How to teach the individual mandate, ctd.

In August, I wrote about the difficulty of teaching the individual mandate in my Introduction to the U.S. health system course this fall at Duke because it was typically presented when discussing Republican approaches to health care reform (this is the ninth time I have taught the course, but the first time since 2008). Now it is the essence of Republican opposition to the ACA.

This Fall I made the individual mandate the topic of the major course paper, and students had to argue whether the individual mandate was constitutional or unconstitutional, using this prompt as a jumping off point:

Trace the history of the individual mandate as a means of expanding health insurance coverage in the U.S. When did this idea emerge? Who/what groups were the intellectual drivers of the arguments behind the individual mandate? What were the arguments in favor? In opposition? Why was the individual mandate often supported by Republicans and Conservatives in the past? Why do you think the individual mandate became a central part of the Affordable Care Act? When did the opposition to the individual mandate arise and why? From your research on the topic, are you persuaded that a federally-enforced individual mandate to purchase health insurance is acceptable under the Constitution or not? Why or why not?

I promised in August to report what the students (undergrads, a mix of majors) concluded.

  • 3 concluded that the individual mandate is unconstitutional
  • 21 concluded that it is constitutional (7 of these profess worries about the federal government taking this step, but still felt it was constitutional)

On the whole, the students took this assignment very seriously, and I am impressed with how deeply they delved into the relevant court cases, scholarship around the issue, as well as the historical and political aspects of the looming Supreme Court case. I think they took the question of whether an individual mandate to purchase health insurance is allowable under the Constitution far more seriously than I have.

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