Affordable care act: Implications for public health law

In recent years, there has been a renewed appreciation for law's ability to protect public health. Although cast primarily as a health care reform law, the Patient Protection and Affordable Care Act (PPACA) in many ways exemplifies this revival: it utilizes legal tools to expand access to health care to broad populations; it fosters preventative health services; and it supports community-based interventions. In addition, PPACA promotes greater use of epidemiology in medical services. Nevertheless, there are several reasons to question whether PPACA will promote a population perspective in law. First, PPACA supports prevention primarily through individual clinical rather than population-based interventions. Second, the Act assumes that individuals retain significant responsibility for their health. Third, the litigation PPACA has sparked may undermine the legal foundations for public health interventions. Although the PPACA litigation is most explicitly about federalism, the litigation expresses a potent libertarian strain in American legal thought that challenges the population perspective undergirding public health law. Moreover, the emphasis in the litigation on the activity/inactivity distinction invokes an individualistic strain in American law antithetical to the interventionist, population perspective of public health law. Although it is too early to predict the outcome of either the litigation or the Act's efficacy should it survive judicial review, the debate it has provoked suggests the challenges that face efforts to use the law to protect public health.