health care reform
While certain repercussions seem evident should all or some of the Affordable Care Act vanish, there are eight possible outcomes from the court ruling; some more likely than others, and some with monumental consequences. (Shutterstock photo)

Thirty million people stand to benefit from the Affordable Care Act (ACA), a health care reform law currently under scrutiny by the United States Supreme Court. Should the law be struck down, provisions such as “donut hole” prescription coverage for seniors could  disappear, sending shock waves through communities already reliant on the programs.

The constitutionality of the Affordable Care Act is being debated – the Supreme Court must decide if federally mandated health care exceeds Congress power. Up for discussion are issues regarding penalizing states that do not go along with the health care reform, if the individual mandate is considered a tax, and whether it is possible to strike down a portion of the law, such as the individual mandate or the Medicaid expansion, while salvaging the rest of it.

While certain repercussions seem evident should all or some of the ACA vanish, according to Ken Klukowski, legal analyst, there are eight possible outcomes from the court ruling; some more likely than others, and some with monumental consequences.

  • Court proceedings get postponed: “The Supreme Court could hold that the individual mandate is a tax for purposes of the AIA, and that it strips federal courts of jurisdiction for the next two years,” Klukowski explains. The Anti-Injunction Act (AIA) prohibits courts from making a ruling prior to a tax being paid to the IRS. In this instance, all lawsuits against ACA would be dismissed and refilled in 2014 after penalties have been collected. This scenario is unlikely. The AIA only refers to lawsuits brought by persons, not sovereign entities like states. Even if the AIA did apply to states, it would only apply to the tax penalty itself, not the individual mandate.
  • ACA upheld with majority option: Majority option means five Supreme Court justices unanimously uphold something with one opinion, and that “something” goes on to set a new precedent, binding to the constitution. Should the health law be upheld with majority option, a questionable model is set forth, one where the government has unarguable authority to force private citizens to enter into contracts with private organizations. Only specific provisions in the Bill of Rights, like owning a gun or free speech, would provide any protection from the government invading people’s lives. This scenario is unlikely, however, due to adamant assertion of government restriction from Justice Anthony Kennedy, whose vote would be needed for majority option.
  • ACA upheld with plurality option: Plurality option means five votes in favor of the ACA — just not all for the same reason. This would mean the individual mandate would be considered exclusive to health care, preventing the government from imposing future mandatory requirements in other areas of private citizens’ lives. Klukowski gives this scenario a 20 percent chance of likelihood.
  • Individual mandate struck down and completely severed from law: It is possible that the individual mandate will be struck down and separated from the 450 other sections of the ACA. This would mean chaos within the health care system, allowing people to pick up health insurance when they were sick and then to drop it as soon as they no longer needed it. Should this scenario occur, health care costs would go into what Justice Sonia Sotomayor called a “death spiral”, and most insurance companies within the country would be bankrupt after a decade.
  • Medicaid expansion struck down and completely severed from law: Instead of eliminating the individual mandate, the Supreme Court may strike down Medicaid expansion, deciding it is unconstitutional to withdraw Medicaid funding from non-compliant states while still taxing the citizens of that state for the federal program.
  • Narrow partial severability: In this situation, the individual mandate is struck down along with the community-rating provision and guaranteed-issue provision. This would also mean disaster for the health care industry; however, the decline would be far more gradual than if the individual mandate were struck down alone. “Then we’re back to the status quo of people being denied because they have preexisting conditions, or being told because they have cancer they’ll be charged 26 times that of a healthy person,” said to USA Today Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute in Washington and supporter of the law.
  • Broad partial severability: Like the narrow partial severability scenario, this outcome strikes down the individual mandate, community-rating and guaranteed-issue provision, but also sends with it other parts of the law like the employer mandate and state-based insurance programs. This scenario is possible, but it would require the Justices to go through section by section and approve or disapprove each section of the law.

The Supreme Court’s decision will affect millions of people in the nation.

With the Affordable Care Act gone, the benefits lost will be insurance coverage for dependents under the age of 26 on parents’ insurance plans, prescription cost assistance for the elderly, elimination of co-payments for preventative screenings, a cease to lifetime limitations on coverage, and a provision that prevents people from being excluded from insurance based on pre-existing health conditions.

Without reform, John Sheils and Randall Haught of the Lewin Group estimate 51.6 million people in the U.S. would be uninsured. With reform, that number drops down to 20.7 million. If the ACA is kept but the individual mandate is struck down, 28.5 million people would be uninsured and a premium hike of approximately 12.6 percent would be seen.

The Obama administration will not likely give up on health care reform, regardless of the Supreme Court ruling sometime in the upcoming weeks. While small or large steps will be made based on the Court’s decision, ultimately, health care reform’s future may rest with the party that wins the White House and Congress in November 2012.

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