Supremes to decide health reform’s fate

It all comes down to this.

After two years of debate followed by two years of recriminations, the fate of President Obama’s health care reform law will come down to a 4-1/2-hour hearing before the U.S. Supreme Court in the spring.

A decision by the court would likely be issued in June, according to reports by The New York Times and Politico, making it a potboiler issue in the middle of the 2012 presidential election.

The Supreme Court announced today it will review the decision by the one federal appeals court, out of four, which ruled against the 2010 Patient Protection and Affordable Care Act.

That ruling struck down only the law’s requirement that all Americans buy health insurance, but let the rest of the law stand. But a lower court previously ruled that the individual mandate could not be separated from the rest of the law, and therefore struck down the entire thing.

The Supreme Court’s announcement said it would consider how much of the law can stand if the individual mandate is ruled unconstitutional.

The Supreme Court will also consider whether the individual mandate, which would be enforced by the levying of a tax or fine on individuals without health insurance, can be challenged in court before it is implemented in 2015. Some have argued that until the law actually causes damages to individuals, they can have no claim to challenge it.

The case the Supreme Court will consider was brought by 26 states, including Indiana, as well as the National Federation for Independent Businesses. The states have also claimed that the health reform law’s requirement that states expand their Medicaid programs represents illegal coercion by the federal government.

Indiana officials, citing predictions by the actuarial firm Milliman Inc., have said the expansion would cost the state roughly $1 billion from 2014 to 2020, or as much as $188 million per year.

With the fate of the law uncertain, many employers in Indiana have been slow to prepare for the law’s changes, most of which take effect in 2014, according to Indianapolis-area attorneys and benefits brokers.

But health care providers have been moving rapidly to position themselves for some the law’s requirements, which include incentives for better coordination of care as well as declining reimbursement from the federal Medicare program.

Those changes, most health care experts say, will likely continue even if the law is struck down entirely.