|By RICARDO ALONSO-ZALDIVAR and MARK SHERMAN, Associated Press|
With a decision by the court expected this month, here is a look at potential outcomes:
Q: What if the
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
Starting in 2014, most could get coverage through a mix of private insurance and
Republicans would keep trying to block the law. They will try to elect presidential candidate
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.
The nation still faces huge problems with health care costs, requiring major changes to
Q: On the other hand, what if the court strikes down the entire law?
A: Many people would applaud, polls suggest.
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 uninsured.
Some Republicans in
But the major
People with health insurance could lose some ground as well. Employers and insurance companies would have no obligation to keep providing popular new benefits such as preventive care with no copayments and coverage for young adults until age 26 on a parent's plan.
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 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. In any event, there would be risks to the health care system. Fewer people would sign up for coverage.
The insurance mandate was primarily a means to an end, a way to create a big pool of customers and allow premiums to remain affordable. Other forms of arm-twisting could be found, including limited enrollment periods and penalties for late sign-up, but such fixes would likely require congressional cooperation.
Unless there's a political deal to fix it, the complicated legislation would get harder to carry out. Congressional Republicans say they will keep pushing for repeal.
Without the mandate, millions of uninsured low-income people still would get coverage through the law's
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 they can charge older people?
A: Many fewer people would get covered, but the health insurance industry would avoid a dire financial hit.
Insurers could continue screening out people with a history of medical problems; diabetes patients or cancer survivors, for example.
That would prevent a sudden jump in premiums. But it would leave consumers with no assurance that they can get health insurance when they need it, which is a major problem that the law was intended to fix.
Obama administration lawyers say the insurance requirement goes hand in hand with the coverage guarantee and cap on premiums, and have asked the court to get rid of both if it finds the mandate to be unconstitutional.
One scenario sends shivers through the health care industry:
Q: What happens if the court throws out only the expansion of the
A: That severely would limit the law's impact because roughly half of the more than 30 million people expected to gain insurance under the law would get it through the expansion of
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
States suing to overturn the federal law argue that the
Q: What happens if the court decides that the constitutional challenge is premature?
A: The wild card, and least conclusive outcome in the case, probably also is the most unlikely, based on what justices said during the arguments.
No justice seemed inclined to take this path, which involves the court's consideration of a technical issue.
The federal appeals court in
So if the justices have trouble coming together on any of the other options they could simply punt.
The administration says it doesn't want this result. Yet such a decision would allow it to continue putting the law in place, postponing any challenge until more of the benefits are being received. On the other hand, it might give Republicans more ammunition to press for repeal in the meantime.
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