In the play Waiting for Godot by Samuel Beckett, Godot never arrives, but the entire play is consumed with hand-wringing about what might happen if he did appear. In the case of health reform and the Affordable Care Act, there is similar hand-wringing over the Supreme Court decision about the fate of health reform, although we know the answer WILL arrive soon - and certainly by the end of June.
What are the possibilities for a Court decision on health reform and what might the impact be in each case?
1. The most negative prediction is that the Court strikes down the whole Affordable Care Act. Since much of the Act has nothing to do with the most controversial aspect under debate -- the mandate that everyone buy health insurance -- this option is presumed to be fairly unlikely.
2. A more likely outcome is that the individual mandate itself will be struck down, and along with it the guaranteed issue and community rating provisions, leaving the State exchanges, the Medicaid expansion and other features of the law intact.
3. The most optimistic option is that the Court upholds the entire Affordable Care Act.
What's at stake for you?
If the entire Act is declared unconstitutional, you could lose several benefits that have already been implemented:
You could also lose the opportunity, once health reform is fully implemented in 2014, to choose a health plan through a state exchange (although some states like California, New York and the State of Washington would likely go ahead with the exchanges anyway) and with that loss, a revival of the high cost of individual insurance plans and the chance of being rejected for coverage.
The law without the mandate
What if only the individual mandate is overturned? There is a lot more to the Affordable Care Act than just the individual mandate. But most economists and business analysts predict that health care costs could increase, because the uninsured would continue to use the system as a last resort, shifting the costs to those of us who are covered. Unless Congress required health plans to accept all applicants, you would once more be in jeopardy of being rejected for coverage if you have ever visited a doctor.
There are, however, a number of ways to get around the overturning of the individual mandate. States could implement their own mandates, like Massachusetts did under Governor Romney; there could be penalties for late enrollment; there could be larger subsidies to entice people to enroll; states could require people to enroll by automatically enrolling them and forcing them to opt out if they don't want insurance.
Whatever way the Court decision goes, the ultimate future of health reform will be dependent on you -- and who wins the Presidency and the Senate in November. Stay tuned.
An earlier version of this blog was posted at www.healthinsurance.org:
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