Corporate profit or public health? : the Affordable Care Act's individual mandate in the context of the neoliberal project

The Patient Protection and Affordable Care Act passed at an apparently contradictory moment when neoliberalism dominates U.S. policy and discourse. Yet, despite its tendency to disparage welfare programs as a menace to individuals, society and the capitalist economy, neoliberalism has historically depended upon the welfare state to achieve its economic and political goals. This paper explores the mechanisms by which the welfare state in general and the healthcare system in particular have historically furthered the neoliberal project, providing context for how the individual mandate of the Affordable Care Act preserves neoliberal institutional and ideological dominance in the healthcare system. I analyze Congressional Hearings, records of lobbying and finance, and the mandate itself with respect to their impact on mechanisms of power and finance within the American healthcare system. Analysis suggests that the mandate’s history as an alternative to single-payer healthcare, its advantages for the health industry, its stated intent to achieve universal coverage without compromising health industry markets, and its surrounding politics that frame it as a public victory reveal a larger policy framework intended to dispel meaningful reforms to the healthcare system. I conclude that the individual mandate is best designed to maintain influence and profit for the private health industry at the expense of government sponsored health insurance alternatives.