The Supreme Court is moments away from delivering an opinion that will determine whether "health care reform" is in need of more reform.
Sometime after 10 a.m. ET, the landmark ruling will be released to the public. The opinion is a secret even to President Obama, who will find out about the ruling just like everybody else.
"We all will await the decision and learn of it at the same time that you do," White House Press Secretary Jay Carney told reporters on Wednesday.
With the opinion poised to have just as much of an impact on Obama's legacy as it does on the American health care system and economy, staffers in Washington have been preparing behind the scenes for the roughly five scenarios that could play out by late morning Thursday.
They are:
- The Supreme Court could uphold the entire law.
- The court could strike down the entire law.
- The court could strike down the just individual mandate -- the requirement that most Americans buy health insurance.
- The court could strike down the mandate, and two provisions tied to it -- a provision that prohibits insurers from refusing coverage based on pre-existing conditions, and one that prohibits insurers from charging extra based on medical history.
- The Supreme Court could punt, and not make any decision at all -- citing a law that bars court challenges over taxes that haven't yet been paid.
On a related track, the court will also be ruling on a challenge over the expansion of Medicaid to the states.
For now, the decision remains anyone's guess, but it is sure to have sweeping consequences.
During an election year and a period of shaky economic recovery, what the high court decrees will ripple through the political world and, more importantly, the sector that counts for one-sixth of the American economy.
Will Americans be guaranteed coverage regardless of medical condition? Will they be forced to buy insurance? Will businesses be able to hire without worrying whether they can afford the accompanying health care costs?
The White House, peppered with questions at Wednesday's briefing, was reticent to entertain the implications of the looming decision and what it could mean for Obama's signature domestic policy achievement and what it could mean for the millions of Americans it affects.
Carney said only that the Obama administration is "confident" the law is constitutional, and he defended what the provisions have done for health care in America to date. He said, for instance, that 3.1 million more young adults have coverage today because of a provision allowing them to stay on their parents' plans until age 26.
Republicans, though, say the myriad consumer protections come with a big cost, and they are vowing to keep up the fight to repeal the law should the court uphold all or part of it.
"If the court does not strike down the entire law, the House will move to repeal what's left of it," House Speaker John Boehner said Wednesday, claiming the law is driving up the cost of health care and making it tougher for small businesses to hire workers.
While Republicans' chief argument against the law is that it stifles economic growth with burdensome regulations, the chief legal argument in court is that the individual mandate requiring most Americans to get health insurance is unconstitutional.
Both parties have been teeing up their next step following the ruling.
Republicans have vowed to repeal whatever's left, and Democrats have vowed to protect what they can.
"We're prepared to build on the landmark health reform to make sure, more and more, we have affordable quality health care for all Americans," Rep. Xavier Becerra, D-Calif., told Fox News.
But if the mandate is struck down, it throws the entire economic formula for implementing the policy out of balance. Health insurance companies are expected to take on a significant amount of additional cost due to provisions that guarantee coverage and implement other consumer protections -- in exchange, the mandate ensured those companies would get millions more customers. Without the mandate, that trade-off disappears.
Democrats have acknowledged that eliminating the mandate would cause problems for implementing the rest of the regulations.
Meanwhile, the decision could have a significant impact on the 2012 presidential race. If the law stands, Obama wins some measure of vindication -- but can also be assured that Romney will continue to run on repealing the policy. If the law falls, Obama faces a major rebuke, but can take solace in the fact that Romney can no longer run on his repeal pledge.
Romney, though, signaled Tuesday he'll be hammering the president over the law no matter how the court rules.
If the law is overturned, Romney said, "then the first three-and-a-half years of this president's term will have been wasted on something that has not helped the American people."
"If it is deemed to stand," Romney continued, "then I'll tell you one thing. Then we'll have to have a president, and I'm that one, that's going to get rid of ObamaCare."
