Cultural Collisions and the Limits of the Affordable Care Act

Abstract

National Federation of Independent Business v. Sebelius (“NFIB”) settled the central constitutional questions impeding the rollout of the Patient Protection and Affordable Care Act (“ACA”): whether the federal government’s “individual mandate” to purchase or hold health insurance and the federal government’s authority to retract existing federal dollars if states fail to expand Medicaid eligibility violate the Constitution. However, a number of residual questions persist in its wake. While most of the focus this year has been on related constitutional issues — such as religious exemptions from offering contraceptive coverage to employees — NFIB also clears the path for a discussion of the merits of the ACA’s policy goals and the extent to which the ACA succeeds on its own terms. This Article explores the normative implications of the ACA’s equal access/mental health agenda with respect to culturally and linguistically diverse communities. While the ACA will certainly extend insurance coverage to additional health care market participants, it falls short of ensuring meaningful access to health care — i.e., changes in health status — because it does not reach or, at best, narrowly addresses the ways in which health care (and mental health care in particular) has been historically defined, delivered, regulated, and experienced in the United States