Health Care Reform:

How Supreme Court Rulings Could Impact Health Care

How quickly would new benefits gained under the law go away? continued...

States will have some flexibility, too. “If the whole law is overturned it’s up to [insurance] carriers and state regulators to decide what to keep in place and what not,” says Blumberg. Many states have legislation in place to enforce rules of the Affordable Care Act, which could help to maintain some of the benefits already gained, such as stronger insurance appeals processes or the requirement that insurers spend at least 80% of the premiums they collect on medical care.

Although there are limits to what states can do without federal guidance and funding, Wright adds: “I think there might be some states ... that will go forward with some [consumer] protections regardless of what the federal government does.”  

What if just the individual mandate is struck down?

If only the mandate is struck down, Americans will no longer be required to buy health insurance, but insurers would still be required to sell a plan to any and all customers, regardless of their health condition.

In this scenario, consumer protections already gained under the law will remain in place. The state-based health insurance exchanges -- online marketplaces where people will be able to shop and compare and buy an insurance plan -- will continue to be developed and will open for business by 2014.

Companies with more than 50 employees will still required to provide workers with insurance or pay a fine. And the federal government will still provide subsidies to help people who qualify pay for a health plan starting in 2014. The Medicaid program will expand to cover more people with low incomes.

What’s lost in this scenario?

Far fewer people would buy health insurance without the individual mandate. By some estimates, the number of uninsured Americans might only shrink by 8 million as opposed to the projected 32 million with the mandate in place.

In addition, there will be little incentive for healthy people to buy coverage since they can wait until they get sick to purchase insurance. That leaves mostly sick people in the insurance pool, and the cost of health insurance, as a result, is widely expected to rise.

Estimates of just how much costs could rise have varied. The Congressional Budget Office estimated a 10% to 20% rise in prices for plans sold on the state-based insurance exchanges. A recent RAND Corporation analysis found, however, that the cost for any individual could rise by only 2%.

There are also real-world examples, showing concern over high insurance prices without a mandate is more than theoretical. Experts point to states such as New Jersey and New York, where insurers are required to sell all customers a health plan, but no mandate to have insurance is in place. The result has been sky-high insurance costs that very few can afford. According to the Kaiser Family Foundation, in 2010 the monthly cost of an individual insurance policy was 69.3% higher in New Jersey than the nationwide average.