Today, the members of the Supreme Court will meet in private to begin deciding the fate of the Affordable Care Act, and the millions of Americans whose lives and futures stand to be made more secure because of the ACA. It's entirely possible that Anthony Kennedy will discover some place in his heart where integrity and a respect for the true role of the Court are supposed to be and the Act will be upheld, but at the moment you won't find too many people willing to bet on it.
So I'd like to spend a few moments working through what might happen if the Court takes the middle course, which could be the most likely—striking down the individual mandate, but leaving the rest of the law intact—both in the short and long term.
The immediate problem would be the fact that the individual mandate is what makes the law's most popular provision, the end of exclusions for pre-existing conditions, possible. Once nearly everyone is insured, the risk pool is expanded and insurance companies can function even if they're no longer allowed to turn anyone away. But if the bar on exclusions for pre-existing conditions is in place but the mandate disappears, no one would bother getting insurance until they showed up at the emergency room or got diagnosed with a serious illness. Insurance companies would eventually have only sick (and therefore expensive) people as customers, and premiums would skyrocket. It's a recipe for disaster.
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