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High court has options on health care law

Friday - 3/30/2012, 10:19am  ET

By MARK SHERMAN and RICARDO ALONSO-ZALDIVAR
Associated Press

WASHINGTON (AP) - 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 Barack 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.

A look at six potential outcomes, from the simplest to the most complicated possible rulings:

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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, including the insurance requirement, an expansion of Medicaid and a ban on private insurers' denying coverage to people with pre-existing health problems.

The political wrangling, however, probably would continue as candidates for Republican presidential nomination and lesser offices are calling for repeal of the law.

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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. One popular provision allowing young adults to stay on their parents' insurance until age 26 has added nearly 2.5 million people to the coverage rolls, at no cost to taxpayers.

But there's no escaping America's double-barreled problem of excruciatingly high health care costs and many uninsured people, more than 50 million according to the latest estimates.

Whether it's dealing with the federal deficit, retirement security for seniors or even the Pentagon budget, elected officials would still have to confront health care at nearly every turn.

Congress would get to roll the ball up the hill again.

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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. That would make it more expensive for the government to subsidize premiums, although millions of middle-class people would still be entitled to such assistance under the law's remaining provisions.

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, no longer allowed to cherry-pick the healthy to keep costs down. They would also be barred from imposing higher premiums on people in poor health and limited in what they could charge older adults.

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.

Experts debate whether or not such a cost spike would trigger the collapse of the insurance market for individuals and small businesses _ or just make coverage even more expensive than it already is.

"Without a mandate the law is a lot less effective," said MIT economist Jonathan Gruber, who advised the Obama administration and, earlier on, then-Massachusetts Gov. Mitt Romney, who put such an insurance mandate in that state's health care law. "The market will not collapse, but it will be a ton more expensive and cover many fewer people."

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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?

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