Author Affiliations: Department of Bioethics, NIH Clinical Center, Bethesda, Maryland (Drs Rulli and Wendler); and Office of Vice Provost and Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia (Dr Emanuel).
The 2010 Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance or pay a financial penalty. Although debate focuses on the constitutionality of this individual mandate, the central concern is a moral matter—is it morally appropriate to require individuals to purchase health insurance?
Proponents argue that a mandate could lower insurance premiums for everyone by pooling individuals with varying health risks. Opponents respond that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Appeal to the collective good could justify requiring individuals to buy gym memberships or eat broccoli.1
Tina Rulli, Ezekiel J. Emanuel, David Wendler. The Moral Duty to Buy Health Insurance. JAMA. 2012;308(2):137–138. doi:10.1001/jama.2012.5648