Public health reacts to Supreme Court's ACA ruling: 'Surprised and then ecstatic'

by Kim Krisberg

For me, there were few better places to hear about today's 5-4 Supreme Court ruling upholding the Affordable Care Act and its individual insurance mandate than at a meeting of the American Public Health Association (APHA). Here in Charlotte, N.C., for APHA's Midyear Meeting, I was surrounded by hundreds of public health practitioners, researchers and advocates as we all watched the magnified scroll of Scotusblog.com, anxiously waiting for the decision.

At 10:08 a.m., the blog declared: "The individual mandate survives as a tax."

That was when the cheers (and tears) began. You could feel the collective sigh of relief as smiles and hugs took over for the days — weeks and months — of nervous hand-wringing and dire predictions. As Gene Matthews of the Network for Public Health Law said, it was a "breathtaking day." For folks at the APHA meeting, the Supreme Court decision not only meant that millions of Americans would now have access to insurance and care, but that the law's $15 billion Prevention and Public Health Fund would remain — at least for today. (The Supreme Court decision doesn't protect the landmark fund from congressional efforts to eliminate it entirely or shift its monies to nonhealth-related activities — efforts that many advocates predict will continue.)

“In upholding these essential reforms, today’s decision marks tremendous progress towards reshaping our health system into one that saves the lives of at least 44,000 people who die annually simply because they do not have health insurance that could keep them healthy," said APHA's Executive Director Georges Benjamin in an APHA news release. “While we celebrate this major public health victory, we must work to ensure the law reaches its full potential. Specifically, we must continue to protect the Prevention and Public Health Fund, a sound, long-term investment in the future of our nation’s health."

And yet in typical public health fashion, celebration quickly transitioned into the task at hand for public health folks: implementing provisions of the ACA and making the case that public health and prevention are fundamental components to achieving better health at lower costs. Here are just a few reactions from attendees at the APHA meeting:

"It is an amazing day," Susan Polan, APHA's associate executive director for public affairs and advocacy, told me. "It is more than 100 years in the making. We will be able to make a difference in millions of lives...There's still much to do and we're looking forward to making sure everyone has access to the care they need."

"Initially, I'm overjoyed," said APHA President-elect Adewale Troutman, former public health director for the city of Louisville, Ky. "We've won a battle, but there's an ongoing conflict...as a nation, we still don't guarantee health as a human right. This is a step in the right direction, but we have a long way to go."

"I was surprised and then ecstatic," said David Reyes of Public Health Seattle-King County. "Now, how do we get the message out about what the ACA means for communities and families?"

"It means we have a lot of work to do before the elections because so many people don't understand (what the ACA does) and its implications," said Alexandra Garcia, an associate professor at the University of Texas-Austin School of Nursing and member of the Texas Public Health Association.

"I'm very happy," said Nicole Hollingsworth of Montefiore Medical Center and a member of the Public Health Association of New York City. "It's in tune with the needs of the American public."

Go here for a good round-up of reactions to the ruling from both supporters and opponents. To read the ruling itself and analysis, visit scotusblog.com.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.