March 30, 2012 -- After hearing three days of heated arguments this week regarding key provisions of the Affordable Care Act, the nine justices of the Supreme Court will cast their initial votes today. Their decisions may change before the final ruling expected by the end of June, but in the meantime, the country is now left to wait and wonder about the law’s ultimate fate.
Here, WebMD answers some frequently asked questions about the Supreme Court case, breaking down a number of possible ways in which the court could rule, and the potential effects of those decisions.
Health Care Reform Decision
The Supreme Court has upheld the Affordable Care Act. Understand the key issues.
Could the whole law be overturned? If so, what happens?
Yes, one possibility is that the Supreme Court justices will decide to toss out the entire law.
“If the entire law is overturned, we go back to the way things were before the law took effect in March 2010,” says Anthony Wright, executive director of Health Access, a California-based health care consumer advocacy coalition.
That means the expansion of both private health insurance and Medicaid would be eliminated, and that the roughly 32 million Americans who were expected to gain health insurance in 2014 would remain uninsured. “It would be a tremendous loss of expansion of the coverage we were expecting,” says Linda Blumberg, senior fellow in the Urban Institute’s Health Policy Center.
As for the millions of people who have already gained health insurance as a result of health reform, they would lose that coverage. That includes the 2.5 million young adults who are now able to remain on their parents’ health plan until age 26, as well as the nearly 50,000 Americans with pre-existing health conditions who gained coverage through the government’s Pre-Existing Condition Insurance Plans (PCIPs).
Other benefits already in effect could be lost as well, including:
Small business tax credits to companies with 25 or fewer employees that offer health insurance to workers
No more lifetime limits on health insurance spending
Review of unreasonable insurance rate increases
The requirement that insurance companies spend at least 80% of the money they collect on medical expenses
In addition, says David Lipschutz, policy attorney for the Center for Medicare Advocacy Inc., already-implemented structural changes to Medicare that are intended to slow rising costs would be lost. That includes new arrangements in which hospitals and doctors team up to better coordinate care, as well as reforms to the way in which health care providers are paid that emphasize quality over the volume of services provided.
How quickly would new benefits gained under the law go away?
Exactly how people would be impacted by the law being overturned would vary across the country, experts say. According to Wright, “Insurance plans have adapted to meet certain consumer protection standards under the health reform law, and would have to abide by the contracts they’re in now.” When the time comes for those plans’ annual renewals, however, most insurers would likely revert to their old ways.