WASHINGTON – Today’s expected Supreme Court health care ruling almost certainly will not be the last word on the nation’s tangled efforts to address health care woes.
A look at potential outcomes:
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. The clear winners if the law is upheld and allowed to take full effect would be uninsured people in the United States, estimated at more than 50 million. Starting in 2014, most could get coverage through a mix of private insurance and Medicaid, a safety-net program. Republicans would keep trying to block the law. They hope to elect Mitt Romney as president, backed by a GOP House and Senate, and repeal the law, although their chances of outright repeal would seem to be diminished by the court’s endorsement.
The nation still faces huge problems with health care costs, requiring major changes to Medicare that neither party has explained squarely to voters.
Q. On the other hand, what if the court strikes down the entire law?
A. Taking down the law would kill a costly new federal entitlement before it has a chance to take root and develop a clamoring constituency. But that still would leave the problems of high costs, waste and millions of uninsured people.
Some Republicans in Congress already are talking about passing anew the more popular pieces of the law if it’s thrown out.
But the major GOP alternatives to Obama’s law would not cover nearly as many uninsured, and it’s unclear how much of a dent they would make in costs.
Some liberals say Medicare-for-all, or government-run health insurance, will emerge as the only viable answer if Obama’s public-private approach fails.
Q. What happens if the court strikes down the requirement that everyone must have insurance, but leaves the rest of the Affordable Care Act in place?
A. People would have no obligation to carry insurance, but insurers would remain bound by the law to accept applicants regardless of medical condition and limit what they charge their oldest and sickest customers.
Studies suggest premiums in the individual health insurance market would jump by 10 percent to 30 percent.
Experts debate whether or not that would trigger the collapse of the market for individuals and small businesses, or just make coverage even harder to afford than it is now.
Q. What happens if the court throws out only the expansion of the Medicaid program?
A. That would limit the law’s impact severely, because roughly half of the more than 30 million people expected to gain insurance under the law would get it through the expansion of Medicaid, the federal-state health insurance program for low-income people.
But a potentially sizable number of those low-income people still might be eligible for government-subsidized private insurance under other provisions.
Private coverage is more expensive to subsidize than Medicaid.
Q. What happens if the court simply punts?
A. 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 says federal courts may not hear challenges to taxes, or anything that looks like a tax, until after the taxes are paid.
So if the justices have trouble coming together on any of the other options, they could agree with the appeals court and simply put the whole thing off.