Wide-ranging scenarios set to unfold upon ACA ruling

The nation awakes on June 28, anxiously awaiting a verdict from the Supreme Court on the constitutionality of the Affordable Care Act (ACA). The high court's ruling is expected to be monumental on a number of levels -- from new industry regulations to popular provisions to the effects on small businesses.

Leaders from Arent Fox, a law firm specializing in healthcare-related issues, provided four predictions regarding the ACA ruling.

1. Changes are here to stay, regardless of the decision. Michael Blass, healthcare partner at Arent Fox, said no matter the decisions, "most major healthcare providers have already made massive investments to comply with provisions of the Affordable Care Act that have taken effect and to anticipate those to be phased in by 2014. So while the court's ruling may be a game-changer, it won't turn back the clock entirely." He added that even if the justices do away with the entire law, "Congress will have to find new ways to fill the void."

2. More industry regulation and compliance mandates. Jill Steinberg, healthcare partner, noted many providers have already begun to comply with ACA mandates and are responding to incentives. "Many healthcare providers will continue with improvements in service delivery and coordination among caregivers, regardless of how the justices rule," she said. "If the ACA is thrown out, there will likely be a fresh wave of industry regulation and compliance mandates."

3. The ruling could impact popular provisions. These include coverage for pre-existing conditions and keeping children on parents' plans, said Elliot Kroll, insurance partner. If the court rules against the individual mandate but preserves the rest of the law, a number of remaining regulations will need some clarification. "The provisions requiring coverage of people with pre-existing conditions and permitting parents to keep their children on their own insurance plan until age 26 are both highly popular, but the former may not be economically viable without the mandate," Kroll said. "Balancing popular expectations that have been reset by the law, economic reality without the mandate, and the regulations left intact, will be a hugely complex undertaking."

4. It will be a waiting game for employers, especially small businesses. Employers will take their first cues from insurers, said employment partner Darrell Gay. "So many employers have already dedicated significant resources to comply with the ACA's coverage requirements," he said. The individual mandate itself may not affect them directly, since employees who get coverage, by definition, fulfill it, he continued. "However, a striking down of the mandate may affect many other regulations, and a rejection of the entire law will entail a chaotic reverse-engineering of recently implemented changes," Gay said. He added that if the law is upheld in whole, he expects small businesses will need to track individual states' development of the insurance exchanges closely, where they — along with individual workers — will be eligible to purchase coverage.

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