25-06-2012 06:48 Some are calling the impending Supreme Court ruling on health care to be "the decision of the century." Indiana Attorney General Greg Zoeller was one of the first to sue the government over the Affordable Care Act of 2010. He weighs in on what could happen when the Supreme Court announces its ruling this week.

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Attorney General weighs in on health care decision - Video

Whats wrong with the mandate?

As we await the Supreme Court judgment of the health-care-reform law [The key point health-law allies failed to address, page one, June 24], the meaning of the mandate so far has not been clarified by the media or by the various courts.

There are many dictionary definitions of the word mandate, and the prevalent interpretation appears to be that a mandate is mandatory or obligatory; that is, it must be obeyed by everyone under penalty of law for disobedience.

However, several sections of the law reveal that enforcement of collection of the fine for failure to comply is nonexistent measures to collect the fine are specifically prohibited. If this is the case, in a real sense, the mandate of this law has no practical meaning, except that it might motivate reasonable people to obtain health insurance somehow under the various provisions of the law. Those who refuse to obtain health insurance still can receive health care at emergency rooms at any hospital at public expense, because that is the law of the land.

Principles of insurance are simple. Auto insurance is required by all states to protect both the public and the driver before an accident. We buy life insurance usually long before we die. Buying health insurance under the new law is a sign of a national sense of community we are all in this together. There is current evidence that the use of health care by others helps to protect the entire population; for instance, the epidemic of pertussis is partly the result of many people in some areas avoiding vaccination of their children.

So what is wrong with the mandate, constitutionally or otherwise?

Irvin Emanuel, MD, Seattle

Not a damaging decision

I am greatly perplexed by the seemingly unquestioned perception that President Obama would be politically damaged by an overturning of Obamacare.

Forget the programs perceived illegalities. Anytime valuable services are stripped from a huge throng of citizens, theres going to be outrage. The majority justices would be perceived as heroes only by a jaded minority, impervious to what gets thrown out in its fanatical bathwater.

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Health-care mandate awaiting Supreme Court ruling

Cable TV hosts are talking nonstop about the Supreme Courts decision on President Barack Obamas health care law. Politicians are waiting anxiously for it. And the health industry is plotting to win the aftermath.

In corporate suites, K Street conference rooms, and Wall Street investment shops, industry players havent all been content to wait and see what the court does.

This is every man for himself, said a K Street Republican who has health care clients. Its a zero-sum game. They all want to make sure they are on the winning side.

But theyre also eager to find out what the future of their world looks like because so much of their world now depends on whether the health care law will survive, be shredded, or be wiped out.

(Also on POLITICO: Full health care coverage)

The war-gaming over the law the Affordable Care Act has been particularly intense for insurers and retailers, who are preparing for a doomsday scenario in which the laws individual mandate is struck down but other provisions are left intact. If insurers are required to cover folks with pre-existing conditions, but young and healthy consumers arent required to buy health plans, premiums will skyrocket.

It would be a worse mess than we already have with the health care law, Neil Trautwein, vice president of the National Retail Federation, said.

Major hospitals and health care systems have been developing their playbooks, too.

Obviously everyone is waiting with bated breath about whats going to happen. Theres lot of talk and gaming out under different scenarios, said Harold Ickes, a lobbyist who served as deputy chief of staff to President Bill Clinton. What we do for our clients is lay out different scenarios.

But Ickes and Delos Cosgrove, CEO of the Cleveland Clinic, said that health providers already have been moving toward giving care in the ways prescribed by the health care law, and that will continue even if the law is fully or partially struck down.

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Ruling is 'zero-sum' game for health industry

Intrade Market Predicts There's a 76 Percent Chance Supreme Court Will Strike Down Obamacare

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Health Care Games: The Odds Are Not In Obamacare's Favor

In what looks to be the biggest Supreme Court decision since Bush v. Gore, the highest court in the land will give its opinion on whether or not the Affordable Care Act (:ACA), popularly known as 'Obamacare', is constitutional. The decision looks to come during the final day of the Supreme Court's session before breaking for the summer and it will undoubtedly be a landmark result either way.

A great deal of the debate is centered on the 'individual mandate' or a stipulation in the bill which required all U.S. citizens and legal residents to obtain government-approved health insurance. If people do not get this insurance, they will have to pay a fine as a penalty for not doing so starting in 2014.

Some on the right believe that this is unconstitutional as the government cannot force you to engage in a contact with a private company. They also feel that by giving the government this power, there is no telling what can be mandated next in any industry under the guise of doing it for the public good (read Invest Like The One Percent with These Three ETFs).

Meanwhile, those on the left believe that the individual mandate is nothing more than a tax, no different than social security or Medicare, each of which we are forced to pay into already as a form of insurance. Beyond that, the left's arguments can also consist of a focus on the Commerce Clause, which gives Congress the ability to regulate economic activity connected to interstate commerce, presumably such as health care.

This issue is at the crux of the health care debate and it appears to be the main focus of the constitutionality in the Obamacare law. With that being said, it should be noted that there are realistically three outcomes for Thursday; the entire bill is constitutional, the mandate is unconstitutional but the rest of the bill is acceptable, or that the mandate is unconstitutional and 'unseverable' from the rest of the bill, rendering the entire ACA bill unconstitutional.

Likely Outcomes

I think it is fair to say that both sides make some excellent points regarding the debate and that this issue really could go one way or another. However, while the decision may still be uncertain, the markets and many participants in the process are starting to believe that the court will rule against the mandate but leave the rest of ACA intact (see Could The Small Cap Health Care ETF Be A Great Pick?).

In fact, Intrade, an online prediction market, currently has the chances of the individual mandate being ruled unconstitutional (before the end of the year) at roughly a three-out-of-four rate. Additionally, a poll of legal experts now expects the Supreme Court to find the individual mandate unconstitutional, although not by a wide margin.

While it is also possible that the Court can postpone the decision to later on in the year, many view this as unlikely. Probably also out of the cards is the Court postponing a decision due to the 'Anti-Injunction Act' suggesting that the ruling will be coming sooner rather than later for Obama's hallmark piece of domestic legislation.

Stock Market Impact

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Health Care ETFs in Focus on Obamacare Supreme Court Decision

by Ken Alltucker - Jun. 26, 2012 11:25 PM The Republic | azcentral.com

The U.S. Supreme Court's highly anticipated ruling on the nation's health-care law is expected Thursday, and the justices' decision will have a profound impact on the way Americans get health care.

The nation's high court could keep intact all -- or just part -- of the Affordable Care Act passed by Congress in 2010. Or the court may strike down the entire law.

Even if the Supreme Court tosses out the act, thorny issues remain, including access to care for the estimated 50 million Americans without health insurance, spiraling health costs, affordability, quality, and waste and abuse in the system.

Here are some possible outcomes of the Supreme Court's ruling:

Question: What happens if the law is upheld in its entirety?

Answer: Arizona consumers would keep early benefits of the law, such as some preventive health care covered at 100 percent and rebates from insurance companies that did not spend at least 80 percent of premiums on medical care or quality.

But the big changes won't come until 2014, when most Arizonans would be required to obtain health insurance. Now, about 1 out of every 5 Arizonans does not have health insurance. Most of these uninsured people would get health insurance through expanded Medicaid coverage or through a health-insurance exchange that matches consumers and insurance companies.

Hospitals, doctors, health insurers and employers have made significant changes to prepare for the law. Arizona hospitals, for example, have started new programs that emphasize a coordinated and team approach to health care. Some health providers will be paid based on how well they keep people healthy, not the traditional fee-for-service model that pays doctors or hospitals based on tests and procedures.

While consumers, employers and the health-care industry have adjusted to the law, the political battle is unlikely to end anytime soon.

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Bracing for big health-care law ruling

In what looks to be the biggest Supreme Court decision since Bush v. Gore , the highest court in the land will give its opinion on whether or not the Affordable Care Act (ACA), popularly known as 'Obamacare', is constitutional. The decision looks to come during the final day of the Supreme Court's session before breaking for the summer and it will undoubtedly be a landmark result either way.

The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of The NASDAQ OMX Group, Inc.

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Health Care ETFs in Focus on Obamacare Supreme Court Decision - Investment Ideas

President Barack Obamas administration says it has no contingency plan if the Supreme Court strikes down the health laws individual mandate.

The best fixes would be legislative but thats not likely when half of Congress wants to repeal whatevers left of the law.

Yet health experts say the administration does have a handful of backstops. The problem? Theyre pretty weak.

Here are four options the president could invoke to try to cover more Americans and why they wouldnt resurrect the full strength of the laws individual mandate.

1. Selling those subsidies

An aggressive outreach or marketing campaign might make the case to younger and healthier people that its a good deal for them to buy insurance, especially since many could qualify for subsidies to help them pay insurance premiums. Thats important because insurance companies cant sustainably cover more sick people without also having healthier people pay in.

If the individual mandate only is stricken, its not that big a deal, said Tim Jost, a National Association of Insurance Commissioners consumer representative. The premium subsidies, he argued, could be enough to entice uninsured healthy people to buy coverage. Thats especially true in the first couple years after the law takes full effect in 2014, when the penalty for not having coverage is so low its unlikely to change many peoples behavior.

But other experts are more worried about potential instability in the insurance market. After all, if a good PR campaign was all that is necessary, the administration wouldnt have fought for the mandate. Families USAs Ron Pollack, for instance, agrees that outreach can help but that it wont completely fix the problem. Outreach, he said, ameliorates I dont say corrects the possible imbalance of the market.

2. Late enrollment penalties

A ruling that eliminates the individual mandate, with or without some related insurance rules, would leave in place the health laws insurance exchanges, the new state-based insurance marketplaces. And the Department of Health and Human Services is setting some of the rules for the exchanges and the health plans that want to do business in them.

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4 health care options post-SCOTUS