The US Supreme Court ruled last week that the healthcare reform passed two years ago—the Affordable Care Act—is constitutional.
The ruling is an important victory for president Barack Obama in an uncertain election year. He made the reform of the expensive and unwieldy US health system a key election promise when he stood for president in 2008.
The right of the Republican Party went to war against Obama’s relatively moderate changes. It got 26 states to launch a lawsuit claiming that the federal government was imposing an “unfair burden” on them.
A central part of the reforms is an expansion of Medicaid, the government-run health care system for poor and disabled people. The legal debate revolved around the degree to which states would face increased costs to help fund this.
Because there is no NHS in the US, people rely on private insurance. And as insurance costs are so high about 50 million people have no insurance.
The healthcare act requires insurance companies to sell policies to everyone, regardless of current or past health issues. As a result, over the next two decades, tens of millions more Americans will get health coverage under the new system.
But it also insists that millions of people who have not previously been able to afford insurance will have to buy a policy by 2014, or pay a penalty of $95 (£60) a year or 1 percent of their income, whichever is greater.
Limitations like this exist because a debate on the creation of a real national health service was never allowed on the floor of Congress.
There was never any discussion within any of the committees about it, and last year when activists attempted to make that case in the Finance Committee, eight people were arrested.
The private health insurance industry has been enormously successful in controlling the debate about this law. This Act only partially guarantees access to healthcare. The new system will still leave 26 million people uninsured, according to the Congressional Budget Office.
The Supreme Court ruling leaves most of the law intact, but it ruled that the federal government cannot withhold Medicaid funding from states that refuse to comply with the programme’s expansion.
Therefore the government cannot penalise states that don’t expand their Medicaid coverage of the poor. States now have the option of not accepting Medicaid dollars from the federal government.
Estimates show that if the 26 states that brought the lawsuit don’t take on that Medicaid expansion, 8.5 million people will remain without care that could have been provided.
But for women in particular this law offers gains. Forty‑five million women have already received cervical cancer screening, breast cancer screening and reproductive healthcare without extra charges.
As of August, women will be able to get contraception without an extra charge or deductibles. It removes gender discrimination in healthcare pricing.
In addition, the Act does put a cap on how much people will have to spend out of their own pockets before our insurance kicks in.
Deductibles are the costs that the insured person must pay up front before an insurance company will pay any expenses. Typically, the lower the insurance premium, the higher the deductibles you have to pay.
The Act will curb increases in premiums, and allow people to compare plans. Right now insurance companies don’t give us a lot of information to make informed decisions.
Also, the companies will now have to spend 80 percent of what we pay in health insurance on our healthcare. If they don’t, they will have to rebate premiums back to us. Without the Affordable Care Act, premiums would simply continue to increase regardless.
So it is a law that brings people into coverage who wouldn’t have it otherwise—and an important step forward in the fight for access to affordable quality healthcare.
But it is not a health service, and many people are angry that we are being legally bound to pay money to profiteering private health companies. Obama has managed to make some changes, but failed to take on the vested interests of the private insurance firms.
Virginia Rodino is a socialist and activist in Washington DC