US health reform still faces challenges

Abstract

Just 3 days after President Barack Obama’s re-election preserved his signature legislative achievement, the Patient Protection and Aff ordable Care Act (ACA), his administration reset a deadline for states to take a crucial step toward implementing it. The delay in the wake of the health law’s dramatic affi rmation—fi rst by the US Supreme Court and then at the polls—is another reminder that the way forward may still encounter obstacles, even if the most serious threat was eliminated on Nov 6. In his acceptance speech, Obama said the law has already helped many Americans, including the Ohio family of an 8-year-old girl “whose long battle with leukaemia nearly cost the family everything, had it not been for health care reform passing just a few months before the insurance company was about to stop paying for her care”. The president’s Republican challenger, former Massachusetts Governor Mitt Romney, promised voters he would begin dismantling the law on his fi rst day in the White House. Although that day will not come, the uncertainty generated by the often bitter presidential campaign has slowed the law’s progress. The deadline delay announc ed Nov 9 gives states as much as 3 more months to decide whether they will create their own health insurance exchanges next year, which will serve as the online marketplace for purchasing coverage that provides at least the minimum “essential benefi ts” required by the law, including maternity care. Only nine states currently require individually purchased insurance to cover maternity care and a report from the Commonwealth Fund estimates that 8·7 million women will have access to maternity care when the law takes eff ect in 2014. Subsidies and tax credits for eligible low-income families and small businesses will be available only for policies purchased through the exchanges. The new system is essential for another reason since the ACA also requires nearly every adult to have insurance and every employer with 50 or more employees to off er coverage or pay a penalty.