The U.S. Supreme Court is expected to issue its ruling this month on the constitutionality of the Affordable Care Act. Speculation is
that an announcement could come today or June 25, when court decisions are scheduled to be delivered. The ruling also might come Thursday or June 28. Ron Pollack, Executive Director of Families USA, who sat through the three days of oral arguments in March and has won two cases in front of the Supreme Court, said the outcome is difficult to predict. “I don’t have a clue what the court is going to do,” he said last week. Still, Pollack and others have outlined the following potential outcomes:
1) The entire law is tossed out. Loren Coppock, managing director of TrueNorth, an insurance brokerage firm in Cedar Rapids, said this scenario might be preferable than if separate portions, such as the individual mandate, are ruled unconstitutional. “If they throw the whole thing out, to some extent, we go back to life as we had it before,” he said, while insurance providers may voluntarily retain popular provisions. On the other hand, University of Iowa professor Keith Mueller, director of the UI-based Center for Rural Health Policy Analysis, said gridlock would likely escalate. “If the entire law is thrown out, it’s not easy to come back and enact even those things everyone agrees to,” he said.
2) Court only strikes individual mandate requiring all Americans to obtain health insurance. “The heart of this legislation is not the individual mandate,” Families USA’s Pollack said of the provision, calling it a tool to ensure insurance pools have enough young, healthy workers to support those who are not. The UI’s Mueller, however, called the mandate the “linchpin,” on which other provisions become affordable for insurance companies. In that case, the question becomes whether or not the mandate can be severed from the rest of the legislation, he said.
3) Medicaid expansion is tossed out; other portions stand. Iowa Medicaid Director Jennifer Vermeer estimates that 150,000 Iowans would be eligible for Medicaid under the expansion. Without the expansion, those low-income adults would not be eligible for Medicaid, she said. Pollack, whose nonpartisan group’s mission is to secure affordable health coverage for all Americans, said no court has invalidated Medicaid expansion in the program’s existence. “It would be precedent-shattering,” he said.
4) Court strikes down guaranteed issue and community rating provisions. The rules ensure coverage is not denied for pre-existing conditions or provided at a higher premium for older or unhealthy individuals. Wellmark Blue Cross and Blue Shield of Iowa has noted nothing will change in customers’ coverage as a result of the court decision, while UnitedHealthcare will continue coverage of preventive health care services, coverage of dependents up to age 26, lifetime policy limits, rescissions and appeals. TrueNorth’s Coppock said insurance companies, however, have not announced plans to provide new coverage for people with pre-existing conditions. That would prove expensive for companies, for example, if patients wait until they are diagnosed with cancer to obtain insurance, he said.
5) Entire statute is allowed to stand, expanding coverage to 30 million Americans. Darlene Schmidt, executive director of the Community Health Free Clinic in Cedar Rapids, said this would be the most encouraging scenario, but is just a starting point, as 17 million Americans would remain uninsured, including many Iowans. “Also, there are other unmet health issues such as coverage for dental and vision that are not included,” she said. “In some cases these are even bigger challenges for low-income (patients) as there are fewer opportunities to receive these services.”