Bell, Jonathan; (2023) Health Care Capitalism and the Precarious Right to Bodily Autonomy in the United States since the Rights Revolutions. Modern American History 10.1017/mah.2023.7. (In press).

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Abstract

In May 1990, in the first case of its kind, the National Gay Rights Advocates (NGRA) secured a California court judgment prohibiting an insurance company from discriminating on the basis of sexual orientation. Great Republic Insurance Company had been using a supplemental questionnaire to screen out “occupations that do not require physical exertion … such as florists, interior decorators, and fashion designers,” as well as to use applicants’ marital status, “living arrangements,” and medical history to assess the likely risk of their exposure to the human immunodeficiency virus (HIV) when denying health care coverage.1 That same year, Moblization for Youth (MFY) Legal Services in New York filed a class action lawsuit on behalf of women living with HIV who had been denied access to Social Security benefits because the government did not recognize their HIV-related conditions as qualifying for state health care coverage under the Medicaid program.2 In one sense, the cases were starkly different: one sought to protect the privately insured from discriminatory scrutiny on the basis of their sexuality while the other attempted to bring a protected class of people into public view to make a claim to health care. Yet both reveal an important truth about the concept of rights in an American context. The structure of the U.S. health care system, one based on private insurance for most and a threadbare, convoluted system of categorical assistance and public insurance for children, the disabled, and the elderly, has shaped Americans’ experience of their own sexuality and bodily autonomy in ways arguably unique to the United States. The public/private hybrid in health care has dramatically curtailed the capacity of those outside the heteronormative family structure to realize their demands for full equality in the wake of the rights revolutions. Efforts to secure a right to sexual or gender identity have foundered on the rocks of the health care system when faced, for example, with a public health crisis like HIV or a lack of health insurance plans willing to fund gender-affirming health care.

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