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Undoing health law could have messy ripple effects

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RICARDO ALONSO-ZALDIVAR
June 10, 2012
— It sounds like a silver lining. Even if the Supreme Court overturns President Barack Obama's health care law, employers can keep offering popular coverage for the young adult children of their workers.

But here's the catch: The parents' taxes would go up.


That's only one of the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month. The law affects most major components of the U.S. health care system in its effort to extend coverage to millions of uninsured people.


Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part.


Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended. Ditto for preventive care with no co-payments, now available to retirees and working families alike.


Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law's promise of more paying customers to offset losses.


If the law is upheld, other kinds of complications could result.


The nation is so divided that states led by Republicans are largely unprepared to carry out critical requirements such as creating insurance markets. Things may not settle down.


"At the end of the day, I don't think any of the major players in the health insurance industry or the provider community really wants to see the whole thing overturned," said Christine Ferguson, a health policy expert who was commissioner of public health in Massachusetts when Mitt Romney was governor.


While it's unclear how the justices will rule, oral arguments did not go well for the Obama administration. The central issue is whether the government can require individuals to have health insurance and fine them if they don't.


That mandate takes effect in 2014, at the same time that the law would prohibit insurance companies from denying coverage to people with existing health problems. Most experts say the coverage guarantee would balloon costs unless virtually all people joined the insurance pool.



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