| May 14 2012
In June, the U.S. Supreme Court will issue a decision about the constitutionality of a key aspect of the Patient Protection and Affordable Care Act: the requirement that all Americans purchase health insurance. That decision will have a major impact on the future of healthcare reform. We can't know what the nine justices will do, but as we await a decision, I thought this would be an excellent time to review some key aspects of the healthcare law and what the future might hold for the ground-breaking legislation.
The big question on everyone's mind is, "What happens if the Supreme Court strikes down the individual mandate?"
If the Supreme Court determines that the individual mandate is unconstitutional, that wouldn't put an end to other parts of the act by itself, which are basically unconnected to the mandate. For example, Medicaid, the health program for low-income individuals that is jointly funded by the federal government and individual states, would still be expanded so that people making up to 138% of the federal poverty line (about $15,000 for an individual) would qualify for coverage. But there's no question that the mandate is a core component of healthcare reform, and if people aren't required to buy insurance the law won't really be able to achieve its stated goals.
Most critically, not having a mandate would make it difficult, if not impossible, to create functional health insurance exchanges. That's because many healthy people would likely choose to not buy insurance until they got sick. And that would mean that insurers participating in the exchanges would have to charge very high rates. There are some steps that Congress could take to help prevent that problem (such as charging a penalty to people who don't sign up for an exchange as soon as they are eligible), but chances are politicians won't take that step.
In addition to the Supreme Court decision, the upcoming presidential election represents another major challenge to the healthcare law. However, if the law survives both those events, we can expect to start seeing some major changes in healthcare in the U.S. Most of those changes will begin taking effect in 2014.
The big shift, of course, will be the requirement for every American to obtain health insurance or pay a fine. Larger employers will also need to offer health insurance coverage to employees or pay fines. In addition, beginning in 2014, states will be required to expand access to Medicaid. Currently, most states restrict Medicaid access to children, women who are pregnant, the elderly or the disabled. Under the new rules, eligibility will be tied solely to income, not demographic factors.
As part of the health reform legislation, uninsured people will also be eligible to receive subsidies to help them buy private insurance through exchanges; small businesses will have access to the insurance exchanges as well. Finally, insurance companies will be forbidden from denying coverage or charging higher premiums to individuals who have pre-existing conditions. The Affordable Care Act also makes some effort to rein in ever-increasing healthcare costs, though it remains to be seen how effective those measures will be.
Currently, there are a lot of unknowns when it comes to the future of healthcare in the United States. For now, we'll simply have to wait and see what happens. Whatever the final outcome of the debate over the Affordable Care Act, this issue isn't going away any time soon. Even if the Supreme Court strikes down the individual mandate, we can expect to hear debate on healthcare reform for years to come.

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