The Struggle to Achieve the Human Right to Health Care in the United States

Abstract

In 2010, the United States Congress enacted, and President Obama signed into law, the Patient Protection and Affordable Care Act (PPACA). Since the 1930s, legislators have passed several health care reforms, addressing the health care needs of specific populations in the United States, such as the very poor (Medicaid) and people over 65 years of age (Medicare). Nonetheless, in 2010, almost 50 million people – over 16% of the population – remained uninsured. Another 30 million were under-insured, for a total of 26% of the US population without adequate health insurance. Moreover, the US health care system was the most expensive in the world, and had relatively poor health outcomes compared to other countries. In short, the United States was overpaying for a fragmented health care system that failed to provide equitable, affordable, quality health care for all. The goals of the PPACA were to expand health insurance to millions of residents, end the worst abuses perpetrated by insurance companies, and control health care spending. While the PPACA has succeeded to some extent in meeting these goals, it has not achieved, nor did it ever envision, a fully universal and equitable health care system. Thus, despite the new reforms, the US health care system fails to conform to standards in international human rights law, which explicitly recognizes health care as a fundamental human right. This article takes a human rights lens to examine the shortcomings of the PPACA, made more evident during its implementation, as well as the potential for state-level alternatives to the PPACA market-based health care exchanges. It concludes that state-level human rights-based health care initiatives may be more successful than any action at the federal level in moving the United States toward universal and equitable quality health care.

Keywords: human rights, right to health, Patient Protection and Affordable Care Act (PPACA)