Constitutionality and Health Reform

Newswise — The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to healthcare for virtually all legal U.S. residents. The U.S. Supreme Court is currently reviewing the constitutionality of the ACA’s “individual mandate,” a vital but controversial provision requiring individuals to maintain health insurance coverage or face a tax penalty. The Supreme Court’s final ruling on the individual mandate will shape the effectiveness of health reform.

In a new paper in the journal Policy, Politics, & Nursing Practice, authors from the University of Pennsylvania School of Nursing examine the constitutionality of the individual mandate through the lens of relevant court decisions.

“A critical issue has been defining the ‘activities’ Congress is authorized to regulate,” explained co-author and Penn Nursing Assistant Professor Matthew D. McHugh, PhD, CRNP, MPH, JD. “Some lower court judges determined that the mandate was constitutional because the decision to go without health insurance -- that is, to self-insure -- is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating ‘inactivity,’ that is, compelling people to purchase insurance when they otherwise would not.”

The Supreme Court’s decision will address some of the United States’ most core and ongoing constitutional issues, particularly the interrelationship of national economic interests and individual freedom from government intervention and the balance of state and federal power, said Dr. McHugh.

“The repercussions of the determination of the individual mandate’s constitutionality extend beyond the mandate itself,” he said. “The result will chart the course of health reform as well as set new precedent on the authority of Congressional regulation.”

The University of Pennsylvania School of Nursing is one of the premier research institutions in nursing, producing new knowledge in geriatrics, pediatrics, oncology, quality-of-life choices, and other areas. Researchers here consistently receive more research funding from the National Institutes of Health than any other private nursing school, and many Master’s programs are ranked first in the country. This year, faculty, students, alumni, and staff celebrate 125 years of nursing at Penn.