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COMMENTARY: Health care reform act decision not final word

COMMENTARY: Health care reform act decision not final word

One of the biggest guessing games in the benefits community right now is when the Supreme Court will hand down its decision regarding the constitutionality of the health care reform law.

Earlier this month, for example, a rumor took off that a high court decision was imminent.

One can understand the speculation. The decision handed down by the justices will be hugely important. I'm hard pressed to think of any ruling in recent years that could affect so many people and organizations as this one.

That said, does anyone think that the decision—unlike so many other Supreme Court rulings that have ended uncertainty—will be the final word on the Patient Protection and Affordable Care Act?

Hardly. If the entire law is found unconstitutional, that will set in motion a big range of issues that regulators and legislators will have to confront. Take the issue of a health care reform law provision—one of the more popular ones—that requires employers to extend coverage to employees' adult children up to age 26.

If the law were to be struck down, does that mean the coverage employers have been providing to employees' older children since the age 26 mandate took effect last year would be retroactively taxable?

And if that was the case, just think of the huge administrative burden on employers in sending out revised W-2 wage and income statements, as they would have to calculate how much employees would owe in taxes.

Legislators in one fell swoop could nip that problem in the bud by passing legislation to make clear that no taxes would be due in that situation. But in today's highly partisan political environment where lawmakers can't agree on much of anything, fast resolution of that issue is no sure bet.

And what if just the law's individual mandate is overturned? That, too, would seem to be a natural trigger for congressional action. If individuals could obtain coverage anytime, such as after they were diagnosed with an illness, wouldn't that lead to massive adverse selection, putting into doubt whether insurers could provide coverage to the uninsured and others in state health insurance exchanges the law authorizes?

And what if the entire law passed constitutional muster? That would not be the end of the debate and controversy over the health care reform law. Republican presidential candidate Mitt Romney, for example, has pledged that if elected one of his first actions as president would be to seek repeal of the health care reform law.

In sum, to paraphrase a famous quote of Winston Churchill's, the Supreme Court ruling may be the end of the beginning regarding the debate and future of the health care reform law, but it is far from the end.