Teaching the Individual Mandate

I have viewed the controversy around the individual mandate in the ACA through the lens of my teaching undergrads at Duke. In August 2011, I posted about how I had to change how I prepped to teach my Introduction to the U.S. Health System course for Fall 2011. The first 8 times I taught this course (from 1999-2008), the individual mandate was presented as a Republican approach to health care reform; by last Fall it had become the essence of Republican opposition to the ACA.

I made the individual mandate the topic of the major course paper for Fall 2011, 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?

The 24 students (undergrads, a mix of majors) concluded the following:

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

On the whole, the students took this assignment very seriously, and I was impressed with how deeply they delved into the relevant court cases, scholarship around the issue, as well as the historical, policy and political aspects of the looming Supreme Court case.

I am teaching Intro to the U.S. Health Care System again in Fall 2012. Not going to be able to finalize the syllabus until a bit later in the Summer.

(a similar post was done at freeforall in Dec, 2011)