As the advent of the Supreme Court’s decision nears, speculation is increasing about what the justices will decide on the constitutionality of the individual mandate that requires everyone to buy health insurance Some are saying the Supreme Court ruling is going to be the “ruling of the century.” The Supreme Court can choose to strike down part or all of the Affordable Care Act.
Predictions are that the decision will not be the final word in efforts to tackle all the elements of health care in America. The issue of escalating costs and millions of people without health insurance will have to be addressed, whether or not the Affordable Care Act is declared constitutional.
Some of the nation’s largest insurers, including United Health and Humana, have already promised to continue to cover young adults up until age 26 on their insurance plans no matter what the Supreme Court decides.
But the justices are unlikely to have the last word on America’s tangled efforts to address health care woes. The problems of high medical costs, widespread waste, and tens of millions of people without insurance will require Congress and the president to keep looking for answers, whether or not the Affordable Care Act passes the test of constitutionality.
The Washington Post in an article today offered probable outcomes of both possible results if the law is declared constitutional and if it does not pass as constitutional.
What happens 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? There would be a political battle, but the legal argument would be settled.
The clear winners if the law is upheld and allowed to take full effect would be uninsured people in the United States, estimated at more than 50 million.
Starting in 2014, most could get coverage through a mix of private insurance and Medicaid, a safety-net program. Republican-led states that have resisted creating health insurance markets under the law would face a scramble to comply, but the U.S. would get closer to other economically advanced countries that guarantee medical care for their citizens.
Republicans would keep trying to block the law. They will try to elect presidential candidate, backed by a GOP House and Senate, and repeal the law, although their chances of repeal would seem to be diminished by the court’s endorsement.
On the other hand, what if the court strikes down the entire law?
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 and millions uninsured. And spreading the costs of providing health care to the nation would rest with fewer covered individuals, which contributes to high costs and less incentive for insurers to create cost saving methods of health care delivery systems.
Some Republicans in Congress already are talking about passing the more popular pieces of the health law.
But the major GOP alternatives to Obama’s law would not cover nearly as many uninsured, and it’s unclear how much of a dent they would make in costs. Some liberals say Medicare-for-all, or government-run health insurance, will emerge as the only viable answer if Obama’s public-private approach fails.
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, although some of the largest providers have said they will keep this benefit. Medicare recipients with high prescription drug costs could lose discounts averaging about $600.
Without the mandate, the choice for young adults to go without insurance until they are sick or for those who need regular medical attention, such as those with diabetes and other illnesses, puts further strain on the system as they use the emergency rooms as their provider of last resort. This is more costly than preventative or continuing care offered by health insurance.
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