Loss of insurance mandate wouldn't kill health law

By RICARDO ALONSO-ZALDIVAR Published: March 27, 2012
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WASHINGTON (AP) — President Barack Obama's health care law would not collapse if the Supreme Court strikes down the unpopular requirement that most Americans carry medical insurance or face a penalty.

The overhaul would lurch ahead, experts say.

But it would make an already complicated law a lot harder to carry out, risking repercussions for a U.S. health care system widely seen as wasteful, unaffordable and unable to deliver consistently high quality.

Premiums could jump for people buying coverage individually, and for small businesses. That's because other provisions of the law require insurance companies to accept people with health problems, and limit the premiums that can be charged to older adults.

Sooner or later, the dilemma of the nation's 50 million uninsured would land back on the doorstep of Congress.

During Tuesday's oral arguments, the Supreme Court's conservative justices fired off sharp, skeptical questions about the constitutionality of the mandate, fanning speculation that it may not withstand review.

Such an insurance requirement is unprecedented in federal law, but it is not the only lever for expanding coverage in Obama's legislation.

“The hyperbolic language that is being used about this is way over the top,” said economist Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush. The mandate “is important, but not that important. There are other strategies to encourage people to purchase health insurance.”

Even if the mandate is struck down, the law's Medicaid expansion would still be carried out under a separate provision.

Starting in 2014, Medicaid would provide health insurance to over half the estimated 30 million people receiving coverage as a result of the law, mainly childless adults living near poverty.

Another provision in the law provides government subsidies for many middle-class people to purchase individual policies in new state markets. Also available starting in 2014, those subsidies would probably entice many to buy a plan.

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