The endorsement by the United States Supreme Court of a key provision in President Barack Obama’s health reform law requiring most individuals to purchase health insurance or pay a penalty, is a progressive decision. As all provisions in the law go into effect, it is bound to strengthen the call for a non-profit universal health care system in America. That the majority verdict delivered by the Chief Justice and four liberal judges chose to lean to the left in a cliffhanger case is a watershed moment in U.S. constitutional history. To those who have campaigned for tax-based health coverage for all, the new law may still fall short, but what it does provide is health protection to millions of uninsured Americans through more affordable insurance choices. It also prevents insurers from refusing to cover people with pre-existing conditions. In spite of such progressive features, the law is not universal in its coverage, exempting prisoners, undocumented aliens, and some poor families. Four years ago, the agenda for the U.S. presidential election virtually centred around health reform, and the Obama presidency has weathered the fierce backlash from Tea Party and Republican conservatives. The legal denouement has now vindicated the President as he pursues a re-election bid, and sustained much of the Patient Protection and Affordable Care Act of 2010.

For sheer scale, President Obama’s health reform evokes comparisons with Franklin Roosevelt’s New Deal. Despite Thursday’s ruling, though, it faces challenges. These arise from the court’s rejection of a portion of the law that requires States to use more federal funds to protect the health of less affluent citizens through the Medicaid programme. Importantly, the principle on which the health reform law has survived is the power of the government to levy a tax (in this case, on those who are eligible but do not take out health insurance). The Affordable Care Act also stipulates the percentage of funds that insurance companies must spend on actual care, thus capping administrative costs. These aspects are of particular interest to India, which has a fast-growing profit-seeking health and insurance industry, and is simultaneously trying to formulate a tax-funded universal health coverage plan over the next five years. A Planning Commission panel here has submitted its report calling for regulatory structures to standardise health care, with a contracted-in role for the private sector. Unlike the U.S., and in spite of the impoverishing levels of out-of-pocket payments for healthcare incurred by citizens, health reform has not become a central issue in Indian politics. As Americans celebrate their constitutional victory, it is a moment for India to think of its own universal health system.

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