High court’s options on health law

Associated Press

WASHINGTON

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.

Here is a look at some potential outcomes:

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 Republican candidates for president and lesser offices are calling for repeal of the law.

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.

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 still would be entitled to such assistance under the law’s remaining provisions.

If the individual mandate is struck, the law’s Medicaid expansion still would cover millions more low-income people.

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?

A. Many fewer people would get covered, but the health-insurance industry would avoid a dire financial hit.

Insurers would be able to continue screening out people with a history of medical problems.

Q. What happens if the court throws out only the expansion of the Medicaid program?

A. Throwing out the expansion would severely limit the law’s impact because roughly half of the more than 30 million people expected to gain health insurance under the law would get it through the expansion of Medicaid, the federal-state health insurance program for low-income people.

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 least likely, based on what justices said during the arguments. No justice seemed inclined to take this path.

It remains at least possible that if the justices have trouble coming together on any of the other options, they simply could decide not to decide the big issues.