Health Care Analysis

, Volume 21, Issue 3, pp 237–247 | Cite as

Freedom of Conscience and Health Care in the United States of America: The Conflict Between Public Health and Religious Liberty in the Patient Protection and Affordable Care Act

Original Article


The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties.


Abortion Contraception Freedom of conscience Health care “Obamacare” Patient Protection and Affordable Care Act Public health Religious liberty Reproductive autonomy Vaccination 



Multi-drug resistant tuberculosis


National Health Service


President’s Emergency Plan for AIDS Relief


Patient Protection and Affordable Care Act


Sexually transmitted infection


Extremely drug resistant tuberculosis



I would like to thank the Arts and Humanities Research Council for their ongoing funding of my graduate research and the participants of the ‘Think About Health’ Network conference in April 2012 for their comments on preliminary research for this paper. Parts of this paper were developed from ideas first presented at the Political Studies Association Annual Conference in Belfast 2012.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of PhilosophyThe University of BirminghamBirminghamUK

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