The High Court's Health Care Decision: A Public Health Perspective
by Dr. Earl Stoddard, CHHS Public Health Program Manager
In what has already been called a landmark ruling by the U.S. Supreme Court, the Justices upheld the constitutionality of the Patient Protection and Affordable Care Act passed in 2010. While the ruling will provide months of political fodder leading up to the 2012 elections, it is important to consider the impacts the legislation will have on public health in the United States.
Many public health advocates say the United States healthcare system isn’t as effective and is more costly than many countries, particularly those in Europe. While the Affordable Care Act (ACA) does not go so far as to transform the existing healthcare system to one that resembles those seen in Europe’s more government-driven universal healthcare programs, it does provide certain palpable benefits for the long term health and well-being of Americans.
Public health officials and associations usually seek to attain universal healthcare coverage. At present, however, 81.4% of Americans have any type of health insurance coverage, whether through public systems such as Medicare, or private health insurance plans. The ACA is predicted to increase that number to 91.7%. Studies show those who will remain uninsured will do so because of such factors as income, insurance costs, employment, legal status and personal choice. The so-called “Individual Mandate,” implemented principally as a mechanism to pay for the legislation, accounts for the majority of that overall 10% increase. Other ACA provisions that enhance healthcare options for the underprivileged account for the remainder of that difference. In real terms, that 10% overall change in coverage equates to more than 30 million additional Americans having healthcare coverage.
Another important feature of the ACA is its requirement that individual healthcare policies allow for certain preventive care. Preventive care represents one of the most cost- effective methods for improving the health of Americans while reducing the long-term, ever-escalating costs of healthcare. In 2007, a report on the impacts of preventive care by the Robert Wood Johnson Foundation summarized the value of such care quite succinctly. It stated, “Increasing the use of just 5 preventive services would save more than 100,000 lives each year in the United States. ” That statistic does not even begin to assess the savings in worker productivity or treatment costs prevented by maintaining a healthier population. What can’t be overlooked is the possibility that insurance companies may simply increase premiums to cover preventive care. There are cost-control measures in the law that aim to quell egregious increases in premium cost, but like any large-scale legislation, unintended consequences may need to be mitigated through additional legislation to stop abuse.
To see the benefits or weaknesses of the ACA, time and political will are critical. It will take years to accurately measure the statistical impact of its programs and it will take nearly as long to assess the impact on the cost-drivers of health care in the U.S. While the ACA survived its trip through the hallowed halls of the Supreme Court, there is still extraordinary resentment and reservations about the law both within government and the general citizenry. While public health and medical organizations have rightfully lauded the court’s decision based on some of the benefits outlined here, it will take time after the law is fully enacted to better grasp whether it is appropriate and sufficient to address the long term goals of attaining affordable, universal healthcare.
Sources: Why the Individual Mandate Matters. The Urban Institute. December 2010. http://www.urban.org/publications/412280.html
Preventive Care: A National Profile on Use, Disparities, and Health Benefits. Robert Wood Johnson Foundation. August 2007. http://www.rwjf.org/pr/product.jsp?id=19896