HEALTH INSURANCE REFORM AND INTIMATIONS OF CITIZENSHIP

Sometimes what is implied and inferred can be as important as what is stated. In this Article, I argue that the political debate that preceded the enactment of the Patient Protection and Affordable Care Act (PPACA), as well as the legal debate that now swirls around the question of its constitutionality, mask a foundational question about national identity. PPACA, of course, does not literally constitute or reconstitute citizenship (although it does require legal residence as the price of admission). But it creates the potential for broad public conversation-as has never before occurred in the United States-regarding the question of what the relationship should be between membership in the American community and meaningful access to health care.