It is expected that in early June the Supreme Court will announce its decision on the constitutionality of the Affordable Care Act. While much attention about the court’s decision has focused on the federal government’s ability to impose a mandate on Americans to purchase health insurance, the Affordable Care Act has critical policy and cultural implications that should not be overlooked.
We live in a country whose primary cultural value has always been self-responsibility, but with the passage of the Affordable Care Act the United States now also embraces the principle that all Americans should have access to affordable health coverage and that no American should go broke when sick or injured. To paraphrase Vice President Joe Biden: "This is a very big deal."
While the law maintains the current employer sponsored method of purchasing health coverage from private insurance companies, it also provides government support for individuals with incomes up to 400 percent of the federal poverty guidelines ($44,688 for an individual, $92,208 for a family of four) who need assistance paying for health insurance. It is estimated that under the law over 32 million uninsured Americans will have access to affordable health coverage.
When comparing the United States health care system with health systems from the other industrialized nations, many bemoan the fact that all other industrialized nations have found a way to provide health coverage for their citizens.
When searching for reasons why we haven’t found a way to cover all Americans, it may be important to note that nations with universal health coverage tend to have a more cohesive sense of national identity. The United States though, is ethnically, racially, economically, and geographically quite diverse. It is more difficult for Americans to accept the notion that we should protect the health and well-being of all of its citizens.
In North Berkshire, for the past 17 years, Ecu-Health Care has been the primary outreach and enrollment site for all of the state health insurance programs. Since the Massachusetts health reform law was passed in 2006 with its expanded income guidelines for public health insurance programs, the individuals we serve now come from a broader socio-economic spectrum. Some individuals work for employers who do not offer access to health benefits, some are self-employed, and some have been laid off as a result of the economic downturn. An individual is only one job or one divorce away from being uninsured.
Many residents we have helped, even since the Massachusetts law was implemented, have expressed feeling uncomfortable when first enrolling in a public health insurance plan. One woman, a divorced single parent who worked two part-time jobs, shared: "I hate being here and receiving government assistance, but this is the only way I can afford health coverage for me and my son." Just being in our office was an affront to her dignity. In contrast, no one over age 65 has ever expressed feeling uncomfortable about being enrolled in Medicare, there is no cultural stigma attached to a program for which everyone is eligible.
It has been said that politics is the process for determining who gets, what, when, where, how, and why. The Supreme Court decision will be very much a political decision, reflecting the justices’ values and cultural beliefs as much as it will be an interpretation of the federal government’s legal authority to require that citizens be covered by health insurance.
The significance of the upcoming Supreme Court decision cannot be overstated. The court’s decision will help determine if more than 32 million uninsured Americans will have access to affordable health coverage and protection from financial harm when sick or injured. Their decision will also help determine if we as a nation value the principle that we should protect the health and well-being of all Americans and that individuals, like the woman above, can receive health coverage with support from the government -- with no loss of dignity.
Charles Joffe-Halpern is the executive director of Ecu-Health Care in North Adams.