Supreme Court's decision on health care reform law expected Thursday
Published: Thursday, June 28, 2012
Updated: Thursday, June 28, 2012 09:06
WALNUT CREEK, Calif. - The ultimate judicial ruling on President Barack Obama's health care reform law has come down to Thursday, the final day of the U.S. Supreme Court's release of opinions for this term.
The decision will affect millions across the nation.
Here is what is happening and some of the issues involved.
Question: What's happening with the national health reform law tomorrow?
Answer: The U.S. Supreme Court is expected to issue its long-awaited decision about the constitutionality of President Obama's landmark legislation around 7:15 a.m. Pacific Time.
Q: What might the court do?
A: It could throw out the law entirely, declare it all constitutional, or reject one portion such as the mandate that most Americans obtain health insurance or the planned expansion of the federal Medicaid program for low-income people, known as Medi-Cal in California.
Q: Will the court definitely issue a decision Thursday?
A: No. It could decide to postpone a ruling and either hear more arguments next term or conclude that it doesn't have the authority to rule until 2014 when the mandate to obtain health insurance goes into effect. However, many experts consider a delay a long shot and believe the court will issue an opinion Thursday.
Q: If the entire law is overturned, how will it affect me?
A: The law contains consumer protections already affecting millions of people that may be eliminated if it is ruled invalid, including:
_Help for seniors who hit a Medicare prescription drug coverage gap known as "the doughnut hole."
_The elimination of lifetime caps on health insurance benefits.
_Free annual wellness visits for Medicare recipients and free preventive services such as mammograms and colonoscopies.
_Insurance company rebates. These are required when insurers fail to spend at least 80 percent of premiums on medical care and quality improvement, rather than salaries and other administrative costs. Nearly 1.9 million Ca1ifornians will receive $73.9 million in rebates this summer, averaging $65 per family.
_A requirement that beginning in 2014, insurers accept all people, regardless of pre-existing health problems.
Q: Would all of the law's major provisions disappear if it is ruled unconstitutional?
A: No. California has passed laws implementing some changes so they will remain in effect no matter what the Supreme Court decides. These include:
_Young adults will be able to remain on their parents' health insurance policies up to age 26.
_Insurers can no longer reject children under 18 because of their health problems.
_New health insurance policies must cover maternity services beginning Sunday.
_ Insurers can no longer cancel people's coverage when they become ill because of unintentional misrepresentations on their applications.
Q: Will California programs be jeopardized if the law is overturned?
A: Yes. California has moved aggressively to implement the law. Programs that would be at-risk include:
_Low-Income Health Program: More than 400,000 low-income, mostly childless adults are receiving coverage through interim programs in 47 counties. These people are to be transferred to Medi-Cal when it expands in 2014. But if the expansion is overturned, funding may not exist to continue the program.
_Pre-Existing Condition Insurance Plan: Nearly 11,000 people are covered under this plan set up for those whose health problems make it difficult, if not impossible, to obtain insurance. This program, funded through the national health reform law, was to last until 2014 when insurers could no longer reject people based on their medical condition. These people may lose coverage if the law is overturned.
_California Health Benefit Exchange: The state plans to open a marketplace in 2014 where many consumers could choose a health plan and determine whether they qualify for subsidies. It is not clear if the exchange could exist if the subsidies and mandate to have insurance are eliminated.
Q: What happens if the court leaves much of the law intact, but throws out the mandate to have insurance?
A: The Obama administration argued that if this key provision is overturned, the court should also remove the requirement that insurers accept people with pre-existing medical conditions and refrain from charging them higher premiums. Without an influx of healthy people into insurance pools, the administration said, it would be too costly to force insurers to accept all of the sickest people. That could cause premiums to skyrocket.
Experts disagree about whether the marketplace, known as the exchange, could exist under such circumstances. Some note that California lawmakers could enact the state's own insurance mandate, or impose incentives and penalties to spur people to obtain coverage. But others note that if the federal subsidies to help people afford insurance are eliminated, California cannot afford to replace them.