ACA doesn't go far enough

The U.S. Supreme Court's disappointing decision may offer access to health care for some who lack coverage ("Reform moves ahead," June 29), but it also leaves millions of others completely out of the equation. In the Pledge of Allegiance, we recite the phrase "with liberty and justice for all." The Affordable Care Act fails to ensure that health care reform will provide either.

Whether the individual mandate is a fee or a penalty or a tax, it fails to address the structural inequities of a health care system that supports huge for-profit insurance companies. Regardless of what we call it, the money will go to maintain this arrangement, guaranteeing that health care costs rise, that insurers prioritize profits over care, and that deductibles, co-payments, and co-insurance continue to impoverish our family members and neighbors. Most Americans who are bankrupted by medical bills have health insurance. The Affordable Care Act does not address these structural problems.

Having all the states expand Medicaid to cover people with incomes at or below 138 percent of the poverty line would have been a step in the right direction. By permitting states to opt out, the Supreme Court voted to assure that millions of our impoverished neighbors continue to go without health insurance — and that all of us pay inflated health insurance rates to cover their emergency care.

Instead of the Affordable Care Act, I'd rather pledge to have a single-payer, not-for-profit system that includes everyone.

Lauren Siegel, Baltimore