“But experts on health care policy say the practical effect of the court’s decision will probably be less earth-shattering than some people think.”

June 10th, 2012

 If the court takes what many observers believe will be the most likely route and strikes down the individual mandate — the requirement that virtually everyone purchase insurance — many more currently uninsured people are still likely to receive health coverage, they say.

Even if the law is struck down entirely — which could happen if the court decides that the other provisions are too intertwined with the mandate — many experts say that some changes the law has already set in motion will continue, probably more slowly, but possibly at a more urgent pace in reaction to the elimination of the federal law.

I gather this NYT piece is some preemptive damage control.

This explains why the administration took the position that the mandate could not be severed from the “guaranteed issue” and “community rating” provision:

Dr. Lischko and other experts said they were more concerned about two other provisions that could be struck down if the mandate was eliminated: guaranteed issue, in which coverage is offered to people who have pre-existing conditions, and community rating, which requires insurance companies to offer coverage at the same price to people regardless of their health status.

But in some ways these two provisions, the mandate and the subsidies all go together. “States that have tried community rating and guaranteed issue without a mandate and without subsidies saw a ‘death spiral,’ ” Dr. Lischko said, in which more sick people and fewer healthy people enter the insurance pool. “That is because healthy people were rated similar to sick people, and sick people were guaranteed coverage, so people waited until they needed coverage” to obtain insurance.

If all these provisions go, “I still think you get some sick people, but maybe not the sickest because plans don’t have to offer coverage to them,” she said. To draw in healthy people, she said, insurance companies might charge a penalty for people who do not buy insurance when they become eligible, something that Medicare already does.