Universal Health Care Coverage in the United States: Is It “Slip Slidin

With passage of the Affordable Care Act, affordable health insur-ance for all Americans is in sight, yet politics could cause it to slip away. A resurgent Republican Party will mount a sustained chal-lenge at the federal and state levels, but the new Congress will not bring about the Affordable Care Act’s repeal. More likely, the law’s effectiveness could be undermined by congressional restrictions on its implementation, underfunding of programs to improve public health and train more primary care physicians, and resistance by many states to its mandates. Congress could instead seek a bipar-tisan accord on improving the law, such as by giving the states more options, but this is unlikely in the current polarized environment. This debate is occurring even as the United States faces an unprecedented crisis in access to health insurance coverage, affect-ing nearly every demographic group, yet the uninsured have largely become an afterthought. Medical professionalism requires a com-mitment to improving access to care, and physicians could play a crucial role in informing lawmakers that providing all Americans with affordable health care coverage is a moral and medical imper-ative to prevent needless suffering and death, and must not be allowed to slip away. Ann Intern Med. 2011;154:118-120. www.annals.or