The Right To Healthcare: Is It In The Constitution?

The US Constitution does not specifically mention health or healthcare, but many have interpreted the promote the general welfare notion in the Preamble as an indication that the federal government can pass laws pertaining to healthcare. This ties in with Article I, Section 8, which states that The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States. The interpretation of the Constitution's Preamble has been a point of contention between supporters and opponents of the federal government's efforts to regulate the healthcare industry. While some believe that the federal government has a responsibility to ensure all Americans have health coverage, others argue that the Preamble is meant to outline the Constitution's goals rather than be a condensed version of the document itself.

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The US Constitution does not specifically mention health or healthcare

The interpretation of the Constitution's Preamble has been a topic of debate, with opponents of federal government intervention in the healthcare industry arguing that the Preamble is meant to outline the Constitution's goals and not be a condensed version of the document itself. They argue that Article I should be interpreted as defining Congress's ability to levy taxes, rather than as a mandate for healthcare legislation.

Despite the lack of explicit mention of health or healthcare in the US Constitution, the Supreme Court has played a significant role in shaping healthcare legislation through its rulings. In the case of NFIB v. Sebelius, the Supreme Court upheld the constitutionality of the Affordable Care Act's individual mandate, interpreting it as a tax provision within Congress's taxing power. This ruling had a significant impact on healthcare coverage for millions of Americans.

In addition to the Supreme Court's rulings, Congress has also introduced amendments to the Constitution that specifically address healthcare. The America's Right to Health Care Amendment, introduced in 2017, is a proposal that seeks to enshrine the right to healthcare in the Constitution. It instructs Congress to enforce this right through legislation, guaranteeing affordable, quality healthcare for all Americans.

While the US Constitution may not explicitly mention health or healthcare, the interpretation of its provisions and the actions of the Supreme Court and Congress have had a significant impact on shaping healthcare legislation and access to healthcare for Americans. The ongoing debate and efforts to include healthcare as a fundamental right in the Constitution reflect the recognition of its importance to the nation's strength and the well-being of its citizens.

The 'promote the general welfare' notion from the Preamble is interpreted by some as an indication that the federal government can pass laws pertaining to healthcare

The Preamble of the US Constitution states that the government is instituted to "promote the general welfare". This statement is part of the interpretation of the role of the federal government in passing laws pertaining to healthcare. While the Preamble does not confer additional powers, it aids in interpreting the substantive provisions of a legal text.

The "general welfare" clause, also known as the Taxing and Spending Clause, is not a grant of general legislative power to the federal government but a qualification on the taxing power. It allows the federal government to spend federal revenues on matters of general interest. This clause has been used as a basis for legislation promoting the health, safety, morals, and well-being of the people. For example, the Supreme Court interpreted the clause in Helvering v. Davis, disavowing almost entirely any role for judicial review of Congressional spending policies, and conferring upon Congress a plenary power to impose taxes and spend money for the general welfare.

The federal government's role in healthcare is further supported by the establishment of the President's Make America Healthy Again Commission, which aims to combat critical health challenges such as rising rates of mental health disorders, obesity, diabetes, and other chronic diseases. Additionally, the Commission is tasked with studying the scope of the childhood chronic disease crisis and addressing the underlying causes, including the American diet and lifestyle choices.

However, the federal government's power to regulate healthcare is not absolute. In NFIB v. Sebelius, the Supreme Court struck down the Medicaid expansion as an unconstitutional exercise of Congress's spending clause powers, characterizing it as a "new program" rather than an expansion of the existing program. This decision preserved expansion funding while barring the Secretary of the US Department of Health and Human Services from withholding traditional Medicaid program funds from states that declined to cover newly eligible adults.

In conclusion, the "promote the general welfare" notion in the Preamble of the US Constitution is interpreted by some as an indication that the federal government can pass laws pertaining to healthcare. This interpretation is supported by the presence of the "general welfare" clause in the Constitution and subsequent Supreme Court interpretations. However, the federal government's power in this area is not unlimited, as demonstrated by the NFIB v. Sebelius case.

The US Supreme Court has ruled on the constitutionality of healthcare legislation, including the Affordable Care Act

The US Supreme Court has played a significant role in shaping healthcare legislation in the country, with several landmark rulings that have had far-reaching implications for Americans' access to healthcare. One of the most notable cases was the 2012 ruling on the constitutionality of the Affordable Care Act (ACA), often referred to as "Obamacare".

The ACA was signed into law in 2010 and included a range of provisions aimed at expanding healthcare coverage and making it more affordable. One of the most controversial aspects of the ACA was the individual mandate, which required Americans to purchase health insurance or face a penalty. This was a key provision of the ACA, as it was intended to ensure a balance between healthy and sick individuals in the insurance market, helping to spread the cost of care.

However, the constitutionality of the individual mandate was challenged in court, with 26 states arguing that it exceeded Congress's commerce power. In a 5-4 decision, the Supreme Court upheld the constitutionality of the individual mandate, but not under Congress's commerce power. Instead, Chief Justice Roberts, writing for the majority, characterised the mandate as a constitutional exercise of Congress's taxing power. In his opinion, Justice Roberts likened the mandate to other taxes, such as those on gasoline or income, which are within Congress's power to impose.

The Court's ruling on the individual mandate had significant implications for the ACA as a whole. By upholding this provision, the Court ensured that the ACA could remain in place, at least in part. However, the Court's decision also had the effect of derailing nationwide Medicaid expansion, as states could now opt out of the expansion without risking the loss of all federal funding. This turned Medicaid expansion from a mandate to an option, reducing the number of people who gained coverage.

In addition to the Supreme Court's rulings on the ACA, the Court has also weighed in on other aspects of healthcare legislation. For example, in 2025, the Court heard arguments in a case challenging the constitutionality of a provision of the ACA that required insurance companies to offer certain types of preventive care for free. The case involved two small Christian businesses and some Texas residents who argued that the provision infringed on their religious freedoms. The Court appeared divided during arguments, and the outcome of this case could have broader implications for the tens of millions of Americans who rely on free preventive care.

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The individual mandate was upheld as a constitutional exercise of Congress's authority to levy taxes

In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law. This act, also known as Obamacare, included an individual mandate that required most people to maintain a minimum level of health insurance coverage. Those who failed to do so were required to pay a financial penalty, known as the shared responsibility payment, to the IRS.

The National Federation of Independent Business, along with several other parties, sued, claiming that the law was unconstitutional. In 2012, the US Supreme Court, in an opinion written by Chief Justice John Roberts, upheld the individual mandate as a constitutional exercise of Congress's power under the Taxing and Spending Clause (taxing power). Roberts' opinion looked beyond the "penalty" label given to the individual mandate by Congress and instead focused on the consequences the provision would have for affected individuals. He found that the mandate had many similarities to other taxes, such as being assessed as part of a taxpayer's annual income tax return, varying by income and number of dependents, and being administered by the IRS.

However, the Supreme Court's decision was not unanimous. Justices Scalia, Kennedy, Thomas, and Alito joined an unsigned dissent, arguing that the individual mandate was an unconstitutional attempt by Congress to regulate beyond its power under the Commerce Clause. They also objected to the reclassification of the mandate as a tax rather than a penalty, characterizing it as a troubling exercise of judicial power.

The individual mandate was again challenged in the 2017 Tax Cuts and Jobs Act (TCJA), which set the shared responsibility payment at zero dollars from 2019 onwards, effectively eliminating the mandate. This led to further litigation, with Texas and several other states suing the federal government, arguing that with the mandate eliminated, the entire ACA was unconstitutional. The federal government agreed with the plaintiffs, taking the unusual position of not defending the constitutionality of the ACA's individual mandate. The 5th Circuit decided that the individual mandate as amended by the TCJA was unconstitutional, and this decision was upheld on a challenge by California and other states.

The US Constitution's impact on the public's health is seen in the Court's rulings on Medicaid

The US Constitution does not explicitly mention healthcare, but the Supreme Court's rulings on healthcare legislation, including Medicaid, have significant implications for the public's health.

The Supreme Court's interpretation of the Constitution and its amendments plays a crucial role in shaping healthcare policies. For instance, in the case of prisoners, the Court has ruled that they are entitled to adequate food, clothing, shelter, and medical care under the protections of the Eighth Amendment. Similarly, involuntarily confined mentally disabled patients have a right to safe conditions, including medical care, under the Fourteenth Amendment's Due Process Clause. These rulings set a precedent for recognizing the right to healthcare for specific groups, even though the Court has not based its decisions on a fundamental right to healthcare.

The Affordable Care Act (ACA), which includes the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, has been a focal point of debate regarding the intersection of healthcare and the Constitution. The ACA's individual mandate, requiring most individuals to carry health insurance, was upheld by the Supreme Court in National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al. The Court's interpretation of the mandate as a tax fell within Congress' constitutional power to tax. However, the Court struck down the provision allowing the withholding of all Medicaid funds from non-compliant states, limiting the federal government's power.

The Supreme Court's rulings on Medicaid expansion have also been influential. In Florida v. HHS, the Court upheld the Medicaid expansion provision, stating that states have a choice to participate and that the expansion was within Congress' spending power. This decision addressed concerns about coercing states into expanding Medicaid by threatening to withhold federal funding. The rulings on Medicaid expansion have direct implications for the public's health, as they determine the availability and accessibility of healthcare services for a significant portion of the population.

The appointment of a new Supreme Court justice, such as Kavanaugh, can also impact public health. His judicial philosophy, which emphasizes interpreting the law and the Constitution as written, has the potential to shift the court in a more conservative direction. His views on executive power and regulatory authority can influence healthcare policies and protections, as seen in his criticism of the Chevron decision, which granted executive branch agencies the authority to interpret statutory law.

In conclusion, while the US Constitution does not explicitly address healthcare, the Supreme Court's rulings on Medicaid and other healthcare-related issues have a significant impact on the public's health. These rulings shape healthcare policies, determine the availability of healthcare services, and influence the interpretation and implementation of healthcare legislation. The Court's decisions can support or overturn policies, directly affecting the health and well-being of the public.

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