The Second Amendment and the Public’s Health

Last November, Michael O’Hear offered an interesting post on whether a Seventh Circuit decision that developed a new test for Second Amendment claims would breath life into the U.S. Supreme Court’s decision in District of Columbia v. Heller, 128 S. Ct. 2783 (2008), which for the first time interpreted the Second Amendment as conferring an individual right to possess and use firearms. Two years after Heller was handed down, I have been wondering about its consequences, too, in the context of public health policy.

Historically, gun-related violence and accidents were not viewed as a public health matter. Rather, gun violence was considered a matter for the criminal justice system; gun-related suicides were seen as a concern for the mental health system; and gun accidents were viewed as best handled by educational safety courses. Perceptions changed, however, with the advent of the field of injury prevention in the 1970s. When all gun violence and accidents were considered together, guns were found to be the second-leading cause of injury deaths in the U.S. 

Continue ReadingThe Second Amendment and the Public’s Health

Health Reform and Racial and Ethnic Health Disparities

One of the most troubling aspects of the U.S. health care system is the existence, and extent, of racial and ethnic health disparities. Research has amply documented that members of racial and ethnic minority groups receive fewer health care services and lower quality health care than non-minority patients (see, for example, the rather damning portrait drawn by the Institute of Medicine’s 2003 study titled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care”). These disparities remain even when insurance status, socioeconomic status, and other important factors are controlled for in scientific studies.

There are many likely causes of race- and ethnicity-based health disparities. Among them: patient-level variables such as cultural preferences, mistrust of health care providers, and degrees of knowledge; system-level factors such as the geographic availability of health care providers, the use of managed care in publicly sponsored health care programs, and a general lack of institutional funding for language interpretation and translation services; and provider-level variables such as prejudice, stereotyping, and clinical uncertainty when treating minority patients.

Yet for all the evidence showing the existence of racial and ethnic health disparities, government agencies, health care providers, and health plans and insurers do not routinely collect data pertaining to patients’ race, ethnicity, and primary language.

Continue ReadingHealth Reform and Racial and Ethnic Health Disparities

The Constitutionality of Health Reform’s “Individual Mandate”


As noted in my blog post last week (“The Beginning of Health Reform“), pushback against the federal Patient Protection and Affordable Care Act was swift.  Members of nearly 40 state legislatures have proposed legislation or constitutional amendments limiting or opposing certain provisions of the Act, with most of the proposals targeting the Act’s requirement that individuals have health insurance coverage or subject themselves to financial penalties (the “individual mandate”).  Virginia, Idaho, and Utah are the only states thus far to have enacted new statutes (each of which more or less prohibits compliance with any law that imposes a fine on an individual for declining to enter into a contract for health insurance coverage), and their validity is sure to be challenged in court on Supremacy Clause and other grounds.  Idaho has also passed a non-binding resolution “urging Congress to take action forthwith to amend the United States Constitution by adding a Twenty-eighth Amendment to provide that Congress shall make no law requiring citizens of the United States to enroll in, participate in or secure health care insurance or to penalize any citizen who declines to purchase or participate in any health care insurance program.”

Most dramatic, though—if drama is measured by the amount of media coverage generated—is the lawsuit initiated by the Attorney General of Florida and joined by 19 other state Attorneys General maintaining that several components of the health reform law violate Article I of and the Tenth Amendment to the U.S. Constitution.  The argument that is drawing the most attention concerns the constitutionality of the Act’s individual mandate.  Like the contention at the heart of the state proposals, the Florida lawsuit argues that the Act’s requirement that individuals have health insurance coverage or pay a tax penalty amounts to an unconstitutional mandate that cannot be upheld under the Constitution’s Commerce or Spending Clauses.

The lawsuit seems unlikely to ultimately succeed, given the procedural and substantive hurdles it has to clear. 

Continue ReadingThe Constitutionality of Health Reform’s “Individual Mandate”