From here, it is difficult to imagine that the NHS depends one iota as much on the performance of non-profit organisations as the Affordable Care Act, frequently called "Obamacare", does in the US. The ACA is not free health care, but coverage provided through multiple private, for-profit, non-profit and government providers - and, for the vast majority, decidedly not free.
With the mandate that every eligible American has to purchase or access health insurance coverage or pay a fine on their income tax bill, the confusing ACA structure is difficult to navigate - thus the federal government's funding of largely non-profit health insurance "navigators". With grant support from the Department of Health and Human Services, these sent staff to homeless shelters, soup kitchens, county fairs and street corners to help people navigate the state and federal health "exchanges".
Despite congressional investigations, these navigators are the unsung heroes of Obamacare for reaching people in need who were unaware, uninformed or simply intimidated by the complexity of signing up for health insurance on the exchanges. Ten million previously uninsured Americans signed up for health insurance for the first time, thanks to the navigators and other mechanisms, but tens of millions are still not covered.
The remaining uninsured and those who find the insurance too expensive will still be coming to non-profit-run health clinics, many funded by the federal government, and a panoply of 1,200 free clinics that offer basic health treatment.
Almost half of the states rejected the federal government's offer of massive subsidies to get them to expand eligibility from 100 per cent of the federal poverty line to 138 per cent for their Medicaid healthcare coverage for the poor, leaving significant numbers too wealthy for Medicaid but too poor to qualify for federal subsidies to purchase private insurance. The challenge in these states is significant.
One achievement of the ACA has been to create a number of non-profit, consumer-owned health insurance cooperatives, which have challenged the for-profit and mutual insurers in many states. These have beaten expectations, signing up 400,000 people in the first year. Round two of the Affordable Care Act begins on 15 November, but with only a three-month window to sign people up. Much non-profit navigational skill will be required.
Rick Cohen is national correspondent for the Nonprofit Quarterly in Boston, Massachusetts