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The Supreme Court decision in the Hobby Lobby case is in many ways a sequel to the Court's 2012 decision on the constitutionality of the Affordable Care Act (ACA). The majority decision, written by Justice Samuel Alito, is a setback for both the ACA's foundational goal of access to universal health care and for women's health care specifically. The Court's ruling can be viewed as a direct consequence of our fragmented health care system, in which fundamental duties are incrementally delegated and imposed on a range of public and private actors. Our incremental, fragmented, and incomplete health insurance system means that different Americans have different access to health care. A central goal of the ACA was to repair some of this incremental fragmentation by universalizing certain basic health care entitlements. The Court has once again expressed its disagreement with this foundational health-policy goal.


Constitutional law, Supreme Court of the United States, reproductive rights, Patient Protection and Affordable Care Act, abortion, medical ethics, health care administration

Publication Title

New England Journal of Medicine

Publication Citation

371 New Eng. J. Med. 862 (2014)