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It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve. Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care. However, challenges to affordability and cost control persist. Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right. (Am J Public Health. Published online ahead of print February 14, 2013: e1-e4. doi:10.2105/AJPH.2012.301180).

It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve.

Recent evaluations of the California Health Service Plan (CHSP) confirmed that financing health care through a single government payer can provide universal coverage—while saving significantly on health care spending—to a degree unparalleled by alternative approaches. Public ownership of the delivery system can further provide authority and accountability for critical reforms that improve the population's health and quality of care, including coordination of the delivery system.

This article analyzes how the Free Trade Area of the Americas (FTAA) would likely exacerbate critical threats to health in the Americas, from the perspectives of public health and human rights. These threats include crises in access to health care, water, and other vital human services; reemerging but preventable fatal diseases; the advance of AIDS; and biohazards. Disparities in power, wealth, health spending, and infant mortality, that undermine equity between and within nations, are documented and analyzed. A case study from Peru proposes that further market liberalization would widen inequalities in health and health care. Major arguments for and against trade liberalization in health care are presented. Under the FTAA, countries' domestic regulations, including those proven effective in advancing and protecting public health, could be challenged in international trade tribunals as unnecessary barriers to trade. Assigning regulatory decisions to trade tribunals violates the democratic obligations and rights of local, state, and national elected officials to protect public health. Addressing health crises is a high priority for the Americas and requires effective, cooperative international efforts.

Global trade and international trade agreements have transformed the capacity of governments to monitor and to protect public health, to regulate occupational and environmental health conditions and food products, and to ensure affordable access to medications. Proposals under negotiation for the World Trade Organization's General Agreement on Trade in Services (GATS) and the regional Free Trade Area of the Americas (FTAA) agreement cover a wide range of health services, health facilities, clinician licensing, water and sanitation services, and tobacco and alcohol distribution services.