MSH and Results for Development Commend Supreme Court Health Care Decision, Huge Step toward Universal Coverage

MSH and Results for Development Commend Supreme Court Health Care Decision, Huge Step toward Universal Coverage

{Photo credit: deltaMike via FlickR.}Photo credit: deltaMike via FlickR.

Co-authored by Gina Lagomarsino, managing director for Results for Development Institute

Cross-posted on UHC Forward.

We welcome the United States Supreme Court decision to uphold President Obama’s sweeping health care overhaul. The Affordable Care Act (ACA) requires all Americans to have health insurance, which will dramatically increase both equitable access and the health of Americans.

It also adds the US to the growing list of countries on the path to universal health coverage.

US Affordable Care Act a good step forward

We have learned that countries must create systems that reflect their history and their current realities. In the US, this means improving upon a system dominated by private insurers that historically have been able to provide subjective and selective coverage – denying coverage or charging exorbitant premiums to those most in need.

To provide health care coverage for all in the US, it was critical that the ACA accomplish the following goals:

  1. Private insurers must be required to accept every patient regardless of pre-existing conditions.
  2. Everyone must be required to purchase health insurance – individual mandate.
  3. Insurers must provide an essential health benefits package.
  4. And finally, the government needs to provide subsidies to insurers for patients who can’t afford premiums.

These changes are expected to extend equitable access to people who have been caught in the middle --- those not poor enough to qualify for government insurance, but who couldn’t afford to buy a policy. The resulting lack of access to preventive and primary care services too often leads to costly hospital emergency room visits after chronic neglect of serious health problems.

In addition to mandating insurance coverage, the ACA requires essential health benefits that include high-impact, cost-effective services such as prevention and wellness services, primary care, and maternal, newborn, and child care. New insurance regulations also will make it harder for insurers to deny coverage for needed care – a relief even for middle class people who have had health insurance all along.

Extending equitable access to all and ensuring essential health benefits should go a long way to reduce the higher rate of preventable mortality in the U.S. compared to other high income countries.  The combination of equitable access and essential health benefits also provides a strong example for other countries seeking to align health spending and health impact.

The ACA is a step in the right direction. More work will need to be done to improve the distribution, quality and efficiency of health providers, community health facilities, and hospitals, and doctors and educate Americans about the benefits of purchasing health insurance.

Support for universal coverage continues to gain momentum

Around the world, countries as varied as Colombia, Ghana, India, Mexico and South Africa have begun implementing health systems reforms to improve access to health care and provide financial protection against catastrophic health care expenditures.  While none of their systems are perfect, these countries have made a commitment to improving the lives of their most vulnerable citizens.

In 2010, the World Health Organization released its annual report, “Health Systems Financing: The Path to Universal Coverage,” followed by World Health Assembly resolution 58.33 in May 2011, “Sustainable health financing, universal coverage and social health insurance.” The Assembly resolution called on UN member states to further develop their health financing system to guarantee access to necessary services while providing protection against financial risk.

Dr. Margaret Chan, Director-General of the World Health Organization, addressed this year’s Sixty-fifth World Health Assembly, saying, “Universal health coverage is the single most powerful concept that public health has to offer. Universal coverage is relevant to every person on this planet. It is a powerful equalizer that abolishes distinctions between the rich and the poor, the privileged and the marginalized, the young and the old, ethnic groups, and women and men.”

Yesterday’s ruling is a victory for Americans and helps the US move forward to ensure that health care is affordable, accessible, and appropriate for all.

Gina Lagomarsino is managing director of Results for Development Institute. Mrs. Lagomarsino focuses on health system design and financing. She leads work aimed at expanding health coverage in low and middle income countries, with a particular interest in how to create vibrant health markets that include high-quality, innovative private care providers that are accessible to people regardless of income.

Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.