By Ricardo Alonso-Zaldivar
The Associated Press
The Obama administration plans to move ahead with major parts of the president's health care law if its most controversial provision does not survive, according to veteran Democrats closely involved with the legislation.
Even if the requirement that nearly every U.S. resident have health insurance is declared unconstitutional, the remaining parts of the law would have far-reaching impact, putting coverage within reach of millions of uninsured people, laying new obligations on insurers and employers, and improving Medicare benefits even as payments to many service providers get scaled back.
The White House says President Barack Obama is confident the whole law will be upheld when the court issues its ruling in the next week or two, but officials will be ready for any outcome.
"We do believe it's constitutional, and we ... hope and expect that's the decision the court will render," senior adviser David Plouffe said Sunday on ABC.
Nevertheless, the Obama administration will move ahead to implement major elements of the law if the individual coverage requirement is struck down, two senior Democrats said. One is a leading Democrat familiar with the administration's thinking, the other a high-level Capitol Hill staffer. The two Democrats spoke on condition of anonymity to avoid appearing to be out of step with the administration's public stance.
Because the law's main coverage expansion does not begin until 2014, there would be time to try to fix serious problems that losing the individual coverage requirement may cause for the health insurance industry.
Surviving parts of the law would "absolutely" move ahead, the congressional official said. A Congress mired in partisan trench warfare would be unable to repeal or amend what's left of the law, allowing the administration to advance. Much of the money for covering the uninsured was already provided in the law itself.
"Legislatively we can't do a thing, and we are going to move full speed ahead," the official said.
How the Supreme Court will decide is unclear. It may uphold the law, strike it down entirely or do something in between. Skeptical questioning by the court's conservative justices during oral arguments this spring has fueled speculation that the court may invalidate the so-called individual mandate.
Opponents say the requirement that individuals have coverage is unconstitutional, that the federal government can't tell people to obtain particular goods or services.
Supporters say the mandate is a necessary component of a broader scheme to regulate health insurance, which is well within the powers of Congress. By requiring people to carry health insurance or pay a fine, the law seeks to broaden the pool of people with coverage, helping to keep premiums affordable.
If the mandate is struck down, that would still leave in place a major expansion of Medicaid, the federal-state safety net program for low-income people.
The Medicaid expansion was originally estimated to account for about half the more than 30 million people slated to get coverage under the law. Without a mandate, the number would be smaller but still significant.
Federal tax credits to help middle-class people buy private health coverage would also survive, as would new state-based insurance markets.
Overturning the mandate alone could have harmful consequences for the private insurance market. Under the law, insurers would still have to accept all applicants regardless of health problems, and they would be limited in what they can charge older, sicker customers.
As a result, premiums for people who directly buy their own coverage would jump by 15 percent to 20 percent, the Congressional Budget Office estimates. Older, sicker people would flock to get health insurance but younger, healthier ones would hold back.
To forestall such a problem, the administration asked the court - if it declares the mandate unconstitutional - to also strike down certain consumer protections, including the requirement on insurers to cover people with pre-existing health problems.
If the individual mandate is struck down by itself, the remaining parts of the law will still have far-reaching effects.