LATER this month, the Supreme Court will rule on the Obama administration’s health care law, the Affordable Care Act, deciding whether to uphold or strike down the entire law, or to keep some provisions. No matter the decision, the political ramifications in this election year will be big.
But experts on health care policy say the practical effect of the court’s decision will probably be less earth-shattering than some people think. If the court takes what many observers believe will be the most likely route and strikes down the individual mandate — the requirement that virtually everyone purchase insurance — many more currently uninsured people are still likely to receive health coverage, they say.
Even if the law is struck down entirely — which could happen if the court decides that the other provisions are too intertwined with the mandate — many experts say that some changes the law has already set in motion will continue, probably more slowly, but possibly at a more urgent pace in reaction to the elimination of the federal law.
Gail Wilensky, a health economist who headed Medicare and Medicaid during the administration of the elder President Bush suggested that, while the individual mandate seems vulnerable to being ruled unconstitutional, striking down the entire law seems “highly unlikely, and to my way of thinking, highly undesirable, because I think it’s unnecessary.”
And if the law is upheld? More people will get coverage, but significant problems in the health care system will remain. Chief among them is the high cost of medical care.
“I think much of the transformation of the health care delivery system is moving forward, regardless of the court action,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation in New York. “How do we get more efficient? How do we keep people out of hospitals? People are kind of gearing up for this. That’s going to continue. Obviously, it will continue at a faster pace if some of the payments for quality and efficiency in the law continue, but we are already beginning to see a slowdown in hospital costs nationally.”
If the individual mandate is eliminated, but the exchanges remain, significant numbers of uninsured people are likely to purchase insurance anyway, said Amy Lischko, who served in Mr. Romney’s administration when he was governor and helped craft the Massachusetts health care overhaul. “PEOPLE are still going to purchase the insurance because it’s a better deal than before,” said Dr. Lischko, now an associate professor at the Tufts University School of Medicine.
Still, some warn that the longer-term consequences of striking down the individual mandate could be more significant.