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Since President Barack Obama signed the Affordable Care Act into law a year ago this month, we've heard endless partisan bickering about repeal efforts, legal challenges and fairness.

But we've heard little about how the law is already helping secure the future of all Americans. To understand how, one need only reflect on another seminal day in health care history, July 30, 1965, when President Lyndon B. Johnson signed Medicare and Medicaid into law in Independence, Mo.

As Johnson left the library, where he presented former President Harry S. Truman and his wife, Bess, the first Medicare cards to honor Truman's unsuccessful effort to establish a national health insurance plan two decades earlier, a young newspaper reporter thanked the president "on behalf of my mother."

Although misunderstood, Johnson's reply was prophetic: "I think you should thank me on behalf of yourself."

People assume Johnson was referring to the day the journalist would have his own Medicare card. But as former secretary of health and human services, I know Johnson meant that, without Medicare and Social Security, the young newsman's quality of life would be diminished. After all, if he had to pay his mother's health care bills, he might have a tough time owning a house, buying a second car or sending his children to college.

Twenty-six states are challenging the constitutionality of the new health care law because it compels all Americans to have qualified coverage starting in 2014. As that case and others move forward, it is important to remember how profoundly Medicare and Social Security altered the lives of senior citizens and middle-class families.

No longer are seniors, who devoted their working lives to building this country, dependent on their children for access to health care or for financial security.

Provisions of the law already in effect hold similar promise. They allow children to remain on their parents' plans until they turn 26, eliminate lifetime and annual insurance caps, prohibit insurers from dropping people who become ill, provide free preventive care under new plans and require coverage for children with pre-existing conditions. When the remaining reforms are implemented in 2014, consumer protections and patient responsibility will grow even stronger.

Three federal judges have upheld the law. But two have declared all or part of the measure unconstitutional, arguing that Congress exceeded its authority in requiring Americans who can afford coverage to purchase it. The Supreme Court will ultimately settle the question.

But for those who dislike the requirement, here's a question: Do our emergency rooms have the right to turn away people who show up with no or lousy insurance? Of course not. Yet those of us who have good insurance are paying for millions of people, many of them hardworking parents struggling to put food on the table, who visit our hospitals, clinics and doctors' offices without adequate coverage.

Cost-shifting isn't fair. It wasn't right in President Franklin Roosevelt's day, and he died regretting his failure to establish a national health insurance plan along with Social Security. It was wrong in Truman's time, but he couldn't overcome opponents who resurrected the dire warnings against "socialized medicine" that doomed Roosevelt's vision.

And it wasn't fair in 1993 when President Bill Clinton dispatched me, as secretary of health and human services, to advocate for universal health care in Detroit. A small business owner there said all her employees had health insurance. I congratulated her for doing the right thing, but then she explained her company didn't cover its employees. They were all on generous plans of spouses who worked in the auto industry.

That is classic cost-shifting. Today, to subsidize those plans, we pay more than $1,000 more for an American car than a Japanese car.

The debate over health care reform boils down to whether government ought to expand its role or leave millions of Americans to pay the hidden taxes in insurance premiums.

Truman and Johnson knew Medicare and Medicaid would be wise investments because no private-sector entity was clamoring to care for the elderly and the poor. Today, Obama believes our government - already the biggest player in health care - should lead the way in making sure those of us with health insurance don't have to continue paying for those of us who don't.

The Affordable Care Act is not perfect; Obama recognized that by supporting the Wyden-Brown bill, which would allow states to opt out of the federal reforms if they come up with something better. But when he signed the law a year ago, the country took a giant and long-overdue step toward equitable health and social policy.

Donna E. Shalala, former U.S. secretary of health and human services and former chancellor of the University of Wisconsin-Madison, is president of the University of Miami.