Professor’s Paper Cited in Defense of Nation’s Health Care Reform

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The U.S. Supreme Court will hear arguments next month in a legal challenge to the nation’s new health care law, known as the Patient Protection and Affordable Care Act (PPACA), and an article by a Yale School of Public Health professor will play a role in the legal proceedings. 

The article written by Jennifer Prah Ruger, associate professor in the division of Health Policy and Administration, is cited in the legal brief filed by the U.S. Department of Health and Human Services (DHHS) supporting the landmark legislation. 

Ruger’s article, “The Moral Foundations of Health Insurance,” originally appeared in the Quarterly Journal of Medicine in 2007, and argues that health risks are uncertain in timing, magnitude, and frequency — making it difficult to predict when health care services will be needed and how much coverage will be necessary. A key component of the DHHS argument is that health care markets are unique in that they fulfill needs that cannot be accurately predicted or budgeted for. Ruger develops an alternative moral framework for analyzing health insurance and health policy that is elaborated in her 2009 book, Health and Social Justice

Since its passage in 2010, the health care reform law has come under scrutiny and its constitutionality has been challenged in U.S. District Courts and U.S. Circuit Courts of Appeal. A Supreme Court ruling on the case is expected this summer. 

“I’ve been following the coverage of the federal health law and health reform,” Ruger said. “An important perspective has been lacking and that is of the ethical underpinnings of the health care system and health policy. This point of view is essential for the ongoing and future debates over health reform.”

The PPACA seeks to improve the performance of the health care market by addressing costs, quality and access to health care. To achieve this, the act requires that non-exempt taxpayers purchase a minimum level of health insurance or pay a penalty. In a Brief for Petitioners in the U.S. Supreme Court, the DHHS argues that the minimum coverage provision is a legitimate use of Congress’ commerce and taxing powers. Additionally, DHHS asserts that because health care markets have near universal participation, the minimum coverage provision is needed to regulate the way that individuals pay for their participation in the health care market.

The uncertainty surrounding health care, Ruger argues, increases individual and community vulnerability and economic and health insecurity. Universal health insurance is morally justified, she maintains, because it reduces, mitigates and copes with risks of ill health and the resulting economic insecurity.

When individuals cannot afford to pay for health care services, billions of dollars from uncompensated health care are shifted to private insurers who pass costs on to insured participants. DHHS notes that “Congress found that this cost-shifting increases the average premiums for insured families by more than $1,000 per year.” The department argues that minimum coverage provision prevents cost and risk shifting to others participating in the health care market and is a reasonable way to address the economic problems associated with uncompensated care.

Ruger’s scholarship was also cited in support of the PPACA during recent legal proceedings in California, Florida, Michigan and Virginia. She is a member of the Ethics Subcommittee of the Advisory Committee to the Director of the Centers for Disease Control and Prevention and a Greenwall Faculty Scholar in Bioethics.


This Article was submitted by Denise Laraine Meyer, on Tuesday, June 12, 2012.