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Health-care reform law will survive even if mandate doesn't, experts say

Chaos will not ensue if the US Supreme Court strikes down the individual mandate to buy health insurance, even if other parts of Obama's health-care reform law are upheld, health experts say. But premiums would be likely to rise.

By Staff writer / June 19, 2012

President Obama gives a 'high five' to 11-year-old Marcelas Owens, of Seattle after holding a rally celebrating the passage and signing into law of the Patient Protection and Affordable Care Act health insurance reform bill while at the Interior Department in Washington, March 23, 2010.

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When the US Supreme Court rules on President Obama’s Affordable Care Act, there’s a distinct possibility that the federal mandate requiring most people to buy health insurance – a pillar of the law – will be declared unconstitutional.

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So if just the mandate goes, does the rest of the law fall apart?

In a word, no. Health-care experts, gaming out scenarios for how the court might rule, say the end of the mandate indeed means that some people wouldn’t buy insurance – but if the court lets stand other provisions of the law, the ranks of the insured will still go up.

If the law is not upheld in its entirety, health-insurance coverage “and how that influences the cost of health care, and whether everyone gets a fair shot at getting coverage – those will be challenges. But I don’t think it will be chaotic,” Dr. Jeremy Lazarus, incoming president of the American Medical Association, recently told The Associated Press.

Even without the mandate, the law’s expansion of Medicaid eligibility would cover some 16 million people, about half the total number of people who would gain insurance if the whole law is upheld, according to the Congressional Budget Office (CBO).

In addition, federal subsidies and tax credits for low- and middle-income people to buy insurance in the new marketplaces, or “exchanges” – think Travelocity for health care – will make coverage more affordable.

The real disconnect comes if the Supreme Court strikes down the individual mandate but lets stand the guarantees of coverage for people with preexisting conditions and the “community rating” provision that bars plans from charging more on the basis of gender or health status.

“If just the mandate goes, there’s no question that there are implications in that for how well the law works,” says Larry Levitt, a senior vice president at the Kaiser Family Foundation in Menlo Park, Calif. “There’s a consensus that premiums will go up, though by no means a consensus around how much they’ll go up.”

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