Boston University School of Law

The Affordable Care Act and Health Promotion:
The Role of Insurance in Defining Responsibility for
Health Risks and Costs

 

Wendy K. Mariner
Boston University School of Public Health, Boston University School of Law,
and Boston University School of Medicine

50 Duquesne Law Review 271 (Spring, 2012)
Boston University School of Law Working Paper 13-10
(April 16, 2013)

Abstract

The Affordable Care Act has three different approaches to promoting health. Two are uncontroversial: supporting education, research and community projects; and requiring insurance coverage of preventive services. The third, encouraging wellness programs within public and private health plans, reintroduces risk rating, which the ACA otherwise largely eliminates, back into insurance pools, although primarily for conditions most prevalent among disadvantaged populations. This article critiques the use of insurance to achieve health outcomes. Insurance influences what we find socially acceptable, which risks we are willing to share, and which risks remain the personal responsibility of individuals. It can transform prejudices based on questionable evidence into socially acceptable discrimination, in both employment and access to public benefits. The Affordable Care Act has three different approaches to promoting health. Two are uncontroversial: supporting education, research and community projects; and requiring insurance coverage of preventive services. The third, encouraging wellness programs within public and private health plans, reintroduces risk rating, which the ACA otherwise largely eliminates, back into insurance pools, although primarily for conditions most prevalent among disadvantaged populations. This article critiques the use of insurance to achieve health outcomes. Insurance influences what we find socially acceptable, which risks we are willing to share, and which risks remain the personal responsibility of individuals. It can transform prejudices based on questionable evidence into socially acceptable discrimination, in both employment and access to public benefits.

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Wendy K. Mariner Contact Information

Boston University School of Law
765 Commonwealth Ave
Boston, MA 02215 USA

Professor of Law
Boston University School of Public Health
715 Albany Street
Boston, MA 02118
United States
617-638-4626 (Phone)
617-414-1464 (Fax)

Email: wmariner@bu.edu

 

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