This blog excerpts an article—Outlook for Obamacare—published in the Fall 2012 edition of the Cairo Review of Global Affairs. In the article, my colleague at the Center on Health Insurance Reforms, Katie Keith, and I describe the changes ushered in by the Affordable Care Act, how states and the federal government have implemented the law to date, and how the law supports the global ethic of universal health coverage.
Universal health coverage is increasingly recognized as a global social norm and moral imperative. With the passage of the Patient Protection and Affordable Care Act (ACA), the United States looks to join an ever-growing number of countries with universal health coverage and embraces the potential for improved access to adequate and affordable health care. Yet, because the ACA adopts America’s existing federalist framework, states and the federal government have much to do to prepare for 2014, when the ACA’s most significant reforms take effect. Because states play a prominent role in the United States’ complex federalist regulatory scheme, state decision-makers have the opportunity to shape how the ACA’s reforms will be enforced, how the insurance exchanges will be run, and whether Medicaid coverage is delivered as promised. If political opposition to the ACA continues and states refuse to adopt and enforce the ACA’s requirements, some of the law’s consumer protections and its promises of access to affordable, adequate, and accountable coverage could be at risk.
Despite this uncertainty at the domestic level, the law brings the United States one step closer to the global ethic of universal health coverage. While much of the international community has been confounded by the political furor over universal health coverage in the United States, the ACA represents a remarkable shift in the way that private insurance is regulated by taking pains to enable every American—including the sick—to access coverage. While imperfect in many ways, the ACA could generate additional momentum for improvements in universal access to coverage around the world as other countries look to the United States because of its prominent role in striving to improve global health. The law could also lend additional credibility to the United States in its leadership role at the WHO and in the global health arena where it has often supported universal health coverage policies while failing to pursue these reforms on its own soil. Finally, with the aim of securing near universal health coverage for its residents, the ACA helps align American domestic policy with long-standing foreign policy and support for universal health coverage, particularly in developing countries.
For more, please be sure to check out the full article here.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.