WASHINGTON (AP) — The Supreme Court has several options in ruling on President Barack Obama's health care overhaul, from upholding the law to striking it down in its entirety. The court also could avoid deciding the law's constitutionality at all, if it finds the lawsuits challenging the law are premature.
Here is a look at six potential outcomes, from the simplest to the most complicated possible rulings >
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.
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.
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 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 keep screening out people with a history of medical problems, such as diabetes patients or cancer survivors.
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 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.
The law would effectively bring under Medicaid everyone making up to 138 percent of the federal poverty level. That works out to about $15,400 for an individual, $30,650 for a family of four. Most of those who would be added to the Medicaid rolls are low-income adults without children.
Q. What happens if the court decides that the constitutional challenge is premature?
A. The wild card, and least conclusive outcome in the case, involves the court's consideration of a technical issue. The federal appeals court in Richmond, Va., held that the challenge to the insurance requirement has to wait until people start paying the penalty for not purchasing insurance. The appeals court said it was bound by the federal Anti-Injunction Act, which is intended to facilitate tax collections and keep the government operating. That law says federal courts may not hear challenges to taxes, or anything that looks like a tax, until after they are paid.
Both the challengers and the administration have urged the justices to decide the constitutional issues now. But if the court were to take this path, most of the six hours of argument time, thousands of pages of legal briefs and ample legal fees devoted to this case would be wasted.
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