Tuesday, March 17, 2015

Does the Affordable Care Act: Healthcare as a Human Right?

Did the Americans who were in favor of passage of the Affordable Care Act in 2010 believe that access to healthcare is a human right? Did the Americans who opposed “Obamacare” reject that assumption and thus favor treating health insurance as a commodity? We can look at political and economic indications to reach an answer.

According to a report by the U.S. Department of Health and Human Services, based in turn on Gallup survey data from early March 2015, 16.4 million people had gained health-insurance coverage since the Affordable Care Act went into effect. The figure includes people who signed up for Medicaid under the law. “When it comes to the key metrics of affordability, access and quality, the evidence shows that the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result,” said Sylvia Mathews, the Health and Human Services Secretary at the time of the report.[1]  That the uninsured rate had fallen to 13% from 20% at the beginning of open-enrollment in October 2013 supports the secretary’s conclusion. 

The strongest gains were from the states whose governments expanded Medicaid. “Those states had an average baseline uninsured rate of 18% in early March, compared with 23% for those that didn’t.”[2] This suggests that an upturn in the economy did not account for all of the change. The overall increase is large enough that the upswing in the economy is not likely to be the sole cause, according to Rachel Garfield, a researcher at the Kaiser Family Foundation.[3]

Furthermore, the difference between the two zones of states (to borrow a catchy term from Europe) points to an ideological condition wherein Americans as a whole were not convinced that access to medical care is a human right, and thus a responsibility of government. Modern federalism, wherein the member-states and federal institutions both have a share of governmental sovereignty, accommodates “being on the fence” concerning whether a benefit is properly a commodity or human right.  To the extent that the benefit is available regardless of state, that extent of being insured from the federal government can be treated as a human right, whereas the amount of benefit left up to the states indicates the extent to which Americans do not consider health-care to be a human right.

Admittedly, a federal base-level combined with various amounts of contribution from member-states does not necessarily mean that “We the People” are on the fence on whether a benefit is a human right. A person could be in favor of more state authority because of an excess at the federal level, for instance, while firmly believing that the benefit at hand is a human right. Clearly, other measures are needed in the assessment.

Another indication of the extent to which Americans as a whole consider health-care to be a human right is how close the percentage of uninsured is to zero. The uninsured rate of 13% for adult Americans and illegal immigrants in March 2015 tells us that health-care was not viewed as a full or established human right. Were access to medical care definitively regarded by “We the People” as a human right and the elected representatives representative of their constituents as a whole, the Federal Government would see to it that every American or even every resident of the U.S. has access to healthcare. This does not necessarily imply a single-payer system, though reliance on private insurance companies without subsidies for every poor person would be insufficient.

[1] Stephanie Armour, “Rate of Uninsured Falls Sharply Under Health Law, Report Says,” The Wall Street Journal, March 17, 2015.
[2] Ibid.
[3] Ibid.