An Expert’s View: The Supreme Court Health Care Ruling May Level the Playing Field

Prof. Margaret Barton-Burke, Ph.D., is the Mary Ann Lee Endowed Professor of Oncology Nursing at the University of Missouri-St. Louis. She has been a pioneer in breast cancer research, especially among African-American women. Her four decades on the front lines of nursing have afforded Barton-Burke firsthand knowledge of how the U.S. health care system works. In October Barton-Burke will be inducted as a fellow of the a fellow of the American Academy of Nursing. (Courtesy: UMSL)

TVC What was your reaction to the ruling? It seems many observers were expecting a different outcome.

Professor Barton-Burke My reaction was, “YES!” It really was. I am in support of this and was holding my breath. This is a big step for poor people, for underinsured people. It’s not just about paying for insurance. Maybe we can really change the health of our citizens in a way that we have not done for a very long time.

TVC To what degree is the ruling a win for the underinsured, specifically those African-Americans without adequate coverage or any coverage?

Professor Barton-Burke African-Americans have some of the worst health care outcomes. In general they get sicker younger, they die younger. In some cases, there are higher incidences of disease. Black women die more often from breast cancer than white women. They get it earlier than white women.

What I hope this will do is help us level the playing field.

TVC In general do health care providers (doctors, nurses) tend to favor the act or oppose it? Or, is the community of providers divided on the issue?

Professor Barton-Burke I think we were always divided opinion on this. What I see this bill does is actually strengthen the role of advanced practice nurses, like nurse practitioners and those with clinical doctorates. It’s in the bill that we will fill the gap in care. We have a primary care physician shortage right now.

Advanced practice nurses with similar expertise to physicians will be filling the gaps. I actually think this is going to be a great boon for advanced practice nursing, which is good for patients.

TVC What have you observed about impact of the provisions that have already gone in effect?

Professor Barton-Burke I can give an example from my research. I looked at white breast cancer survivors. All of them talked about not being able to change jobs. They didn’t feel they had the freedom to make a move because of pre-existing condition. People can now look for another job and not have this held against them.

TVC You’ve been involved in cancer research for 40 years. How does the Supreme Court ruling rank in terms of important events for American health care?

Professor Barton-Burke I think this is huge. I’ve always said that health care is broken. This is big regardless of whether it get repealed of not.

I’m a Pollyanna, but I’m also a realist. What’s going to happen when we institutionalize this? How are insurance companies going to deal with this?

How hospitals and insurance companies change their practices according to the mandates, only time will tell. I don’t know how they’re going to operationalize the law in such a way that they can continue to make money.

I’m so excited. We needed something like this in the U.S. for a very long time. I’m not for socialized medicine. This is step for equality in medicine.

Read more: The Supreme Court’s Affordable Care Ruling Is a Big Deal For African-Americans