Health Care Reform, Disparities, and the Supreme Court Decision

The Affordable Care Act (ACA) is a consumer-focused, market-based law. The Supreme Court's decision on June 28 affirmed that market–based solutions are a legitimate constitutional approach to U.S. health care policy. The Roberts-led majority supported the concept of choice, which is central to our society. This concept shaped the writing of the ACA and the solutions it offers to private individuals and the states.

Under the ACA, an individual is free to reject purchasing health insurance, and a state is free to reject participation in Medicaid. Freedom, however, comes with responsibility—but the "price" is often a matter of debate. The United States is still a young country learning to balance individual freedom and social responsibility.

Will a choice-based approach diminish health disparities?  I predict that the answer to this question is yes. But the ACA does not have explicit race- or ethnic-focused language, so how can the ACA decrease these and other disparities? By linking payment to the voice of the consumer, the ACA opens the pathway for all Americans to identify the barriers they encounter.  Furthermore, it does this with an emphasis on improving the quality of health care. There is overwhelming evidence that poor quality health care leads to health disparities. These disparities are not race-based; they are market-based. Low-quality health insurance plans for young workers in entry-level jobs create barriers to health care for these workers and their families, who may not receive the treatments they need. Insufficient or nonexistent insurance for near-retirement adults leads to delayed treatment and excess spending in the first few years of Medicare eligibility. People with chronic disease but inadequate plans may face insurmountable financial barriers to the care they need.

Title III of the ACA directly confronts these barriers to health care. By preserving freedom of choice, the Roberts-led decision preserves a pathway to quality health care in the United States and gives us hope that we can conquer health disparities. 

Click here to read more from Miles in her piece for the New American Media.

Toni P. Miles, MD, PhD, is director of the Institute of Gerontology and professor of epidemiology and biostatistics in the College of Public Health, both at the University of Georgia, Athens. She has served previously as Health and Aging Policy Fellow on the U.S. Senate Finance Committee and is the founding director of the Pennsylvania State University Center for Special Populations and Health. 


Her latest book, Health Care Reform and Disparities: History, Hype, and Hope (Praeger 2012), is available now!