Boston University School of Law

Understanding the Failure of Health-Care Exceptionalism
in the Supreme Court's Obamacare Decision


CHEST, forthcoming 2012
Boston University School of Law Working Paper 12-37
(July 16, 2012)

Abigail Moncrieff

Boston University School of Law



On June 28, 2012, a mere century after the first presidential proposal for national health insurance, the Supreme Court issued a resounding victory for President Obama and for health-care reform generally, upholding the Patient Protection and Affordable Care Act against a serious constitutional challenge. Nevertheless, the Court also struck a potential blow to future health-care reform efforts. A majority of the Court refused to accept the Solicitor General’s argument that health care is a unique market with unique regulatory needs that justify special constitutional treatment. The failure of health-care exceptionalism in the Court’s opinion might render future reform efforts more difficult than they would have been if the Solicitor General’s argument had carried the day. This Commentary seeks to shed light on the Court’s hesitation to recognize the uniqueness of health insurance and health care, noting that market-based exceptionalism in constitutional law has a long, dark history that the Court was understandably loath to repeat. Although the result of the majority's one-size-fits-all approach to constitutional analysis in this case is an odd holding that elides some genuine uniqueness of American health care, the alternative of health-care exceptionalism might have been much worse for our overall constitutional system.

Number of Pages in PDF File: 8

Keywords: health-care reform, Patient Protection and Affordable Care Act (ACA), Insurance Exceptionalism, Taxing Power, Market Exceptionalism

JEL Classification: K23, K32, K34, K49

Accepted Paper Series


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Abigail Moncrieff Contact Information
Boston University School of Law
765 Commonwealth Ave
Boston, MA 02215 USA
Phone: (617) 353-2212



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