How Supreme Court's healthcare ruling will affect you

If a key part of the healthcare reform law is ruled unconstitutional it could change the way you practice, say health law experts. And one group of your patients is especially vulnerable.

The number of uninsured patients at your practice likely will stay the same or increase in the next few years in light of the U.S. Supreme Court’s hearings last week about the healthcare reform law.

The Patient Protection and Affordable Care Act’s (PPACA’s) requirement that all Americans must carry insurance by 2014 probably will be ruled unconstitutional, health law experts told Medical EconomicseConsult. Other legal issues facing the act, such as an expansion of Medicaid eligibility and whether the mandate can be separated from the rest of law, are uncertain.

Judging from some of the justices’ hostile questions during last week’s hearings, it seems likely that the Supreme Court will, at the very least, strike down the mandate that all Americans must carry insurance or pay a fine, experts said.

“Making bets based on oral arguments does entail a significant amount of speculation,” says Theodore Ruger, professor at the University of Pennsylvania Law School. “However, I think many of us, myself included, were struck by how skeptical a number of justices seemed of the government’s case.”

Ruger, who was a law clerk to Justice Stephen Breyer from 1997 to 1998, says that Justice Anthony Kennedy, considered to be the swing vote on the court, revealed his mindset during questioning on the individual mandate.

“He said, in effect, that the [PPACA] would change the average American’s fundamental relationship with the federal government,” Ruger says,“suggesting that he feels the act is quite a bit more sweeping than I think it actually is.”

If the court overturns the mandate, doctors would likely see more uninsured patients at their practices, says Timothy Jost, professor at the Washington and Lee University School of Law and co-author of a casebook, Health Law.

More patients may also defer care to avoid out-of-pocket expenses or visit their physicians despite being unable to afford a copayment.

“Millions of Americans now have coverage for preventive care without cost-sharing,” Jost says. “Frankly, cost-sharing is important to doctors because a lot of it is uncollectable.”

The statute also contains provisions for primary care physicians to receive a 10% payment bonus on their Medicare charges through 2015 and to equalize Medicaid payment rates with those of Medicare in 2013 and 2014.

Physician practices likely will be less affected than will hospitals if the law is overturned, Jost says. Hospital emergency departments are required by the Emergency Medical Treatment and Active Labor Act to care for patients who are uninsured or unable to pay.

“Young adults don’t consume very much healthcare, but they are the group most likely to end up in an emergency room with a trauma-related injury,” Jost says. “[Reversing the law] will have a direct economic effect.”

Justices are expected to issue their ruling in June.

“I don’t think we can say that the fact the judges gave the solicitor general a hard time means that the statue is on its last legs,” Jost says. “But some of the justices did tip their hand.”

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