ACA Reax, a View from Abroad: If a Law Passes at Home when you're not there, does it make a difference?

Affordable Care Act
By Nadia Sheikh

Like many other Americans yesterday, I was absolutely glued to my phone and the Internet, waiting to hear the U.S. Supreme Court's announcement on President Obama's health care plan, the Affordable Care Act (ACA) (also known as "Obamacare" by pundits).

The Court's decision was full of some unanticipated shifts -- ranging from the court's voting patterns -- to how they formed their decision on ACA's legality. It was also interesting to watch CNN alongside Pakistanis with very little interest or knowledge of the politicized nature of this health care plan. "Is it good or is it bad for you?" asked a family friend.

To be honest, I had to think about this for a bit. Yes, I'm a liberal and voted for Obama. Yes, I agree that universal health care is important initiative with too much backlog in the United States. Yes, it sucks not to have health care insurance (a predicament I've found myself in a few times in the past five years.  For instance, one does not want to end up in the ER with a fractured ankle -- a terrible experience I had my first weekend of college in 2005, resulting in several thousand dollars in costs for an 8 hour visit.


You can read elsewhere how the court ruled (5-4, with the conservative Chief Justice John Roberts voting with the liberals on the court), or the individual mandate would be upheld under the Commerce Clause, requiring US citizens to purchase their own health care, and if they cannot afford it, with the aid of subsidies and credits. Some articles rallied behind CJ Roberts for supporting a bipartisan plan, making the Supreme Court 'above politics.' An interesting article in The Atlantic even compared Roberts' to former CJ John Marshall's judicial activism in the pivotal case Marbury v. Madison (which I wrote about in an earlier post on judicial activism and the Pakistani Supreme Court).

My home state of Oregon's Medicaid plan will likely serve as a model for other states, because it has experimented with the extension of health insurance to the poor, making them healthier and happier. One of Oregon's senators, Ron Wyden, who I previously interned with in 2008, has also been a huge proponent and supporter of health care reform even before it was fashionable.  The bottom line with ACA, I think, is that it helps those without health insurance get coverage, and helps children with pre-existing conditions. President Obama's press conference last night clarifies these points, which I found incredibly confusing at first.

Honestly, when I was skimming articles, tweets, and news coverage, I just tried to figure out how it actually does affect me. I don't have health insurance here in Pakistan. Back in the US, my parents have added me back to their plan, which covers me until the age of 26. In other words, I have six more months of health insurance coverage stateside. Starting in 2014, if someone like myself fails to get health care insurance, it will be considered a penalty or tax.  If anything, this signifies how much I need a job with health care insurance, as well as the start of adulthood.


Nadia Sheikh is a 2009 Georgetown grad who just finished her Master’s in International Relations at the London School of Economics. You can find more of Nadia’s writings at nadiainpakistan.blogspot.com, or follow her on Twitter (@sheikhandbake).