US HEALTHCARE - The Supreme Court is expected to issue its ruling Thursday morning on the challenge to the Affordable Care Act. Challengers insist that the health care law’s requirement that citizens carry health insurance exceeds the Congress’ commerce clause powers.
They also argue that the law’s expansion of Medicaid is an unconstitutional use of power over the states. They claim that the various pieces of the law cannot be taken apart, and have asked the Supreme Court to throw out the entire statute.
Those are indeed the most likely outcomes. But there are actually more like six plausible rulings, with varying consequences for the fate of health care reform. They are as follows:
Uphold
The Court could find that — whether as an exercise of commerce clause powers or taxing power — Congress is within Constitutional limits to penalize uninsured people who fail to purchase coverage. If, as expected, they also uphold the Medicaid expansion, then the law stands. No change. The legal dispute over the law will have yielded nothing.
Strike The Mandate
If the Court determines that the mandate violates the Constitution, it can “sever” the mandate from the rest of the law. The rest of the law would stand, and implementation of it would continue.
This outcome would leave it up to Congress and the states to deal with the “adverse selection” problem — without a mandate, experts and industry insiders believe young and healthy people would avoid purchasing insurance until stricken by illness or injury, leaving older, sicker people in the risk pool.
Premiums would spike and the market could ultimately collapse.
Some experts doubt the policy would completely fail. But lawmakers would be under intense pressure from the insurance industry to forestall the potential calamity. Since the law’s main provisions don’t take effect until 2014, Congress could pass a slightly different, constitutionally bulletproof version of the mandate, or some other incentive for everybody to purchase insurance.
States could pass their own mandates, like the one in Massachusetts. But either way the health care reform saga would enter a new chapter.
Strike The Mandate And Coverage Guarantee
Though the Obama administration obviously wants the Court to uphold the mandate, it has argued that if the justices throw it out, they should also throw out the measures ending insurance company discrimination against people with pre-existing medical conditions. This would avoid the adverse selection problem, but it would also hollow out the law. Instead of creating a universal health care system, it would instead be a program that provided subsidies to uninsured people who were healthy and interested enough to seek insurance. Congress and the states could seek to reanimate the law, but they wouldn’t be under as intense pressure from the insurance industry to do so. (Click here for the rest of this TalkingPointsMemo column.)
(Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight, and the debt limit fight. Read Brian regularly at talkingpointsmemo.com) -cw
Tags: Brian Beutler, healthcare, Obamacare, Supreme Court, individual mandate, Congress, President Obama, Constitution, healthcare reform
CityWatch
Vol 10 Issue 51
Pub: June 26, 2012