Supreme Court Ruling on ACA Expected Thursday

Megan Brooks

June 25, 2012

June 25, 2012 — The US Supreme Court's ruling on the Affordable Care Act (ACA), the sweeping signature healthcare reform legislation of the Obama Administration, is expected on Thursday, June 28, the final day of the court's 2011-2012 term.

Court-watchers had been expecting the decision at the end of June, and many predicted that it would be left until nearly the end of the session because of "sharp disagreement" noted by Justice Ruth Bader Ginsberg in a speech earlier this month.

Most observers agree that there are 5 possible outcomes for the decision:

  1. Strike down the individual mandate that requires Americans to buy health insurance or pay a penalty as unconstitutional, but uphold the rest of the law. Many view this as the most likely outcome. (Read Medscape's coverage of day 2 oral arguments before the Supreme Court, which examined whether the individual mandate is constitutional.)

  2. Strike down the individual mandate as well as 2 insurance reforms considered inseparable from the individual mandate: guaranteed issue of health insurance coverage (meaning that insurers cannot deny anyone coverage on the basis of preexisting conditions) and community rating for premiums (this would keep insurers from charging high rates because of preexisting conditions).

  3. Strike down the entire law. This would happen if the court deems the individual mandate unconstitutional and cannot be separated from the rest of the ACA, known as the severability issue. (Read Medscape's coverage of day 3 oral arguments, which partly examined the severability issue.)

  4. Uphold the individual mandate but strike down the dramatic expansion of the Medicaid program as unconstitutional. (Read Medscape's coverage of day 3 oral arguments that examined this issue.)

  5. Uphold the entire law. Most observers consider this and the fourth scenario to be the least likely, especially in the wake of Justice Ginsberg's recent comments and discussions during oral arguments in March.

A decision upholding the entire law would be a major victory for Democrats and President Obama. A decision against part or all of the law would not only be a major blow to Democrats and President Obama but also ratchet up pressure on Republicans to come up with their own legislation to deal with the growing healthcare crisis.

If the law is allowed to stand, in part or in whole, Republican presidential candidate Mitt Romney and GOP congressional leaders have indicated that they would repeal the ACA if they get control of Congress and the White House in November elections.


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