White House planning its strategy on health-care law

As a Supreme Court decision looms, Democratic sources say several options are being weighed.

Posted: June 20, 2012

WASHINGTON - Planning its strategy ahead of a momentous Supreme Court ruling, the Obama administration plans to move ahead with major parts of the president's health-care law if its most controversial provision does not survive, according to veteran Democrats closely involved with the legislation.

Even if the requirement that nearly every U.S. resident have health insurance is declared unconstitutional, the remaining parts of the law would have far-reaching impact, putting coverage within reach of millions of uninsured people, laying new obligations on insurers and employers, and improving Medicare benefits even as payments to many service providers get scaled back.

The White House says President Obama is confident the entire law will be upheld when the court issues its ruling in the next week or two, but officials will be ready for any outcome.

"We do believe it's constitutional, and we . . . hope and expect that's the decision the court will render," senior adviser David Plouffe said Sunday on ABC. "We obviously will be prepared for whatever decision the court renders." Administration officials have not wanted to discuss contingency plans to avoid creating the impression that the president is preparing for a high court rebuke.

Nevertheless, the Obama administration will move ahead to implement major elements of the law if the individual-coverage requirement is struck down, two senior Democrats told the Associated Press. One is a leading Democrat familiar with the administration's thinking, the other a high-level Capitol Hill staffer. They spoke on condition of anonymity to avoid appearing to be out of step with the administration's public stance.

Because the law's main coverage expansion does not begin until 2014, there would be time to try to fix serious problems that losing the individual-coverage requirement may cause for the health insurance industry.

Surviving parts of the law would "absolutely" move ahead, said the congressional official. A Congress mired in partisan trench warfare would be unable to repeal or amend what's left of the law, allowing the administration to advance. Much of the money for covering the uninsured was provided in the law itself.

"Legislatively we can't do a thing, and we are going to move full speed ahead [with implementation]," the official said.

How the Supreme Court will decide is unclear. It may uphold the law, strike it down entirely, or do something in between. Skeptical questioning by the court's conservative justices during oral arguments this spring has fueled speculation that the court may invalidate the so-called individual mandate.

Opponents say the requirement that individuals have coverage is unconstitutional, that the federal government cannot tell people to obtain particular goods or services.

Supporters say the mandate is a necessary component of a broader scheme to regulate health insurance, which is well within the powers of Congress. By requiring people to carry health insurance or pay a fine, the law seeks to broaden the pool of people with coverage, helping to keep premiums affordable.

If the mandate is struck down, that would still leave in place a major expansion of Medicaid, the federal-state safety-net program for low-income people. Federal tax credits to help middle-class people buy private health coverage would also survive, as would new state-based insurance markets.

Such subsidies have never previously been available, and millions are expected to take advantage of them regardless of whether insurance is required by law. Still, it could be tricky to salvage the law's full blueprint for helping middle-class uninsured people.

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