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Health care: What the Supreme Court's ruling means for US consumers

The US Supreme Court ruling to uphold Obama's health-care reform law affects households across America. Millions without insurance are on track to get it. But costs are an unresolved issue.

By Staff writer / June 29, 2012

In this June 25 photo, physician assistant Anna Streuli, left, examines Maria Guzman at the Multnomah County's Mid-county Health Center, in Portland, Ore.

Rick Bowmer/AP

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The US Supreme Court's decision on health-care reform Thursday opens the door to a major expansion of health insurance, affecting households across America.

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Millions of people who currently lack health insurance are now on track to get it, as core provisions of President Obama's reforms go into effect in 2014.

However, while the word "affordable" is prominent in the title of Mr. Obama's reform law, the court's ruling leaves rising medical costs as an unresolved issue of public concern. Though the ruling clears the way for the 2010 Patient Protection and Affordable Care Act to influence costs in a variety of ways, the law won't fully resolve the problem, say policy experts.

That hints at another important fact: The court's ruling also doesn't codify the Affordable Care Act (ACA) in stone. Politicians of both parties are bound to seek changes to the law, with Republicans on the campaign trail pledging a "repeal and replace" approach. Where supporters say reforms of broad scope are needed, critics say it's a case of misguided federal intrusion in the affairs of individuals and states.

Looking at the law as it stands, after Thursday's court ruling, here's an overview of how it is poised to affect families and individuals:

Expansion of insurance coverage

The law's major goal is to expand access to health insurance by making more people eligible for Medicaid (those with incomes up to 1.33 times the poverty level), and by offering generous subsidies to help families pay for insurance.

One estimate, published by the nonpartisan Congressional Budget Office, projects that by 2020 some 32 million Americans who would be uninsured without the law will have coverage.

Those gains would include about 17 million people added to Medicaid, and 22 million who are expected to buy insurance on their own from private firms – on "exchanges" set up at the state level. (The gains would be offset somewhat by a projected decline in the number of people covered by employer-sponsored health plans.)

Although it didn't strike down the law's Medicaid expansion, the Supreme Court held that states cannot be coerced into participating. Thus, depending on state-level choices, the Medicaid expansion may reach many fewer than 17 million people.

"Individual mandate"

A highly controversial element of the law is the mandate that individuals carry insurance or pay a fine. This provision was at the center of the Supreme Court's legal review. Although the court said this provision was not constitutional as a federal regulation of interstate commerce, a 5-to-4 majority of the justices found it to be constitutional under Congress's power of taxation.

Who is affected by the mandate? In practice, most Americans already have health insurance, such as from their employer or from a government program like Medicaid. The mandate does affect the millions of people who don't have insurance, with some important exceptions: Some people, such as Amish households, will be able to claim a religious exemption, while others won't be affected because they are in prison or are undocumented immigrants.

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