The U.S. Supreme Court is expected to rule today on the constitutionality of the Affordable Care Act, but it almost certainly will not be the last word on the nation'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 probably still require Congress and the president to keep looking for answers. Here is a quick look at six possible outcomes from the court, and what each might mean:
1 What if the Supreme Court upholds the law and finds that Congress has the 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. GOP-led states that have resisted creating health insurance markets under the law would have to comply. 2 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, but it would still leave the problems of high costs, waste and tens of millions of uninsured people.
Some Republicans in Congress have discussed trying to revive the more popular parts of the legislation.3 What if the court strikes down the requirement that everyone must have insurance but leaves the rest of the law in place?
A. People wouldn't have to carry insurance, but insurers would have to accept applicants with pre-existing conditions; cover children on parents' plans until they're 26; and limit what they charge their oldest and sickest customers. Premiums could jump 30 percent.4 What if the court strikes down the mandate and invalidates parts that require insurance companies to cover people regardless of medical condition, and limit how much some are charged?
A. Insurers could continue screening out those in poor health. That scenario would probably prevent a sudden jump in premium prices but would also leave many with no assurance they could get coverage.5 What happens if the court throws out only the expansion of Medicaid?
A. That would limit the law's impact a lot because roughly half of the more than 30 million people expected to gain coverage under the law would gain it through Medicaid.6 What if the court punts, deciding it's too early for a constitutional challenge?
A. That would be the least conclusive outcome, and is also the least likely, based on what justices said during oral arguments. No justice seemed inclined to take this path, which involves the court's consideration of a technical issue.