Thursday 13 June

29 June 2012

SECTION27 applauds yesterday’s decision by the United States Supreme Court to uphold the Patient Protection and Affordable Care Act. The Act is President Barack Obama’s comprehensive health care reform legislation. It has the potential to enable the United States to achieve a goal that all countries, including South Africa, should strive toward: universal health care that is both high quality and affordable. In other words, quality health care for everyone.

Amongst other things, the Act requires every American to purchase health care insurance, and provides subsidies to assist those who would otherwise be unable to do so. The Supreme Court decided on the constitutionality of this piece of the Act, known as the “individual mandate”, yesterday and upheld the entire law in a 5-4 decision. The full decision is available below.

The law will lead to millions of currently uninsured Americans becoming insured, and will spread the costs of health care over a wider group of people. Over time, the Act is expected to extend health care coverage to 30 million people that are currently uninsured.

For many people that were previously unable to purchase insurance, either because they couldn’t afford it or were excluded due to a disability or condition, the law will provide their first opportunity to purchase insurance. The law also expands Medicaid, the program through which families with low incomes and people with certain disabilities, access health care.

Speaking after the announcement from the Supreme Court, President Obama described some of the impact of the law “Insurance companies can no longer impose lifetime limits on the amount of care you receive. They can no longer discriminate against children with preexisting conditions. They can no longer drop your coverage if you get sick. They can no longer jack up your premiums without reason.”

The law, however, does have shortcomings. It does not, for example, create a nationalised health insurance option. Overall, the law is not nearly as ambitious as South Africa’s National Health Insurance is envisaged to be.

The question for South Africans becomes: what lessons should South Africa take from this? The United States and South Africa are very different; each has a unique legal system, history, economy and social context. But both countries share a desperate need to address the inequities in their health care systems.

Therefore, as we think about improving the quality of and access to our public health care system, and approach the development and implementation of National Health Insurance, we can take inspiration from what has just occurred in the United States. The United States has shown that it can pass comprehensive health care reform legislation, and defend it in court, in terms of a constitution in which the word “health” does not even appear. With this in mind, we can ask another important question: what more can South Africans do with section 27 of our Constitution, which opens with this inspiring promise: “everyone has the right to have access to health care services”?

Enquiries: Contact John Stephens at 011 356 4100 or


National Federation of Independent Business et al v. Sebelius, Secretary of Health and Human Services, et al