High court decision could change law's provisions already in effect

By David Lightman and Michael Doyle • McClatchy Newspapers | Posted: Sunday, April 1, 2012 12:00 am | (1) comments.

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WASHINGTON • The Supreme Court's historic health care decision, expected in June, has strong potential to jolt consumers, Congress, this year's political campaigns and the nation's health care industry.

Depending on the outcome, young adults who recently gained coverage could be dropped from their parents' plans. The insurance industry might have to jack up premiums. Political candidates will gain new talking points, and, in the most dramatic possibility — a repeal of the law — legislators would have to start over in tackling health care reform.

"All that has been done would have to be undone," said Len Nichols, the director of the Center for Health Policy Research and Ethics at George Mason University in Virginia.

After three days of Supreme Court oral arguments, almost anything seems possible.

While any decision is likely to be close, the justices sounded as if they could strike down the law's "individual mandate," which requires nearly everyone to obtain coverage by 2014 or pay a fine, as well as the directive that states expand Medicaid coverage. Although perhaps less likely, they could even kill the entire 2,700-page health care law.

"My approach would say, if you take the heart out of the statute, the statute's gone," Justice Antonin Scalia said during the arguments.

Should the court strike down the entire Patient Protection and Affordable Care Act, as 26 states urge, the immediate impact would be the sudden demise of dozens of provisions that already are in effect.

A temporary program that bars insurers from considering pre-existing conditions would be gone. So would the requirement that young adults up to age 26 be allowed to stay on their parents' policies, as well as certain breaks for Medicare prescription-drug beneficiaries.

Those provisions are popular, even with many Republicans, but the Democrats who wrote the health care bill have no precise strategy for reinstating them quickly.

"There (are) discussions quietly among some people about the what-ifs," said Sen. John Kerry, D-Mass., a senior member of the Senate Finance Committee, which has a key role in writing such legislation.

The most closely watched what-if involves the fate of the individual mandate.

"This is unprecedented. This is a step beyond what our cases have allowed, the affirmative duty to act to go into commerce," Justice Anthony Kennedy, who's considered a pivotal voice, suggested at one point last week.

Despite the uproar, most might not notice the mandate's disappearance.

Ninety-four percent of the population wouldn't have to purchase new insurance coverage or face the penalty, according to a study by the Robert Wood Johnson Foundation for Washington's Urban Institute, an independent research group. Older people already are covered through Medicare. Others would be exempt from the mandate or have insurance through employers or other programs.

But there are benefits to keeping the law intact, said the Urban Institute's Linda Blumberg, who led the analysis.

"While a small number of people would be directly affected by the individual responsibility requirement, the overall benefit to the population would be large," she said.

The insurance industry is concerned that the high court will overturn the mandate but keep other requirements intact.

Eight states tried to revamp insurance laws without a mandate in the 1990s.

"These reforms resulted in a rise in insurance premiums, a reduction of individual insurance enrollment and no significant decrease in the number of uninsured," said Karen Ignagni, the president and chief executive of America's Health Insurance Plans, the industry's trade association.

Independent studies have found that imposing new requirements without retaining the mandate could mean a dramatic rise in premiums. That could trigger an increase in the uninsured population, since fewer people are likely to buy coverage.

"You'd have fewer healthy people and more unhealthy people in the insurance pool," said Timothy Jost, a professor of law at Washington and Lee University. "Health insurance will become more expensive."

Posted in National on Sunday, April 1, 2012 12:00 am Updated: 9:20 pm. | Tags:

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