Nine justices are expected to determine the fate of the Affordable Care Act (ACA) in June, but their decision may well push the U.S. whither many conservatives would not go. This is why: The course toward insurance reform already is in process. Nurses, doctors, hospitals, and patients know what politicians and pundits haven’t yet realized: The transformation will continue to move forward irrespective of what the Supreme Court decides. If the individual mandate is found to be unconstitutional, this may well accelerate the movement toward government-sponsored health care. It might reverse Washington’s relentless push to regulate individual and business behavior, but could ultimately push the United States into a single-payer system like Medicare. ACA prohibits insurance companies from denying anyone coverage or charging people with preexisting conditions higher premiums. To appease private insurance companies, the act also requires all citizens to obtain healthcare coverage or pay a financial penalty (the mandate), and thus by weight of numbers subsidize coverage for low-income individuals–which, according to statements made by Supreme Court justices during the April hearings, the Supreme Court is likely to find unconstitutional.
ACA could be implemented without the individual mandate, except that costs are rising rapidly (and have been for decades) and each year more Americans—now totaling 50 million—are becoming uninsured. Requiring health insurance companies to cover everyone without price discrimination—and with no mandate—would accelerate health insurance inflation and push millions more Americans out of the private health insurance system. But that won’t stop them from going to emergency departments (EDs), which by another law must treat them. When people can’t pay EDs and hospitals, uncompensated care costs will rise, and so will charges to insurance companies, causing costs to skyrocket. At that point, Americans would have a choice: Watch people without health insurance suffer and die, or finance health insurance for them by extending government-run programs, most likely Medicaid, to the entire uninsured population. No matter how poorly government programs were run, millions of Americans currently insured by their employers would find themselves without insurance as employers will opt out of private insurance due to skyrocketing costs; this would leave employees with little choice other than the public option. Thus, America would be backed into a single-payer system—perhaps ultimately one much like Medicare.