UNIVERSAL MEDICARE: Americans supporting the ACA attend a gathering outside the U.S. Supreme Court in Washington, D.C. on June 28 (ZHANG JUN)

U.S. President Barack Obama must have breathed a sigh of relief when the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA) on June 28.

The decision is good news for Obama and his campaign team. However, if he loses the election, the ACA's future will be hard to predict.

Much-needed reform

The ACA, initially passed through Congress in 2010, is a plan to expand health insurance to more Americans. According to the U.S. Congressional Budget Office, it could potentially cover more than 30 million people who are currently uninsured in the United States.

The United States needs such a law. Statistics show that in 2010, medical insurance covered 84.7 percent of Americans, leaving at least 47.2 million Americans without medical insurance. "Such a statistic can be considered as a shame of the United States, because the country has the most developed medical industry in the world, which creates one sixth of the nation's GDP and has spread all over the world," said Xu Tongwu, a senior research fellow with the Institute of American Studies at the Chinese Academy of Social Sciences to Beijing Review.

The United States has an urgent need to carry out the reform. Aging baby boomers born after World War II are reaching retirement age. And the country's healthcare spending growth is exceeding the growth rate of the country's economy. Some Americans who don't have medical insurance choose to go to emergency rooms, because, according to U.S. laws, hospitals cannot refuse treatment to patients in emergencies. Often patients are unable to pay for the treatment they receive, putting financial pressure on hospitals.

In fact, U.S. leaders were considering conducting a healthcare reform over 100 years ago. Xu said the idea can be traced back to Theodore Roosevelt in the early 20th century.

Because of the sluggish U.S. economy, the number of people with a low income is increasing. "The ACA benefits 10 percent of Americans, who mostly are the poorest in the country," said Guo Xiangang, Vice President of the China Institute of International Studies.

The ACA is a big credit to Obama. Obama is fortunate to have fulfilled the goal of pushing forward the U.S. healthcare reform, which most previous Democratic presidents, like Bill Clinton, failed to do, Xu said. "This will be an important political legacy of Obama," Xu stressed.

Stern opposition

Once the ACA is implemented, the medical insurance coverage will expand to about 95 percent of Americans. However, a recent poll showed about 49 percent of the respondents opposed the reform plan, while only 38 percent supported it.

The ACA seems to be a good plan to benefit more Americans. Why is there so much opposition? Actually, most opponents didn't oppose the idea of expanding health insurance, but disapproved of the way to do it.

The court declared support for a key piece of the law—the individual mandate, which will become effective in 2014. The individual mandate states that all Americans must have health insurance or else pay a fine, making buying health insurance compulsory. The law makes people feel they are losing freedom to make their own choice.