Since the 2010 health-care bill became law two years ago Friday, it has launched fundamental changes to Medicaid, Medicare and the private health-insurance system relied on by millions of Americans.
Its most transformative — and controversial — provisions are not set to take effect until 2014, but a complex web of new rules has already extended coverage and
expanded benefits across the country.
A look at how the law got to the Supreme Court and the issues in play
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So what happens to the existing provisions if the Supreme Court, which will hear challenges to the law next week, ultimately decides to go with its most sweeping option: overturning the law in its entirety?
The answer depends on where you live, who you work for and how you get your insurance.
Take one of the law’s most well-publicized provisions: the requirement that insurers allow parents to keep adult children on their health plans until age 26. The administration estimates that an additional 2.5 million young adults have been able to get health insurance coverage as a result.
Overturning the law would immediately release insurers from the federal rule. But it is hard to predict how many would actually exercise their right to revert to their original policies.
Compared with other provisions, the young-adults requirement proved fairly uncontroversial among insurers. Many even volunteered to comply well before the deadline set by the law, noted Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry group.
In addition, nearly all states, which regulate many forms of private insurance, have already codified the young-adult rule at the state level. In some cases this was done through actions that could be easy to undo. For instance, South Dakota’s law adopting the young-adults requirement included the proviso that if the health-care law is found unconstitutional, the state statute would automatically be repealed as well.
But in plenty of other states, insurers would not be free of the rule unless state leaders rolled back the statutes or regulations they adopted to implement the health-care law.
The same is true of the host of other mandates the federal law currently imposes on insurers. These include prohibitions against imposing lifetime limits on insurance payouts or dropping someone’s coverage after they get sick on the grounds that their insurance application contained inaccuracies.
There’s also the requirement that private insurers cover preventive services such as mammograms and colonoscopies without imposing co-pays or other out-of-pocket charges. About 54 million Americans now have expanded coverage of at least one preventive service as a result, according to an analysis by the Kaiser Family Foundation.
Lawmakers are unlikely to unwind these rules in many states, predicted Sabrina Corlette, a Georgetown University professor and co-author of a study analyzing state actions to align their insurance rules with the health-care law. “These are market reforms that are really very popular,” she said.
But Michael Cannon, director of health policy studies at the libertarian Cato Institute and an opponent of the law, argued that scrapping these requirements could actually benefit many Americans. They have driven up the cost of many insurance plans, he said. So without them, “there will be more affordable coverage options.”
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