Soon after passage of the United States’ health care reform act, I wrote a charticle for Americas Quarterly describing the implementation of the law. Today the Supreme Court upheld the insurance reforms of the  Affordable Care Act in their entirety.  This means that the U.S. now in fact joins some of the other countries in the Americas (including Canada, Chile, Colombia, Costa Rica, and Mexico) that have sought to broaden access to health care for all—and is yet again proving how we are a leader in some of the most pressing issues confronting society in the twenty-first century.

From the beginning, it was clear that this was a political case.  It was brought by Republican attorneys general and governors as a challenge to the signature achievement of a Democratic Congress.  From the beginning, most legal scholars gave the lawsuit little chance of success.  The majority of federal appellate courts, including distinguished conservative judges, rejected the challenges.  The Supreme Court has—to its great credit—demonstrated that it remains committed to the rule of law.  It is troubling that the Court used this occasion to limit the ability of the federal government to condition participation in the Medicaid program on compliance with program requirements. 

The ramifications of this decision for many cooperative federal-state programs are far reaching and will be litigated for years, but may turn out to be quite limited.  But in the end, this is a great day for millions of Americans who will gain access to health care because of this decision.  It is time for the states and the federal government to move forward expeditiously with implementing the ACA.   Thousands of lives literally depend on it.

Timothy Jost holds the Robert L. Willett Family Professorship at the Washington and Lee University School of Law and writes about health policy and law.