It seems as if the entire nation is holding its breath for the Supreme Court’s health care ruling — the presidential candidates, governors of virtually every state, insurers with billions at stake, companies large and small and countless millions of Americans concerned about their own medical care and how they’ll pay for it. Still, Thursday’s expected ruling almost certainly will not be the last word on the nation’s efforts to address health care woes. A look at potential outcomes:
Q: What if the Supreme Court, despite justices’ blunt questions during public arguments, upholds the law and finds Congress was within its authority to require most people to have health insurance or pay a penalty?
A: That would settle the legal argument but not the political battle.
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. Republican-led states that have resisted creating health insurance markets under the law would have to scramble to comply, but the U.S. would get closer to other economically advanced countries that guarantee medical care for their citizens.
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.
Obama would feel the glow of vindication for his hard-fought health overhaul, but it might not last long even if he’s re-elected.
Q: On the other hand, what if the court strikes down the entire law?
A: Many people would applaud, polls suggest.
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.
Employers and insurance companies would have no obligation to keep providing popular new benefits such as coverage for young adults until age 26 on a parent’s plan. Medicare recipients with high prescription drug costs could lose discounts averaging about $600.
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.
Q: What if the court strikes down the mandate and also invalidates the parts of the law that require insurance companies to cover people regardless of medical problems and that limit what people can be charged.
A: Many fewer people would get covered, but the health insurance industry would avoid a dire financial hit.
