And if only part of the law survives, both sides will scramble to reposition. The Obama administration and its allies will do their best to protect what is left. Republicans have vowed to repeal it all as soon as they can, and eventually, to offer an alternative.
However the court comes down, most Americans are not likely to be happy with the result. In a poll released Monday, the Pew Research Center asked about all three scenarios and found that fewer than half of those surveyed would be satisfied with any of them.
The one that garnered the most support — at 44 percent — was throwing out the entire law. Upholding the entire law got the least, at 39 percent. And 40 percent said they would be in favor of striking only the most controversial aspect, which is a mandate requiring individuals who do not receive coverage from their employers or the government to buy it from private insurance companies, or pay a fine.
The Pew survey also found that public preferences tracked sharply along party lines, with Republicans hoping the court will throw out the law and Democrats wanting it to stand.
Partisanship is also certain to drive the initial reaction to the decision, which will land right in the middle of an intensely competitive presidential race.
“It will be heavily politicized, regardless of whatever decision the court makes. It will be overstated, exaggerated,” said former Senate Democratic leader Tom Daschle, who was Obama’s initial choice for health and human services secretary.
In the longer run, however, each of those scenarios raises a whole new set of political and policy questions for the two parties. That means the real implications of the decision are not likely to become apparent until next year.
“No one is going to be in a mood for any fixes, certainly before the election,” said Jonathan Gruber, a Massachusetts Institute of Technology economist who advised the Obama administration in formulating the Affordable Care Act. Gruber also consulted with then-Gov. Mitt Romney, when he was putting together the 2006 Massachusetts health-care law that has many of the same characteristics.
Once the election is behind them, both parties will have to come to grips with either making sure what’s left of the law is working, or deciding whether there is a better way to address the problems of a health-care system that leaves 16 percent of the population without coverage and is gobbling nearly 18 percent of the gross national product.
“It will take a while for people to take a deep breath and say, ‘Okay, now what?’ ” said Gail Wilensky, a critic of the law who was a top health-care policymaker in both Bush administrations. “Then we get back to the serious fight: Is this reflective of the direction we want the economy to go? Is this reflective of the direction we want the government to go?”