Holding on to a huge victory for American health

Abstract

The past week was a historic one for health in America. In a much-anticipated decision, the country's highest court—the US Supreme Court—ruled that most provisions in President Barack Obama's Patient Protection and Affordable Care Act (ACA) were constitutional. President Obama's health reform, designed to expand coverage to nearly all Americans, passed into law in 2010 but it has faced many challenges, culminating in the Supreme Court case. One provision under question was a mandate that required individuals to pay a penalty for not obtaining health insurance. However, the Court of nine judges ruled 5–4 that this penalty met the criteria for a tax and that it was Congress's constitutional authority to levy taxes. The ruling means that millions of Americans will be financially protected in the event of illness. The Court did strike down one provision in the law. The Court said that Congress could not coerce states to expand Medicaid—the joint federal–state programme that provides health care to people who are poor or disabled—by withholding existing federal payments for the programme. Now states can opt-out of expansion. This means that the predicted 32 million more Americans set to gain from the ACA could now be potentially halved. Some Republican governors have already stated that they will not participate in the expansion, meaning that some lower earners in those states will lose their chance to gain coverage under the ACA. As observers have noted, these low earners are disproportionately black or Latino. The federal government will have to come up with substantial incentives to encourage states to participate in the Medicaid expansion. It must also ensure that insurers and employers do not begin to circumvent the ACA provisions by closing any potential legal loopholes. And it needs to raise public awareness about the immense health benefits of the ACA. Presumptive Republican presidential nominee Mitt Romney, whose response to the Court decision was a promise to repeal the act on his first day if elected as president, has placed health care centre stage in the run-up to the Nov 6 election. The ACA provides a vital social safety net for Americans. It should remain as law for the future health of the nation. US Supreme Court makes historic health rulingThe US Supreme Court decided last week that most provisions in the 2010 Patient Protection and Affordable Care Act were constitutional. Susan Jaffe reports from Washington, DC. Full-Text PDF