Many handicappers say that based on the questions asked by the justices identified as possible “swing votes,” that answer will more than likely be yes, our patient can choose not to be a participant in the market, and thus the individual mandate is illegal.
The court may also rule on other issues within the act, it they will certainly decide on the individual mandate. Many on both sides of the political aisle believe that a determination that the individual mandate is unconstitutional would spell the death of the Act entirely.
But regardless of the outcome, does the Supreme Court's decision really alter the calculus that's changing the business of healthcare right now?
Not by very much.
Yes, it looks like lawmakers will go back to the drawing board on some or all of the Act, but much of the pressure for reform has been coming organically, in fits and starts in some regions, in leaps and bounds in others, through commercial contracting relationships with both health plans and directly with employers.
Unlike three years ago, when this legislation was being debated, hospitals, health plans, physician practices and other affiliated healthcare providers have already begun building the structures that will deliver more value for the payer. If you're an executive leader, and you're counting on the Supreme Court to return you to the good old days, you're counting on hope instead of innovation, and there's not much future in hope when the business model is changing underneath you.