ABSTRACT

One of the most controversial aspects of the U.S. Supreme Court’s ruling on the Affordable Care Act (ACA) is the claim that the Commerce Clause of the U.S. Constitution does not allow for the regulation of economic inactivity. This aspect of the Court’s decision has implications of great importance not only for the distribution of health care resources but also for questions more generally about the relation between individual autonomy and distributive justice, or as Chief Justice John Roberts puts it, about “the relation between the citizen and the Federal Government.” 1 While there has been a great deal of discussion of the argument against the interstate commerce justification (ICJ) of the ACA’s individual mandate, there has been little systematic discussion of the ethical implications of this argument. This chapter attempts to provide a systematic discussion of the ethical implications by focusing specifically on the role played by concerns about individual autonomy in Roberts’s argument.