the Patient Protection and Affordable Care Act (ACA). The ACA includes provisions such as the expansion of Medicaid to cover low-income nonelderly adults, most of whom had been excluded from the traditional program. However, in the same decision, the Supreme Court also struck down the Medicaid expansion as an unconstitutional exercise of Congress's spending clause powers.
While the Supreme Court has not interpreted the Constitution as guaranteeing a right to health care, Congress has enacted numerous statutes that establish and define specific statutory rights of individuals to receive health care services from the government. These include federal programs such as Medicare and EMTALA, as well as state-based programs such as Medicaid and the Children's Health Insurance Program. These programs represent substantial but incomplete steps toward operationalizing a more robust and complete right to health care.
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State constitutions may provide more expansive health care rights than the federal Constitution
The United States Constitution does not explicitly guarantee a right to health care, and the Supreme Court has never interpreted it as such. However, several states have passed laws, amended their constitutions, or entered into interstate compacts to "nullify" or "opt out" of federal health care provisions. This has led to direct conflicts between federal laws and state statutes or amendments, which are likely to be resolved in favor of federal law under the Supremacy Clause of the US Constitution.
The inclusion of health care rights in state constitutions has been linked to improved health outcomes, particularly a reduction in infant mortality rates. For example, a stronger constitutional commitment that obligates state legislatures to provide health care was associated with a subsequent reduction in infant mortality rates of approximately 7.8%. Additionally, the introduction of provisions explicitly targeting the poor was associated with a 6.5% reduction in infant mortality rates. These health benefits are primarily evident in non-White populations.
While state-level constitutional rights to health care have been poorly enforced through the judiciary, their presence may lead to a better health care system through legislative action. The democratic process can be seen as a system of collective reasoning, incorporating additional information, perspectives, and voices into the public debate. This social commitment to the right to health care, through public discussion, social monitoring, investigative reporting, and social work, may contribute to improved health outcomes.
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The Supreme Court's NFIB v. Sebelius decision upheld the Affordable Care Act
The United States Constitution does not set forth an explicit right to health care. The Supreme Court has also never interpreted the Constitution as guaranteeing a right to health care services from the government for those who cannot afford it. However, the Supreme Court's decision in NFIB v. Sebelius upheld most of the Patient Protection and Affordable Care Act (ACA).
The National Federation of Independent Business v. Sebelius was a landmark legal ruling that upheld the constitutionality of the Affordable Care Act's individual mandate. The Supreme Court's decision preserved the expansion funding while barring the US Department of Health and Human Services secretary from withholding traditional Medicaid program funds from states that chose not to cover newly eligible adults. This decision was unprecedented in two ways: it struck down a spending clause program as exceeding Congress's constitutional powers, and it saved federal funding by introducing a remedy that enabled states to spend federal funds at their discretion.
The Supreme Court's ruling in NFIB v. Sebelius was a victory for the Barack Obama administration, which had staked much of its legacy on the success of the Affordable Care Act. The Affordable Care Act's individual mandate required certain individuals to pay a financial penalty for not obtaining health insurance. Chief Justice Roberts found this constitutional by characterizing it as a tax. He wrote, "it is not our role to forbid it, or to pass upon its wisdom or fairness." The Supreme Court's decision in NFIB v. Sebelius was also significant because it upheld the Affordable Care Act's expansion of Medicaid to cover low-income, nonelderly adults, most of whom had been excluded from the traditional program.
The Supreme Court's decision in NFIB v. Sebelius had far-reaching consequences for the poorest Americans, especially those in states that chose not to expand Medicaid. While the decision preserved expansion funding, it effectively turned Medicaid expansion from a mandate into an option for states. As a result, the remaining 19 states, predominantly in the South and home to a disproportionate percentage of low-income African Americans, have left their poorest residents without a coverage pathway. These individuals are ineligible for Medicaid, and their incomes are too low to meet the premium tax credit lower threshold. Their only pathway to coverage is if they qualify for Medicaid on traditional grounds, such as pregnancy, disability, or being an exceptionally poor parent or caretaker of minor children.
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Congress has the power to enact and fund health care programs
Congress has the power to "make all Laws which shall be necessary and proper" to carry out its mandate "to ... provide for the ... general Welfare." This authority has been used to enact and fund healthcare programs such as Medicare, Medicaid, and the Children's Health Insurance Program. These programs establish and define specific statutory rights of individuals to receive healthcare services from the government.
In 2010, Congress enacted the Affordable Care Act (ACA), a comprehensive healthcare reform law. The ACA includes a requirement that most individuals purchase health insurance and significantly expands the Medicaid program. The ACA's individual mandate was upheld by the US Supreme Court in NFIB v. Sebelius, which ruled that the ACA did not exceed Congress's constitutional powers. However, the Court's decision in this case also derailed the nationwide Medicaid expansion by declaring it to be a "new program" rather than an expansion of the existing program. This effectively made the expansion optional for states, and as of June 2016, 31 states and the District of Columbia had adopted it.
Congress has also used its power to regulate interstate commerce and its power to levy taxes to enact legislation relating to health insurance and healthcare. For example, Congress has passed spending bills for fiscal year 2024, which include funding for the US Department of Health and Human Services (HHS) and "health extenders" for community health centers. Additionally, Congress has shown interest in improving accountability in Medicare Advantage, with a focus on protecting consumers against misleading marketing practices and removing inappropriate financial incentives for brokers.
Furthermore, several states have passed laws or amended their constitutions to "nullify" or "opt out" of the federal individual health insurance mandate and other federal healthcare provisions. While direct conflicts between federal laws and state statutes or constitutional amendments would generally be resolved in favor of federal law under the Supremacy Clause of the US Constitution, state constitutions may provide more expansive constitutional rights than the federal Constitution.
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Frequently asked questions
No, the US Constitution does not set forth an explicit right to health care.
No, 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, in a 1976 landmark decision in *Estelle v. Gamble*, the Supreme Court found a right to adequate medical care for prisoners grounded in the Eighth Amendment of the Constitution.
Yes, in 2017 and 2019, Congresswoman Betty McCollum introduced an amendment to the US Constitution to make health care a right for all Americans. The Health Care for All Amendment (H.J. Res. 17) states: "Health care, including care to prevent and treat illness, is the right of the people and necessary to ensure the strength of the Nation."
Yes, several states have passed laws, amended their state constitutions, or entered into interstate compacts to "nullify" or "opt out" of federal health care provisions. State constitutions may provide constitutional rights that are more expansive than those found under the federal Constitution.
