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What's at Stake in the Supreme Court's Health Care Decisions

Today the Supreme Court begins hearing arguments on the health care reform law. Here we map the possible outcomes, following the Court’s schedule over the next three days. The Court will hear all three days of arguments, even if they eventually decide not to decide the bulk of the case, and is unlikely to issue a decision on the case until late June or early July.

For more information on different states' progress implementing health care reforms, see this comprehensive list.

Day 1: Monday, March 26

Can the Court review the health care law yet?


The law goes into effect, and the Court must wait until at least 2015 to review it.

Most observers think that as time goes on and more provisions take effect, it will become harder as a practical matter to overturn the law.

Under the Tax Anti-Injunction Act of 1867, the court can only review a tax once it goes into effect, because people must first be "harmed" by a tax before they can challenge it. The health care law would impose a penalty on people who don't buy health insurance as required, and the court will decide whether this penalty counts as a "tax."


Day 2: Tuesday, March 27

Is the individual mandate constitutional?


The law goes into effect.

Of the estimated 32 million uninsured Americans who will gain coverage by 2016 (most reform law provisions will have gone into effect by then), 16 million will gain health insurance because of the mandate.

The Court will decide whether Congress overstepped its authority in requiring most Americans to buy health insurance, or pay a penalty.


Day 3: Wednesday, March 28

Does that mean the rest of the law must be struck down?


The law goes into effect without the mandate, and perhaps few other provisions.

Experts predict that if insurance companies are required to cover everyone, but not everyone is required to buy insurance, premium costs may rise.

At issue is whether the rest of the health care law is so inextricably reliant on the mandate that the whole thing must fall. The Court will decide if the other parts of the law (including popular provisions such as the ability for children to stay on a parent's insurance plan until the age of 26) can survive without the mandate provision.


The entire health care law is thrown out.

The roughly 32 million Americans who would gain coverage under the new reform law would stay without insurance.

Day 3: Wednesday, March 28

Is the Medicaid expansion constitutional?


The law goes into effect with the Medicaid provision (unless the whole law has been struck down by an earlier decision).

An estimated 16 million Americans become newly eligible for Medicaid in 2014.

Unrelated to the mandate, the Court must decide whether Congress overstepped its authority in requiring that states extend Medicaid coverage to people who make up to 133 percent of the poverty level (about $14,000 for an individual or $29,000 for a family of four).


The provision falls.

An estimated 16 million Americans remain ineligible for Medicaid, and many would still be unable to afford to buy private health insurance.

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