US Efforts to Realise the Right to Health Through the Patient Protection and Affordable Care Act

Abstract

The political acceptance and policy implementation of the right to health long remained uncertain in the United States, leaving it until recently as the only developed nation without policies to realise universal health coverage. By reengaging longstanding debates on government obligations to secure the health of every American, the 2010 Patient Protection and Affordable Care Act (Affordable Care Act or ACA) draws on an internationally recognised conception of a human right to health, seeking to progressively realise the ‘highest attainable standard of physical and mental health’ through policies that ensure the availability, accessibility, acceptability, and quality of health care. With the US Supreme Court upholding the constitutionality of most key aspects of the Affordable Care Act, this precedent-setting decision has created an imperative for health care reform in the United States and a model for realising universal health coverage pursuant to the right to health. This article examines the evolution, implementation, and implications of US efforts to realise health-related rights through health care policy. In the evolution of norms for health, Part 2 examines the intertwined history of US development of a right to health in international law and implementation through national health care reforms. Culminating in the promulgation of the 2010 Affordable Care Act, Part 3 analyses how this national policy effort corresponds with the principles of the international right to health – even as it neglects any explicit recognition of the right to health. With the Affordable Care Act immediately challenged as a violation of the US Constitution, Part 4 looks to the first major challenges to the Affordable Care Act, analysing the Supreme Court’s decision on these challenges. As the Supreme Court has now largely upheld the government’s constitutional authority for health care reform, Part 5 considers the continuing challenges to the Affordable Care Act and the precedential impact of this decision on rights-based health reforms throughout the world. This article concludes with a hopeful assessment of the role of the United States as it moves progressively toward universal health coverage and frames an agenda for renewed American participation in global efforts to realise the highest attainable standard of health.