WASHINGTON — Some are already anticipating the Supreme Court’s ruling on President Barack Obama’s health care law as the “decision of the century.” But the justices are unlikely to have the last word on America’s tangled efforts to address health care woes. The problems of high medical costs, widespread waste and tens of millions of people without insurance will require Congress and the president to keep looking for answers, whether or not the Affordable Care Act passes the test of constitutionality. With a decision by the court expected this month, here is a look at potential outcomes:
Q: What if the Supreme Court upholds the law and finds Congress was within its authority to require people to have health insurance or pay a penalty?
A:The clear winners if the law is upheld would be uninsured Americans, estimated at more than 50 million. Starting in 2014, most could get coverage through a mix of private insurance and Medicaid. Republicans would keep trying to block the law. Obama would feel the glow of vindication for his hard-fought health overhaul. The nation would still face problems with health care costs, requiring changes to Medicare that neither party has explained squarely to voters.
Q: What if the court strikes down the entire law?
Taking down the law would kill a costly new federal entitlement before it has a chance to take root, but that still would leave the problems of high costs, waste and millions uninsured. Some Republicans in Congress already are talking about passing anew the more popular pieces of the health law. But the major GOP alternatives to Obama’s law would not cover nearly as many uninsured.
Q: What happens if the court strikes down the individual insurance requirement but leaves the rest of the Affordable Care Act in place?
A: Individuals 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 to 30 percent.
Q: What if the court strikes down the mandate and also invalidates parts of the law requiring insurance firms to cover people regardless of medical problems?
A: Many fewer people would get covered, but the health insurance industry would avoid a dire financial hit. That would prevent a jump in premiums, but it would leave consumers with no assurance that they can get health insurance when they need it — the major problem that the law was intended to fix.
