Imagine you had to choose between your health and your freedom. Many Americans do. Choices to work, marry, retire, move, cohabitate—all are influenced by health care finance laws. Access to health insurance is not guaranteed, and eligibility comes with social costs. For the publicly insured, recipients forgo work, marriage, and security in old age to meet strict income and asset tests. People with disabilities, their medical needs pigeon-holed into public programs, are denied equal opportunity in this way. Employer-sponsored insurance presents its own costs, limiting the range of jobs people take, when they can retire, and whether to marry and divorce. Medicaid expansion and premium tax credits mitigate these harms by degrees but are diminished under the current presidential administration.
\nResearch is conclusive that social conditions shape our health. The inverse is also true, that the health care system shapes social conditions. This undermines goals of a health care system to make people healthier, insulate them financially, and enable them to live meaningful lives. It breeds social inequality.
\nThis Article names and defines this problem, with an effort to center it in the health reform work of scholars, lawmakers, and judges. The Article offers minor and major policy reforms to address the problem. It contributes to scholarly discourse and policymaking on health and welfare reform at state and federal levels.
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