What the Supreme Court Decision on Health Care Means for You

Despite today’s drama, the Supreme Court’s decision to uphold the Affordable Care Act may mean less for the future of universal health coverage than meets the eye, for two reasons:
 

1. The upcoming election, not today’s ruling, will determine the health care law’s ultimate fate. House Republicans have already pledged to repeal Obamacare. That might be difficult in the current Congress — but it’s possible, even likely, if Republicans win the White House and control of both houses in November.  
2. Health care costs will continue to rise, though not as much as they would if the law had been struck down, according to the federal government’s estimates.

Meanwhile, the court’s 5-4 vote upholding the health care overhaul clears the way to providing unprecedented benefits to those at or approaching Medicare age. Under the Affordable Care Aact, enrollees in traditional Medicare are entitled to annual wellness check-ups and preventive screenings, like mammograms, at no cost. Those approaching the “donut hole,” the insurance gap in prescription drug coverage, will continue to receive drug discounts until the gap is eliminated in 2020.
 
(More: What if Supreme Court Rolls Back Health Reform)

If you’re a few years shy of Medicare eligibility and don’t have employer-provided coverage, the health insurance market will no longer be quite as daunting. Until now, individuals were often refused coverage because of their age or health status. The new law prohibits insurers from denying coverage to children with pre-existing medical problems; by 2014, that protection will apply to adults as well.
 
The court also let stand the law’s most contentious provision: the individual mandate, which requires everyone to buy health insurance or pay a penalty. Individuals who don’t have coverage will be fined $95 (or 1 percent of income, whichever is greater) in 2014. By 2016, the fine will increase to $695 for individuals and $2,085 for families, or 2.5 percent of income; after that, the amount of the fine will rise with the cost of living.
 
Small business owners, however, might find reason to cheer today’s ruling. Companies with fewer than 25 full-time employees and average annual wages below $50,000 now qualify for a tax credit of up to 35 percent if they provide health insurance to employees. In 2014, the subsidy will increase to 50 percent. Though relatively few have taken advantage of the credit to date — probably because the recession has crimped jobs and made money tight — that may change as the economy picks up speed.
 
Another provision of the new law that most patients are likely to applaud: Insurers can no longer impose a ceiling on lifetime benefits or cancel coverage for any reason except fraud. Annual limits on benefits will be phased out by 2014. Insurers are also required to allow children to remain on their parents’ health plans until age 26.
 
But despite the court’s affirmation that the new law is constitutional, its ultimate fate will probably be decided by another vote — on Election Day.