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From 2014.igem.org
Published: June 14, 2012
How the Supreme Court Could Rule on the Health Care Law
The Supreme Court will issue a decision this month on President Obama’s
2010 health care law. The court is considering a series of questions to
determine whether the law, or parts of it, will survive. Related Article »
2010 health care law. The court is considering a series of questions to
determine whether the law, or parts of it, will survive. Related Article »
1. Is it too soon to consider this case?
The Anti-Injunction Act says that taxes cannot be challenged in court until
they are first levied. The justices will decide if the health law’s penalties,
which will not be due until 2015, can be considered a tax.
they are first levied. The justices will decide if the health law’s penalties,
which will not be due until 2015, can be considered a tax.
Try again later
The door would be left open for
a challenge later on, but the law
would continue to go into effect.
a challenge later on, but the law
would continue to go into effect.
2. Is the individual mandate constitutional?
The mandate requires most people to have health insurance or pay
an annual penalty. Opponents of the law say the requirement to buy
a product or service is not within the federal government’s powers.
an annual penalty. Opponents of the law say the requirement to buy
a product or service is not within the federal government’s powers.
Carry on
If the mandate is upheld,
it will take effect as
planned in 2014.
it will take effect as
planned in 2014.
3. How much of the law will have to be cut?
Two of the law’s major provisions — health insurers must take all applicants and cannot
charge them different rates based on health — rely on the mandate to help offset costs. Congress
did not include an explicit “severability” clause in the health law, which is sometimes
used to say what parts of a law survive if other parts are found unconstitutional.
charge them different rates based on health — rely on the mandate to help offset costs. Congress
did not include an explicit “severability” clause in the health law, which is sometimes
used to say what parts of a law survive if other parts are found unconstitutional.
If the mandate is struck down, it would be up to Congress to retool the law to ensure the remaining rules don’t trigger a “death spiral” of soaring premiums as all but the sickest flee the market. During oral arguments in March, liberal justices indicated they preferred cutting as little as possible and leaving any necessary changes to Congress.
How the outcome could affect:
People
People who do not want to buy health insurance would not be penalized if they don’t. Premiums could be higher in the individual market.
Insurers
This is a nightmare outcome for insurers, who fear the burden of covering sicker people without a large pool of healthier people to offset the cost.
Health care providers
The law has spurred structural changes for health providers since 2010, and many of those changes are here to stay even if portions of the law are not. Some hospitals have prepared for more patients by hiring doctors and upgrading computer systems. There would be some uncertainty until it becomes clear how Congress may react.
States
The state insurance exchanges required by the law rely on the mandate to calculate rates and attract a pool of users. States could choose to enact their own laws that require or encourage residents to buy insurance before they need it.
What stays and what gets cut
The mandate
Individual mandate
Most Americans must have health insurance or pay an annual penalty.
Bans on discrimination
Guaranteed issue
Insurers must accept all applicants, regardless of health.
Community rating
Insurers cannot charge different premiums based on health status or demographic characteristics.
Consumer provisions
No rescinding coverage
Insurers cannot stop covering peple who become sick.
No lifetime limits
Insurers cannot impose lifetime dollar amounts on coverage.
Preventive care at no cost
Insurers must cover some services, including immunizations, contraceptives and mental health screening, without copays or deductibles.
Expanding coverage
Medicaid expansion
This provision was considered separately by the court. It would expand Medicaid to an estimated 16 million low-income Americans.
State exchanges
With federal grants, states must �build clearinghouses for health insurance options.
Employer mandate
Employers with at least 50 employees must offer group-rate insurance or pay penalties.
Pre-existing condition coverage
Insurers must cover children who have a pre-existing condition. A federal program offers coverage until 2014 for some adults who haven’t been insured because of pre-existing conditions.
Coverage for young adults
Young adults can stay on their parents' plans until age 26. An estimated 2.5 million people have used this coverage.
Medicare prescription drug discounts
Spans the “doughnut hole” gap in coverage with rebates and discounts.
Other provisions
Tax credits for individuals
Families and individuals with income up to 400 percent of the poverty line get subsidies to help pay for insurance.
Tax credits for small businesses
Businesses exempt from the employer mandate get assistance in providing insurance.
Community health centers
Several hundred clinics have received grants for construction projects.
