Kyriacou: Big victory for public health

The much-anticipated Supreme Court decision to uphold the entirety of the individual mandate and most of the Medicaid expansion central to the Patient Protection and Affordable Care Act, moves our country closer to solving one of our most pressing social and economic problems — health care — and is a significant public health victory.

Today's historic decision maintains the momentum already under way across the country to reform our health care system by changing the way we deliver and finance health care services so that we can improve the health of our population. With this decision, the United States falls in line with the rest of the industrialized world — and many developing countries — in recognizing the importance of increasing access to health care for all citizens.

Some specifics: The individual mandate has been upheld as a tax rather than a legal mandate to purchase something. Those who do not purchase health insurance will have to pay more in taxes starting in 2014. The goal of this tax is to encourage people who do not have insurance (but still use the health system inefficiently, for example by going to the emergency room for nonemergent issues) to purchase insurance, pay regular premiums and use more appropriate levels of care.

More affordable insurance plans will be available, fewer restrictions on eligibility will be allowed, and subsidies will be provided for those who cannot afford health insurance. 

This strategy — with both economic and social underpinnings — will reduce the numbers of uninsured, bring people into care sooner, improve health outcomes and use resources more efficiently.

It's true that concerns remain regarding how effective the tax for not purchasing health insurance will be on bringing people into the system. However, while there may be some within the coveted "young and healthy" (i.e., less costly) group that will opt to pay the tax instead of purchasing health insurance, we shouldn't minimize the power of the law to encourage people to do the right thing. Furthermore, we can look with hope at the experience of Massachusetts, where the rate of uninsurance fell dramatically following the passage of their individual mandate.

Allowing the federal government to move forward with the Medicaid expansion will increase access to care to millions of vulnerable people with incomes above the poverty line; however, the Supreme Court also ruled that states choosing not to participate in the expansion cannot be penalized. While states certainly need autonomy to make budgetary decisions that are reflective of their individual situations, this decision will exacerbate already wide state-by-state variations in Medicaid coverage.

Overall, today's ruling by the Supreme Court keeps health care reform on solid ground, and moves us closer to a more rationale, viable, efficient and effective health care system.

Corinne Kyriacou, PhD, is an associate professor and director of the master of public health program at Hofstra University in Hempstead.