That would prevent a sudden jump in premiums. But it would leave consumers with no assurance that they can get health insurance when they need it, which is a major problem that the law was intended to fix.
Obama administration lawyers say the insurance requirement goes hand in hand with the coverage guarantee and cap on premiums, and have asked the court to get rid of both if it finds the mandate to be unconstitutional.
One scenario sends shivers through the health care industry: The Supreme Court strikes down the mandate only, and delegates other courts to determine what else stays or goes.
Q: What happens if the court throws out only the expansion of the Medicaid program?
A: That severely would limit the law’s impact because roughly half of the more than 30 million people expected to gain insurance under the law would get it through the expansion of Medicaid, the federal-state health insurance program for low-income people.
But a potentially sizable number of those low-income people still might be eligible for government-subsidized private insurance under other provisions. Private coverage is more expensive to subsidize than Medicaid.
States suing to overturn the federal law argue that the Medicaid expansion comes with so many strings attached it amounts to an unconstitutional power grab by Washington. The administration says the federal government will pay virtually all the cost and that the expansion is no different from ones that states have accepted in the past.
Q: What happens if the court decides that the constitutional challenge is premature?
A: The wild card, and least conclusive outcome in the case, probably also is the most unlikely, based on what justices said during the arguments.
No justice seemed inclined to take this path, which involves the court’s consideration of a technical issue.
The federal appeals court in Richmond, Va., held that the challenge to the insurance requirement has to wait until people start paying the penalty for not purchasing insurance. The appeals court said it was bound by the federal Anti-Injunction Act, which says that federal courts may not hear challenges to taxes, or anything that looks like a tax, until after the taxes are paid.
So if the justices have trouble coming together on any of the other options they could simply punt.
The administration says it doesn’t want this result. Yet such a decision would allow it to continue putting the law in place, postponing any challenge until more of the benefits are being received. On the other hand, it might give Republicans more ammunition to press for repeal in the meantime.