Document Type


Publication Title

UMKC Law Review

Publication Date

Fall 2011


This article reviews and analyzes the sweeping 2010 health care reform bill (the 'Affordable Care Act'). It describes the Act’s central provisions, reviews legal challenges to the Act, and examines the social, cultural, and economic roots of the widespread and intense opposition to the Act among the public, a year after the Act’s promulgation.

Efforts to invalidate, repeal or limit the Affordable Care Act have moved forward in courts, Congress, and state legislatures. Politicians and lawyers opposing the Act have delineated a set of presumptive problems with it – that, for instance, Congress lacked authority to provide for the Act’s central provisions (e.g., the so-called 'individual mandate'), that implementing the Act will increase the nation’s deficit, and that the Act fundamentally limits freedom and choice. The Article reviews each claim and examines it in light of the nation’s long-standing reluctance to reform its health care system. It then examines the socio-cultural assumptions that have undergirded the nation’s refusal for almost a century to affect universal or near-universal health care coverage. In that failure the United States differs from virtually each other wealthy nation. Even more, the United States has long spent more for health care per capita than any other nation, and yet has a higher rate of infant mortality and a lower life expectancy than most industrialized nations. The article examines that history and suggests that the same assumptions that have long precluded significant reform of the nation’s health care system now encourage opposition to the Affordable Care Act.