We still have much to learn about the court’s decision on the Affordable Care Act, but today is a great day for the nearly 50 million people in this country who do not have health insurance and who, as a result, face major barriers to getting the health care they need. Many challenges are still ahead and not everyone will get coverage under the ACA, but we have taken a giant step forward as a country.
I hope the court’s decision gives new hope and resolve for those in public health to continue working to address the health care inequities in the U.S. I know it has done that for me. We should take just a few minutes to reflect on this really significant day.
It is rare that I cry when listening to NPR, but I had tears in my eyes as I tried to explain to my 4-year-old eating breakfast that this was one of the most momentous days for equality in US history. It is a heartening and motivating decision, and it is thrilling to be a part of the transformation of American healthcare that this decision allows to continue with full momentum.
The health reform debate has brought to center stage the challenges of the unsustainable trajectory of healthcare costs, the need to provide more whole-person, patient-centered care, and the imperative to improve and reduce disparities in quality of care and in health outcomes for all individuals in this country.
The highest court in the land has interpreted the Constitution to allow the wheels of health reform to continue to turn at full speed while recognizing the critical role of mandating insurance coverage in order to overcome our health system’s most pressing challenges. This ruling will ultimately make for a healthier United States – physically and financially.
I’ve spent my professional career working in what I have come to call an “unfortunate growth industry” – addressing issues of access to care for the underserved and uninsured populations in our country. This morning I was waiting with a mix of excitement and horror to see if our nation would discard the Affordable Care Act on what would have amounted to a technicality that has little to do with the intent of the law or the underlying issues it addresses.
Thankfully the Supreme Court saw the law for what it was – a reasonable legal approach to expanding access to care and to compel/assist people to obtain insurance. I see it as more than that. It is the greatest step our nation has taken in generations to assure the well being of our society and see that 50 million Americans don’t continue to suffer the physical and financial consequences of diseases we can readily prevent or cure. It’s a great thing for our country and the institutions through which it operates that this law could be both passed and upheld.
From our perspective here in Massachusetts, where Gov. Mitt Romney signed similar health care reform into law in 2006, this is very good news for the millions of people across the country who currently lack health insurance. We’ve seen the positive consequences. Health reform has resulted in health insurance coverage for 98 percent of the people of Massachusetts, where the program enjoys wide popularity. I expect the results will be similar across the country.
It is well-documented that health care coverage leads to better quality of life and better well being, so this is a real win for low-income populations of all types, who are now going to have coverage.
But even with health care reform, there is still a huge population with barriers to access, such as barriers due to culture and language, low health literacy, and lack of transportation. Safety net organizations serve the populations that struggle with access, and JSI’s role is to help those safety net organizations become higher quality, more efficient and more patient-centered providers, especially since their traditional clients, the uninsured, will have more choices with the ACA.
In response to the Supreme Court decision on the ACA, some people are celebrating “health care for all.” But this doesn’t equal health care for all – rather it is insurance coverage for all, and insurance coverage does not equal access to care.
I do believe there have been positive impacts on the health care system due to the ACA, such as the cultural shift we have seen toward quality, the higher level of awareness about the importance of prevention, and that it started a dialogue about whether health care was a right to be had by all or a privilege to be enjoyed by a few. But, I feel that the decision to uphold the individual mandate puts an end to the discourse on this important issue, and we are losing the opportunity to move our discussion to the next level and more importantly to shift our action to bringing access to services to all through a single payer system.
The Supreme Court decision to uphold the ACA is a victory in the ongoing battle for social justice in America. Without widespread access to health care, we can’t possibly begin to mitigate the disparities between the rich and the poor or the middle class, who when faced with serious illness must often bankrupt themselves to pay for care. Please, please see this triumph as a call to become involved in the coming election. We must support candidates who support access to health care or this important decision will be for naught.
There’s no other way to say it: This is a big deal. It’s a win for women, and all citizens across the nation. I know the fight isn’t over, but for today I’m celebrating a step in the right direction.
Natalie Truesdell: Consultant, Health Services, JSI-WEI/Boston
I’m excited that the court upheld the individual mandate. But it will be interesting to see to what extent Medicaid will be expanded in the states considering that as a result of today’s ruling, federal Medicaid dollars will not be tied to required expansion.
Medicaid expansion is a significant component of the law, through which a large proportion of the population would get coverage. Many people who would be covered by Medicaid expansion won’t be able to afford coverage through the ACA-created exchanges.
While the supreme court ruling gives me great hope that everyone–especially uninsured vulnerable populations–will have access to healthcare, the question that still remains for me is what is our role as citizens will be to change the paradigm that makes people sick in the first place? ‘Healthcare’ per se has not been reformed–different ways of paying for health care have. While access to health care accounts for part of a person’s overall health, the socio-economic determinants of health play a greater role in what makes a person, a community, a society healthy (access to adequate housing, employment, race, income, education, etc.)
It is my humble opinion that JSI/WEI are in a great position to raise awareness of these social factors and to empower people to be agents of change in their neighborhoods and communities. Addressing the root causes of unhealthy communities will require multi-sectoral collaboration and policy changes. It seems like an impossible task, but I believe it is doable and that we at JSI/WEI are the ones who can do it!
My 60-year-old uncle is self-employed. He owns his own doggie pooper-scooper franchise business in Florida. He lost his job, in publishing, and found at his age it was hard to get another, so he found a way to make a living in a new line of business. He did what he is supposed to do. He scoops poop. He works hard. He raised two sons, coached their soccer and helped them with their homework. He is also uninsured. He has a pre-existing condition – chronic pain from a back injury – which makes health insurance unaffordable for him right now.
Although he still works every day, he spent a good deal of time during our recent family reunion lying down – as it is too painful for him to sit or stand for long periods of time. It was only when I went to check on him that he let me in on his pain. He told me he was just waiting for healthcare reform to kick in so that he could purchase health insurance at a reasonable rate and get the surgery he needs. This is why we need health care reform. Thank you to the Supreme Court for understanding this.
That decision meant life or death to millions of Americans. I’m glad the Supreme Court decided to choose life.
For more reactions to the day’s historic ruling, check out JSI’s Storify page, “Public Health Professionals React to Health Care Reform Ruling”.