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The Patient Protection and Affordable Care Act, Public Health, and the Elusive Target of Human Rights

Published online by Cambridge University Press:  01 January 2021

Lance Gable
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Extract

The passage of the Patient Protection and Affordable Care Act (ACA) in March 2010 represents a significant turning point in the evolution of health care law and policy in the United States. By establishing a legal infrastructure that seeks to achieve universal health insurance coverage in the United States, the ACA targets some of the major impediments to accessing needed health care for millions of Americans and by extension attempts to strengthen the health system to support key determinants of health. Yet, like many newly passed legislative provisions, the ultimate effects and significance of the ACA remain uncertain. Those charged with implementing the ACA face formidable obstacles — indeed, some of the same obstacles that have been erected to impede other major pieces of social legislation in the past — including entrenched political opposition, constitutional challenges, and what will likely be a prolonged struggle over the content and direction of how the law is implemented. As these debates continue, it is nevertheless important to begin to assess the impact that the ACA has already had on health law in the United States and to consider the likely effects that the law will have on public health going forward.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 39 , Issue 3 , Fall 2011 , pp. 340 - 354
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

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References

Patient Protections and Affordable Care Act, P.L. 111–148 (signed signed into law March 23, 2010).Google Scholar
Id., at §§ 1501, 1502.Google Scholar
Id., at § 4002.Google Scholar
Id., at § 4003.Google Scholar
Id., at § 4205.Google Scholar
Id., at §§ 2601, 2704–2707, 3126, 4206, 4306, 5304, 5507, 6112, 6114, 10504.Google Scholar
Gostin, L. O. et al., “Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population's Wellbeing,” Pennsylvania Law Review (forthcoming 2011).Google Scholar
Copeland, C. W., “Rulemaking Requirements and Authorities in the Patient Protection and Affordable Care Act (PPACA),” Congressional Research Service, Report R41180 (Feb. 18, 2011).Google Scholar
See, generally, Quadagno, J., One Nation, Uninsured (New York: Oxford University Press, 2005); Starr, P., The Social Transformation of American Medicine (New York: Basic Books, 1982).Google Scholar
Id.Google Scholar
Skocpol, T. Seliger Keenan, P., “Cross Pressures: The Contemporary Politics of Health Reform,” in Mechanic, D. et al., eds., Policy Challenges in Modern Health Care (Piscataway, NJ: Rutgers University Press 2005): At 27.Google Scholar
P.L. 104–191 (1996).CrossRefGoogle Scholar
P.L. 105–33 (1997).Google Scholar
P.L. 108–173 (2003).2.0.CO;2>CrossRefGoogle Scholar
Report by the Assistant Secretary for Planning and Evaluation for Health and Human Services, Effects of Health Care Spending on the U.S. Economy (2005), available at <http://aspe.hhs.gov/health/costgrowth/report.pdf> (last visited July 8, 2011) (“Since 1998, health care spending has increased at faster rate of growth than has gross domestic product [GDP], inflation, and population”).+(last+visited+July+8,+2011)+(“Since+1998,+health+care+spending+has+increased+at+faster+rate+of+growth+than+has+gross+domestic+product+[GDP],+inflation,+and+population”).>Google Scholar
Anderson, G. F. Frogner, B. K., “Health Spending In OECD Countries: Obtaining Value Per Dollar,” Health Affairs 27, no. 6 (2008): 1718–1727; Centers for Medicare and Medicaid Services, National Health Expenditures, 2007, Office of the Actuary, National Health Statistics Group (2007); Organisation for Economic Co-operation and Development (OECD), OECD Health Data 2009: Statistics and Indicators for 30 Countries (2009).CrossRefGoogle Scholar
WHO, World Health Statistics 2009 (2009).Google Scholar
The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance (2008).Google Scholar
Kulkarni, S. C. et al., “Falling Behind: Life Expectancy in U.S. Counties from 2000 to 2007 in an International Context,” Population Health Metrics 9, no. 16 (forthcoming 2011).CrossRefGoogle Scholar
U.S. Census Bureau, Current Population Survey, 2008 and 2009 Annual Social and Economic Supplements (2009).Google Scholar
Cohn, J., Sick: The Untold Story of America's Health Care Crisis – and the People Who Pay the Price (New York: Harper Collins Publishers, 2007).Google Scholar
Commonwealth Fund, Exhibits: The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs (2009), available at <http://www.commonwealthfund.org/∼/media/Files/Publications/Fund%20Report/2010/Jan/Coverage%20Report/PDF_Collins_cong_bills_coverage_report_172010_exhibits.pdf> (last visited June 27, 2011).+(last+visited+June+27,+2011).>Google Scholar
See PPACA, supra note 1.Google Scholar
Senator Harkin made a particularly strong appeal for the passage of the ACA citing the many benefits to public health, and even claiming the Bill would create a “right to health” during the senate floor debate on December 21, 2009. 155 Cong. Rec. S13661 (daily ed. Dec. 21, 2009) (statement of Sen. Harkin). However, during that day's debate, there are only seven references to “public health”, 21 references to “wellness”, 0 references to “population health”, and an overwhelming 266 references to “insurance” (30 of which to insurance companies) throughout the day's speakers. Id., at 13661–13695. This pattern is repeated throughout the debate materials.Google Scholar
Eggan, D., “‘Single-Payer’ Supporters Challenge Democrats,” Washington Post, June 6, 2009, available at <http://www.washingtonpost.com/wp-dyn/content/article/2009/06/05/AR2009060503518_2.html?sid=ST2009060504116> (last visited July 8, 2011).+(last+visited+July+8,+2011).>Google Scholar
Stolberg, S. G., “Public Option in Health Plan May be Dropped,” New York Times, August 16, 2009, available at <http://www.nytimes.com/2009/08/17/health/policy/17talkshows.html> (last visited July 8, 2011).+(last+visited+July+8,+2011).>Google Scholar
Obama, B., “Remarks by the President to a Joint Session of Congress on Health Care,” 2009, available at <http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/> (last visited June 28, 2011).+(last+visited+June+28,+2011).>Google Scholar
Id.Google Scholar
Yamin, A. E., “The Right to Health Under International Law and Its Relevance to the United States,” American Journal of Public Health 95, no. 7 1156–1161 (2005): 1156–1161.CrossRefGoogle Scholar
Alston, P., “Putting Economic, Social, and Cultural Rights Back on the Agenda in the United States,” in Schultz, W. F., ed., The Future of Human Rights (Philadelphia: University of Pennsylvania Press, 2008).Google Scholar
Lewis, H., “‘New’ Human Rights: U.S. Ambivalence toward the International Economic and Social Rights Framework,” in Soohoo, C. Albisa, C. Davis, M., eds., Bringing Human Rights Home (Westport, Connecticut: Praeger, 2009).Google Scholar
Koh, H. H. Sebelius, K. G., “Promoting Prevention through the Affordable Care Act,” New England Journal of Medicine 363, no. 14 (2010): 1296–1299.CrossRefGoogle Scholar
42 U.S.C. 300u-10 (2011).Google Scholar
Department of Health and Human Services, National Prevention Strategy (2011), available at <http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf> (last visited July 8, 2011).+(last+visited+July+8,+2011).>Google Scholar
42 U.S.C. 300u-11 (2011).Google Scholar
P.L. 111–148, § 6302.Google Scholar
Id., at § 2601.Google Scholar
Id., at §§ 10503, 4101, 4201.Google Scholar
Id., at § 4004.Google Scholar
Id., at §§ 1002, 1103.Google Scholar
Id., at §§ 3507, 5507.Google Scholar
Id., at § 4205.Google Scholar
Id., at §§ 4103, 4106.Google Scholar
Id., at § 1001.Google Scholar
See 42 U.S.C. 280g-10, 300u-12.Google Scholar
Shearer, G., APHA Issue Brief – Prevention Provisions in the Affordable Care Act (October 2010), available at <http://www.apha.org/NR/rdonlyres/763D7507–2CC3–4828-AF84–1010EA1304A4/0/FinalPreventionACAWeb.pdf> (last visited July 8, 2011).+(last+visited+July+8,+2011).>Google Scholar
P.L. 111–148, §§ 1101, 1201 (Amending PHSA § 2704), § 1001 (Amending PHSA §§ 2711, 2712).Google Scholar
Id., at § 1501 (Amending IRC § 5000A).Google Scholar
Id., at § 1513 (Amending IRC § 4980H).Google Scholar
See Hall, M. A., “Commerce Clause Challenges to Health Care Reform,” Pennsylvania Law Review 159, no. 6 (2011): 1825–1872 (arguing that the individual mandate is valid constitutionally), and Barnett, R. E., “Commandeering the People: Why the Individual Health Insurance Mandate Is Unconstitutional,” New York University Journal of Law & Liberty 5, no. 3 (2010): 581–637 (making the counter argument).Google Scholar
P.L. 111–148, § 1401 (Amending I.R.C. § 36B).Google Scholar
Id., at § 1311.Google Scholar
Id., at § 1201, Amending PHSA § 2707, minimum set by § 1302(a).Google Scholar
Id., at §§ 2001, 3301, 1333.Google Scholar
See Virginia ex rel. Cuccinelli v. Sebelius, 728 F. Supp.2d 768 (holding the individual mandate exceeded congressional scope under the commerce clause); Florida ex rel. Bondi v. Dept. Health and Human Services, — F.Supp.2d —, 2011 WL 285683 N.D.Fla., 2011 (finding same and declaring the entire statute unconstitutional).Google Scholar
Chandra, A. et al., “The Importance of the Individual Mandate – Evidence from Massachusetts,” New England Journal of Medicine 364, no. 4 (2011): 293–295.CrossRefGoogle Scholar
Oberlander, J., “Throwing Darts: Americans' Elusive Search for Health Care Cost Control,” Journal of Health Politics, Policy & Law 36, no. 3 (2011): 477–484.CrossRefGoogle Scholar
P.L. 111–148, §§ 1104, 1413.Google Scholar
Id., at § 9001 (Amending IRC § 1513).Google Scholar
See Oberlander, , supra note 57.Google Scholar
P.L. 111–148, § 3022, supra note 5.Google Scholar
Id., at § 3403 (Amending SSA § 1899A).Google Scholar
American Medical Association, “News: AMA Physicians Send a Message to Congress: Stop Medicare Meltdown,” June 13, 2010, available at <http://www.ama-assn.org/ama/pub/news/news/white-coat-release.page?> (last visited July 7, 2011).+(last+visited+July+7,+2011).>Google Scholar
See discussion supra of “Health Care Reform in the United States: The Perennial Struggle for Common Ground.”Google Scholar
See Yamin, , supra note 29; Kinney, E. D., “Recognition of the International Human Right to Health and Health Care in the United States,” Rutgers Law Review 60, no. 2 (2008): 335–379; Mann, J. et al., “Health and Human Rights,” Health & Human Rights 7 no. 1 (1994): 6–23.Google Scholar
World Health Organization, The Constitution of the World Health Organization (1948).Google Scholar
Henkin, L., The Age of Rights (New York: Columbia University Press, 1990).Google Scholar
Henkin, L., How Nations Behave (New York: Columbia University Press, 1979).Google Scholar
United Nations General Assembly, Universal Declaration of Human Rights, 10 December 1948, 217 A (III), available at <http://www.unhcr.org/refworld/docid/3ae6b3712c.html> (last visited July 7, 2011).+(last+visited+July+7,+2011).>Google Scholar
International Covenant on Economic, Social and Cultural Rights, adopted by General Assembly resolution 2200A (XXI) of December 16, 1966, available at <http://www2.ohchr.org/english/law/pdf/cescr.pdf> (last visited June 28, 2011).+(last+visited+June+28,+2011).>Google Scholar
U.N. Committee on Economic, Social and Cultural Rights, The Right to the Highest Attainable Standard of Health, CESCR General Comment 14. 22d Sess., Agenda Item 3, U.N. Doc. E/C.12/2000/4. 2000 [hereinafter GC 14].Google Scholar
Id., at para. 11.Google Scholar
Id., at paras. 53–56.Google Scholar
Id., at para. 34.Google Scholar
Id., at para. 35.Google Scholar
Id., at paras. 36–37.Google Scholar
Id., at para. 12.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Gable, L., “The Proliferation of Human Rights in Global Health Governance,” Journal of Law, Medicine & Ethics 35, no. 3 (2007): 534–544.CrossRefGoogle Scholar
U.N. Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (2008), Human Rights Council, 7th session, Agenda item 3, at 12, UN doc. A/HRC/7/11, January 31, 2008, at 12 [hereinafter “Special Rapporteur Health Systems Report”].Google Scholar
See WHO, Everybody's Business: Strengthening Health Systems to Improve Health Outcomes (2007), available at <http://who.int/healthsystems/strategy/everbodys_business.pdf> (last visited July 8, 2011). (last visited July 8, 2011).' href=https://scholar.google.com/scholar?q=See+WHO,+Everybody's+Business:+Strengthening+Health+Systems+to+Improve+Health+Outcomes+(2007),+available+at++(last+visited+July+8,+2011).>Google Scholar
Backman, G. Hunt, P. Kholsa, R. Jaramilla-Strouss, C. Mikuria Fikre, B. Rumble, C. et al., “Health Systems and the Right to Health: An Assessment of 194 Countries,” The Lancet 372, no. 9655 (2008): 2047–2085; Hunt, P. Backman, G., “Health Systems and the Right to the Highest Attainable Standard of Health,” Health and Human Rights 10, no. 1 (2008): 81–92.CrossRefGoogle Scholar
42 U.S.C. 300u-11 (2011).Google Scholar
P.L. 111–148, § 2601.Google Scholar
Id., at § 6302.Google Scholar
Id., at §§ 10503, 4101, 4201.Google Scholar
Id., at, § 4004.Google Scholar
Id., at §§ 1002, 1103, 3507, 4205, 5507.Google Scholar
Id., at §§ 4103, 4106.Google Scholar
Id., at § 1001.Google Scholar
See Shearer, , supra note 46.Google Scholar
See Special Rapporteur Health Systems Report, para. 63 (stating that “often legitimate but competing claims aris[e] from the same human right”).Google Scholar
GC 14, at para. 19.Google Scholar
P.L. 111–148, §§ 1101, 1201 (Amending PHSA § 2704), § 1001 (Amending PHSA §§ 2711, 2712).Google Scholar
GC 14, para. 35.Google Scholar
Id., at para. 12.Google Scholar
P.L. 111–148, §§ 1501 (Amending IRC § 5000A), § 1513 (Amending IRC § 4980H).Google Scholar
Id., at §1401 (Amending I.R.C. §36B).Google Scholar
Id., at § 1311.Google Scholar
Id., at § 1201, Amending PHSA § 2707, minimum set by § 1302(a).Google Scholar
Special Rapporteur Health Systems Report, para 52.Google Scholar
P.L. 111–148, § 1303 (42 USC 18023).Google Scholar
Id., at §§ 2001, 3301, 1333.Google Scholar
Id., at §§ 1104, 1413.Google Scholar
Id., at § 9001 (Amending IRC § 1513).Google Scholar
Id., at §§ 3022, 3403.Google Scholar
Id., at § 3403 (Amending SSA § 1899A).Google Scholar
Id., at §§ 1104, 1413.Google Scholar