The arguments are done and the case has been
submitted, as Chief Justice John Roberts says at the end of every
Supreme Court argument. Now the justices will wrestle with what to
do with President Obama's health-care overhaul. They have a range of
options, from upholding the law to striking it down in its entirety.
The court also could avoid deciding the law's constitutionality at
all, although that prospect seems remote after this week's
arguments.
Here is a look at six potential outcomes, from the simpler to the
more complicated possible rulings:
Q: What if the Supreme Court upholds the law and finds Congress
was within its authority to require most people to have health
insurance or pay a penalty?
A: A decision in favor of the law would end the legal fight and
allow the administration to push forward with implementing its
provisions over the next few years.
The political wrangling, however, probably would continue as
Republican candidates for president and lesser offices are calling
for repeal of the law.
Q: What if, on the other hand, the court strikes down the entire
law?
A: That would kill a costly new federal entitlement before it has
a chance to take root and develop a constituency of beneficiaries
and supporters, namely more than 30 million people who are supposed
to wind up with health insurance because of the law.
In addition, some parts of the law already are in effect and
would be rolled back.
Q: What happens if the court strikes down the individual insurance
requirement, but leaves the rest of the Affordable Care Act in
place?
A :Knocking out the requirement that Americans carry insurance
would not be the end of Obama's health-care overhaul. There's a lot
more in the 900-plus pages of the law.
But it would make the complicated legislation a lot harder to
carry out, risking more complications for a U.S. health-care system
already seen as wasteful, unaffordable and unable to deliver
consistently high quality.
Ten million to 15 million uninsured people who would have gotten
coverage under the law could be left out.
The cost of individually purchased private health insurance would
jump.
If the individual mandate is struck, the law's Medicaid expansion
would still cover millions more low-income people, mainly childless
adults.
And a host of other mandates would stay in place. Starting in
2014, medium-sized and large employers would be hit with fines for
not providing coverage to their workers.
Insurance companies would be required to accept people with pre-
existing medical problems.
If that happens, premiums in the individual health insurance
market would jump anywhere from 10 percent to 30 percent, according
to various forecasts from economists.
Q: What if the court strikes down the mandate and invalidates the
parts of the law that require insurance companies to cover people
regardless of medical problems and that limit what they can charge
older people?
A: Many fewer people would get covered, but the health insurance
industry would avoid a dire financial hit.
Insurers would be able to continue screening out people with a
history of medical problems, such as diabetes patients or cancer
survivors.
That would prevent a sudden jump in premiums. But it would leave
consumers with no assurance that they can get health insurance when
they need it, a major problem the law was intended to fix.
A related requirement limits premiums charged to older adults.
Currently people in their late 50s and early 60s can face premiums
as much as six or seven times higher than those charged to 20-year-
olds. The law says insurers may charge older adults no more than
three times what they charge younger ones.
Q: What happens if the court throws out only the expansion of the
Medicaid program?
A: Throwing out the expansion would severely limit the law's
impact because roughly half the more than 30 million people expected
to gain health insurance under the law would get it through the
expansion of Medicaid, the federal-state health insurance program
for low-income people.
The law would effectively bring under Medicaid everyone making up
to 138 percent of the federal poverty level. That works out to about
$15,400 for an individual, $30,650 for a family of four. Most of
those who would be added to the Medicaid rolls are low-income adults
without children.
But a potentially sizable number of those low-income people might
still be eligible for government-subsidized - though probably more
expensive - private insurance under other provisions of the law.
Private coverage will probably be more expensive for taxpayers to
subsidize than Medicaid.
Q: What happens if the court decides that the constitutional
challenge is premature?
A: The wild card, and least conclusive outcome in the case,
probably also is the least likely, based on what justices said
during the arguments. No justice seemed inclined to take this path,
which involves the court's consideration of a technical issue. The
federal appeals court in Richmond, Va., held that the challenge to
the insurance requirement has to wait until people start paying the
penalty for not purchasing insurance. The appeals court said it was
bound by the federal Anti-Injunction Act, which is intended to
facilitate tax collections and keep the government operating. That
law says federal courts may not hear challenges to taxes, or
anything that looks like a tax, until after they are paid.
It remains at least possible that if the justices have trouble
coming together on any of the other options they could simply decide
not to decide the big issues.
