The justices of the U.S. Supreme Court gather for a group portrait at the Supreme Court Building in Washington. Seated from left to right are: Clarence Thomas, Antonin Scalia, John Roberts, Anthony M. Kennedy, Ruth Bader Ginsburg. Standing, from left are: Sonia Sotomayor, Stephen Breyer, Samuel Alito Jr., and Elena Kagan. | AP Photo

The court could uphold the law, strike it down, or do something in between.

Pick an ending: 6 possible outcomes

Strike down the mandate and anything linked to it

Another possibility is that the court would overturn the mandate but also rule that provisions that seem directly connected to it — like the pre-existing condition coverage — must go, too. That’s what the Obama administration says should happen if the court rules against the mandate. The court also could throw out other provisions, but that’s the provision most likely to go if the mandate is overturned. If this happens, it could renew the debate over how to help people who can’t get insurance — but everyone would remember that the guts of President Barack Obama’s health care law got knocked out.

Strike down the Medicaid expansion

States argue that Congress exceeded its powers by essentially forcing them to expand their Medicaid programs because even though it’s just a condition of receiving federal Medicaid funds, the states say that dropping out of the program isn’t a realistic option. Most legal experts think it’s unlikely that the Supreme Court would get rid of the Medicaid expansion because there are many precedents for allowing Congress to tie strings to federal funds. But a ruling against Medicaid expansion could put a lot of other federal initiatives at risk — from highway funds to a variety of social programs.


If the court wants to avoid ruling in a presidential election year — or decides this issue should be decided in the legislature, not the courts — it could use a tax law called the Anti-Injunction Act. That law prevents people from challenging a tax law in court until they’ve paid the tax. The court is spending Monday’s session examining that law — because under the individual mandate, people who don’t get coverage would pay a fee collected by the IRS. The justices are under a lot of pressure not to take that option, though — because states, businesses, health care providers and everyone else who has to implement the health reform law wants a decision now.

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