New York Times reporters Reed Abelson and Katie Thomas feared for the consequences of a world without Obama-care on Saturday's front page: "A Health Law At Risk Gives Insurers Pause [1]." The Times quoted nine people, from insurance executives to liberal activists, who suggested that a defeat for Obama-care at the Supreme Court would be harmful for U.S. health care, compared to only one who welcomed the prospect, treating that side as a vast minority, even though 26 states have sued to challenge the constitutionality of the legislation. (Another quote was deemed neutral.)
As the Supreme Court considers the constitutionality of the federal health care law, one option that had seemed unthinkable to its designers and supporters now seems at least possible: that the court could strike down the entire law.
Although it would be folly to predict what the court will conclude, policy experts, insurers, doctors and legislators are now seriously contemplating the repercussions of a complete change in course two years after the nation began to put the law into place.
Their concerns were heightened after three days of court arguments in which some justices expressed skepticism about whether the full law could stand without the individual mandate requiring almost everyone to have insurance.
“Many of us did not get the bill we wanted, but I think having to start over is worse than having to fix this,” said Robert Laszewski, a health care industry consultant and former insurance executive who opposed the bill.
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The most ambitious provisions would be nearly impossible to salvage, like the requirement that insurers offer coverage even to those with existing medical conditions and the broad expansion of the Medicaid program for the poor. Popular pieces of the legislation might survive in the market, like insuring adult children up to age 26 through their parents’ policies, along with some of the broader changes being made in the health care system in how hospitals and doctors deliver care.
Abandoning the efforts and billions of dollars invested since the law was passed in 2010 would result in turmoil for hospitals, doctors, patients and insurers.
Many insurers would have difficulty changing course. “The risk of repeal and starting from zero frightens them infinitely more” than having to comply with the law as written, said Michael A. Turpin, a former insurance executive who is now a senior executive at USI Insurance Services, a broker.
Maryland’s health secretary, Dr. Joshua M. Sharfstein, said he was worried about the 50,000 people nationwide who are enrolled in a federally financed insurance program because they are seriously ill and cannot find coverage otherwise. If the entire law is thrown out, those people “don’t have other options,” he said.
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And there is little hope that Congress could devise an alternative to the law anytime soon. “If this law is completely thrown out, a lot of momentum to solve some of these problems is going to be vitiated,” said Helen Darling, the chief executive of the National Business Group on Health, which represents employers that offer health benefits.