Supreme Court Obamacare Decision: What's at Stake

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The Supreme Court is set to render its decision on the constitutionality of the Affordable Care Act, aka Obamacare, in the coming days. It's been two years since the bill was signed into law, so it seems prudent to take a look back at the variety of features the law contains.

The act is rather long; you can read it here in its entirety if you're having trouble sleeping. Or you can improve your health by printing it out and using the bound copies as weights for curls and bench presses. I'll focus on the parts that affect companies you might be invested in and ignore the government-specific changes like cracking down on Medicare and Medicaid fraud.

Health insurance
Most of the Affordable Care Act affects health insurers like UnitedHealth Group (NYSE: UNH  ) and Aetna. Many of the changes have already gone into effect:

  • Coverage for young adults to stay on their parents' insurance until they turn 26.
  • Certain preventive services are covered without charging a deductible or copay.
  • Preventing insurers from rescinding coverage for errors or technical mistakes on an application after a customer becomes sick.
  • The ability to appeal insurance companies' decisions.
  • Removal of lifetime limits on essential benefits like hospital stays.
  • Insurers must cover pre-existing conditions for children.
  • Minimum percentages of premiums that insurers must pay out for services.
  • Elimination of increased payments for privately administered Medicare Advantage plans over standard Medicare.

Most of those are fairly minor and can be passed onto customers in the form of higher premiums. The last two definitely cut into insurers' bottom lines.

In the future, assuming the Supreme Court doesn't strike down the entire law, we'll see two big ones that are substantially more costly:

  • Annual limits on insurance coverage being phased out starting in 2014.
  • No discrimination due to pre-existing conditions for adults starting in 2014.

To help curb the cost, the most controversial part of the law mandates that all individuals have health insurance coverage beginning in 2014 and instills fines for individuals who can afford insurance but choose not to. There are also fines for certain businesses that don't offer health insurance to their employees.

More ways to foot the bill
Medical device makers like Medtronic (NYSE: MDT  ) and Boston Scientific (NYSE: BSX  ) are set to pay 2.3% tax on medical devices they sell starting in 2013. The House passed a bill repealing the measure this month, but it isn't expected to get through the Senate, so the companies will have to hope for a full repeal by the Supreme Court to get relief from the tax.

Drugmakers like Pfizer (NYSE: PFE  ) and Merck (NYSE: MRK  ) are also on the hook for some of the cost, but their "tax" isn't as broad. The companies agreed to offer discounts to seniors in the "doughnut hole," the time after Medicare Part D prescription drug coverage is removed before catastrophic coverage kicks in. Seniors were paying 100% of the cost of the drugs in the interim period each year, but with the discounts, the cost for seniors starts at 50% for brand-name medications and drops to just 25% of brand-name costs in 2020.

The Supreme Court releases its decisions when it's ready. The current term is set to end at the end of June, so we should hear shortly. Opinions are generally released on Mondays, but sometimes on Wednesdays or Thursdays as the term winds down. Assuming the opinion isn't handed down tomorrow, Monday appears to be the most likely day for a decision, but the Court has other cases to render opinions on, so the decision could get pushed back to Wednesday or Thursday of next week.

If I were a justice, I'd certainly save the controversial one for last and quickly slip out of town.

Up next
The Fool will have full coverage of the decision, point to how you can profit before the decision, and lay out what you need to know once the decision is handed down. Check back here, where we'll list all the Fool articles on this hot topic.

While you're waiting, check out the Fool's free report, "These Stocks Could Skyrocket After the 2012 Presidential Election," where you'll get ideas for companies in health care and beyond that can benefit from each candidate's platform. Get your free copy by clicking here.

Additional Foolish coverage

Fool contributor Brian Orelli holds no position in any company mentioned. Click here to see his holdings and a short bio. The Motley Fool owns shares of Medtronic. Motley Fool newsletter services have recommended buying shares of UnitedHealth Group and Pfizer. The Motley Fool has a disclosure policy.

We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. Try any of our Foolish newsletter services free for 30 days.

Read/Post Comments (38) | Recommend This Article (57)

Comments from our Foolish Readers

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On June 20, 2012, at 5:45 PM, souht wrote:

    The article is fine as far as it goes but it fails to really address the nationalization of health care. Whether you consider this good or bad, the regulation of health care provided by employers (even if they are self insured) and the current eligibility levels for exchanges means ultimately that no employer will be able to afford to provide insurance because the healthy people will all run to the exhanges. And most of the people in many industries will be subsidized when they move given the 4 times poverty level eligibility rules. If you think health care with the efficiency of the Transportation Services Administration and the compassion of the Internal Revenue Service is a good idea, then this seems fine.

  • Report this Comment On June 20, 2012, at 5:54 PM, gensosad wrote:

    Oh So Sorry, BUT Affordable Care Act is the very best thing for "our" country. Sometimes you have to look at the good instead of your greed.

  • Report this Comment On June 20, 2012, at 5:56 PM, souht wrote:

    If you can't attack the logic, attack the person?

  • Report this Comment On June 20, 2012, at 6:01 PM, xetn wrote:

    Fact: there has never been a government program that did not get much more expensive and much less efficient. Just look at the USPS. The only reason it is still around is because they have a government monopoly on 1st class mail. Even with the monopoly, they consistently lose 10 plus billion annually.

    Or, take another example from the Medicare program which stated that it would never cost more than $12 billion per year. It now has unfunded liabilities exceeding $25 trillion as of June 2011.

  • Report this Comment On June 20, 2012, at 6:04 PM, 1spring wrote:

    How about " the compassion of an insurance company"?

    the compassion of a hedge fund?

    medicare has been efficient and delivered needed services. the new law will be for of the same.

    not single payer, but better than nothing.

    do see mike moore's movie on healthcare. it has good information. get past the spin and listen

  • Report this Comment On June 20, 2012, at 6:09 PM, georgetag wrote:

    I guess it's the best thing for this country if you want it to go in the direction of Europe.

  • Report this Comment On June 20, 2012, at 6:13 PM, xetn wrote:

    Yeah, socialism! But that is not the right term: it is fascism: private ownership of the means of production with government control.

    It seems we fought a war to end fascism (Italy and Germany) while FDR was actually incorporating those same policies (minimum wages, gold confiscation, production boards (to limit competition), agriculture price supports, wage and price freezes).

  • Report this Comment On June 20, 2012, at 6:15 PM, souht wrote:

    You are entitled to your opinion and Mike Moore as your advocate. But the "affordable" care act will not be affordable. We already spend almost 16% of our GDP on medical care which is more than any European country I am aware of. An suprising portion of that is medicare which is not efficient. It may be needed but it is not efficient. As a plan administrator for health care plans covering over 4000 employees and 10,000 people, the Act "dumbs down" health care the same way we have dumbed down education. We used to have the best education system in the world. I am afraid that several years from now, we will be saying the same thing about health care.

  • Report this Comment On June 20, 2012, at 6:22 PM, EBerg13 wrote:

    Everyone needs health care at some point in their lives ... and those who have problems have a harder time getting it. If the mandate to purchase it is struck down and the rest stays law, the next step is single payer (just ask a Canadian what they think of OUR system) because health insurers will go out of business. This is the best compromise, but far from what we need.

  • Report this Comment On June 20, 2012, at 6:38 PM, chris293 wrote:

    Competition and capitalism would work if government would quide rather than try to control the business aspects of the medical industry. We have the best(?) medical industry, not the cheapest. What real medical breaktroughts are happening in the rest of the world ? These thoughts are true for practical all our industries that some (i don't want to get in trouble) groups play with. Remember, beware of the person who reads one book.

  • Report this Comment On June 20, 2012, at 6:38 PM, sulli92786 wrote:

    Affordable health care is what the country wanted and the #1 reason we voted Obama in office. Now that he has done what we asked....many are complaining.

    The individual mandate is necessary to keep the program afloat. I'm sorry but I have a problem with being concerned about the big insurance companies making unrealistic profits on the backs of the Americans.

    It is time the government do something to make sure EVERYONE has access to affordable health care.

  • Report this Comment On June 20, 2012, at 6:40 PM, Kerroj wrote:

    It's funny how some people think this health care law is such a bad socialist concept (oh, but wait, wasn't this a Republican idea to begin with?:

    And hypocrites like Rick Santorum are so against it yet he ,being a millionaire, laments how he has to pay for his special needs child out-of-pocket because his insurance company won't pay.

  • Report this Comment On June 20, 2012, at 6:51 PM, Jomo01 wrote:

    Can we all just agree that a single payer system is best? That places like Cuba and Canada have better healthcare outcomes than we do. That it's cheaper to do it the single payer way. It's not perfect, but it's better than what we have. Sure, it's socialism, but not all parts of socialism are bad, just like all parts of capitalism aren't great. OK, glad we could agree.

  • Report this Comment On June 20, 2012, at 6:59 PM, BHOmustGO wrote:

    Something doesn't compute here.

    How can one be for Obamacare and at the same time do their due diligence in researching stocks prior to making their buy/sell decisions.

    With just a modicum of due diligence in reviewing the key aspects of Obamacare (ie. 16,000 new IRS agents to be employed, as one example) how can anyone be in favor of Obamacare knowing the 1 out of every 7 Dollars will be taken over by your kind, benevelent government, ruin the health industry and eventually put all the health insurance companies out of business with the single payer program. DO YOU REALLY WANT THIS? And once the government accomplishes this then they will be able to tell you how to live your life and what to eat if you expect to receive any medical care.

  • Report this Comment On June 20, 2012, at 7:01 PM, Chontichajim wrote:

    It doesn't help to have the best surgeons, best biotech research, and greatest medical devices in the world if many in the population can not even get care.

    Nearly every developed, and many developing countries in the world provide some form of universal coverage which may be 100% private (e.g. Japan) to almost 100% public (e.g. Britian). It is time to stop hiding behind excuses like "socialism" and force our representatives to make the bill better rather than killing it.

  • Report this Comment On June 20, 2012, at 7:15 PM, barbiee01 wrote:

    You may have left out one small item...What is this bill going to end up costing us as tax payers in the long run? I think that is part of the package to know.

  • Report this Comment On June 20, 2012, at 7:32 PM, verdure wrote:

    I'm hoping the Supremes strike it down so we can have single payer system like Australia. it isn't socialis -, health care providers remain independent, its just that health insurance is no longer for-profit. Employers can compete with international companies because they are no longer weighed down with health costs and entreprenuers can safely start businesses and succeed or fail because they won't be wiped out if they or someone in their family has a health problem.

  • Report this Comment On June 20, 2012, at 7:39 PM, harrydweeks wrote:

    Hey Fools ..... Can you give us readers a list of companies that you feel will be hurt if this bill passes?

  • Report this Comment On June 20, 2012, at 8:35 PM, tomsin wrote:

    I have read almost all comments and i think, socialism is good for medicare as Life is utmost important even than capitalism. Capitalism has only one weakness that capitalism doesn't belong to one country , the day these business honchos will get better and cheaper employees , they will take the first flight to other countries and that's what they did in last two decades and millions people lost jobs and if those people will not even get healthcare, what is the use of such capitalism. Capitalism is hit hardest by the innovation of internet which outsourced all jobs over internet to cheaper countries. Till now , Asia was the hottest destination for outsourcing, next will the African countries.

    Good luck

  • Report this Comment On June 20, 2012, at 8:54 PM, CMFStan8331 wrote:

    Capitalism is a good healthcare model only if we are willing to allow people who don't have the means or wisdom to purchase adequate insurance coverage to die. As soon as we refuse to turn people away from the ER for insufficient health insurance, we seriously compromise capitalism as a model for the provision of medical services.

    If we did allow folks with inadequate insurance to simply die, our healthcare system would be far more efficient. I would not be interested in living in a society that made that choice.

  • Report this Comment On June 20, 2012, at 8:58 PM, luckyagain wrote:

    The Supreme court will probably just declare the act unconstitutional on 5 to 4 vote. Since the Supreme court justices are really smart, they will find something in the Constitution that supports their viewpoint, no matter which way they decide to rule. After all corporations are almost citizens now. I just wish that our "corporate" citizens could be drafted into the military when our next war comes along.

  • Report this Comment On June 20, 2012, at 9:01 PM, roulette911 wrote:

    all the doctors will be altruistic. The ones that want to pay of their loans will be semewhere else. There is a new tax on selling your home. Of course it's only 4.25% of thamr over 250000. This

    may not be accurate numbers Just what I remember. The tax is real. I have seen the results of socialized medicine. A cousin of my wife had to have drugs smuggled into the hospital. Had to pay to be cared for while in the hospital and I don't mean the Hospital furnished the care. Buy the way have you experienced long lines at emergency . They will be longer. I have many more issues with Obamacare but am going to stop now

    Bob Curtis

  • Report this Comment On June 20, 2012, at 11:33 PM, sheldonross wrote:

    A) This is just another form of government intervention punishing success.The people that have worked hard and achieved get to pay more, and subsidize the people who have made poor decisions. Yes it's a tax on medical devices largely covering it, but the people that can pay for these do, and the same applies to the people behind the company developing them.

    B) I'm always amazed the the rose-colored glasses everybody views these issues with. For every time that "little old lady" cannot afford her pills, there's some white / black / brown trash living in ghetto/trailer house. They're smoking two packs a day, and downing a six pack a night. Harsh, but you're lying to yourself if you believe there's not truth in that. Or possibly every other place in the US is pristine and everywhere I've lived is an exception.

    C) This is just obfuscated socialism mixed with fascism; rerouted through more bureaucracy.

    If it were opt out, or non-profit - though I have issues with that as well - I'd be ok with it. Insurance companies make money by ensuring that the AVERAGE payer pays more into the system than they take out. Otherwise it's unsustainable. So what most people don't realize is that it's a form of gambling. You're placing a bet that you're going to be the exception (expensive care) and end up beating the house. Now we're all being forced place our bets. But I guess it's Keynesian in that since, we'll support the government and insurance companies by digging holes.

  • Report this Comment On June 20, 2012, at 11:58 PM, demotu wrote:

    As a practicing surgeon in a remote rural area and caring for an equal mix of well insured, medicare and truly indigent with virtually no resources, I am appalled that we tolerate siphoning off of 28-30% of our health care dollars for insurance company profit. Those of you who throw about uninformed opinions about medicare efficiency should look into the fact that it is extremely efficient with a low operating cost few private companies ever achieve. Simply by virtue of its' size it is vulnerable to fraud and does require a large workforce to prevent and combat that. Yes, it can occasionally be difficult to work with, but I have yet to work with a private insurance company that is anywhere as simple to work with as medicare. I am, like the clear majority of my colleagues, convinced that we need single payor health care to accomplish excellent health care delivery for all at a cost we can afford.

  • Report this Comment On June 21, 2012, at 1:12 AM, KROMNOVA wrote:

    Does anyone here have any existing major health problems, lost their job and and used up their COBRA health insurance and then triy to get health insurance? Good Luck!

    This is not all about money. It's about being a compassionate country and taking care of each other. I do not live in a gutter and shoot up all day. I am not lazy either but shi#$@ happens to the best the best of us.

    Insurance companys will lobby as hard as they can to make all the money they can. They don't care about peoples health. It's all about the bottom line so they don't want to insure people people with existing health problems.

    The Supreme Court will go down party lines again. By the way, who pays for their healthcare insurance?

    I am for single payor healthcare and agree with "demotu".

  • Report this Comment On June 21, 2012, at 1:59 AM, spex101 wrote:

    I would maintain that the current health insurance business model, as practiced by insurance companies, is not sustainable in the long run.

    The cost of healthcare is increasing at twice the rate of inflation, or more. So insurance premiums need to keep pace. Wages are increasing at a rate less than inflation so more people can't/won't afford insurance every year. Then there are the increasing number of people with pre-existing conditions.... The relationship between the increasing cost of insurance and the decreasing number of people that can/will pay for insurance is known as a positive feed back loop.

    Positive feed back loops are very difficult to stop once they get going and they accelerate slowly at first then very quickly. So at some time in the near future there will be a very few, very wealthy people who will be insured. The insurance companies will have increasing margins on decreasing subscribers. Not a prescription for making money in my book.

    I don't see competition between insurance companies making much of a dent in this scenario. Actuarial tables are pretty much cast in stone. The best use of them, as far as insurance companies go is to determine how much to charge and, more importantly, who not to sell to.

    I might add that insurance companies are very much aware of this problem. They need to have some way of forcing more people to buy insurance. It is the only way that they can continue to make money.

  • Report this Comment On June 21, 2012, at 7:26 AM, JimJam18 wrote:

    No one ever considers that healthcare is expensive because Americans are incredibly unhealthy and overweight and diabetic eating vast quantities of unhealthy, factory processed foods: too much meat, sugar and sweet drinks, not enough exercise. Crummy diets - fast food, politicians wolfing down cheeseburgers and cokes. Human kind evolved from hunter gatherers. They had to run for their it's drive ups, and pills to cover the consequences.

  • Report this Comment On June 21, 2012, at 7:37 AM, XMFBiggles wrote:

    @ JimJam18 -

    We actually covered the role of unhealthy food in the cost of health care earlier this month. You can find the article here:

    - Alex

  • Report this Comment On June 21, 2012, at 8:15 AM, SAMSCREEK wrote:

    Frankly, I don't understand why the government doesn't utilize the many VA Medical Centers

    scattered thru out the country. I retired from the

    VA, and remember at one point it was talked about utilizing the network of hospitals for national medical care for medicare, to reduce the cost of


    There is 150+ hospitals and numerous satelite

    clinics. Why can't these facilities be used to

    take care of the uninsured and /or people with

    severe disease or disabilities and remove the

    stress from state, local and private hospitals.

    I'm sure it would be cheaper than requiring

    everyone in the USA to purchase insurancce.

    If you wished to use the VA, you could pay a small

    insurance premium each month. If you are

    poor and couldn't afford the premium, it would be

    free, or you could have your own private insurance. It would be your choice as to having

    insurance or not.

    Just a suggestion. I'm sure it could be tweeked

    to help everyone without forcing people to buy

    into a gov't run program built on a ponsy

    scheme like Obamacare.

  • Report this Comment On June 21, 2012, at 8:22 AM, trdhrdr007 wrote:

    If health insurance costs $12,000/year, the fine for not having health care is $2500 & you can't be denied coverage for pre-existing conditions why would anyone buy insurance?

  • Report this Comment On June 21, 2012, at 10:04 AM, howboutme wrote:

    Its all going to boil down to one thing; as the government takes more control of the individual's life and more of their freedom (whether it is through their financial well being or their decision making) the people will need to fight back or becomes slaves. Since we went through the slavery process once before the only forseeable future is the good old revolutionary war. The people will have to fight back even if it comes down to hand-to-hand combat versus marking a piece of paper at election time. This is what your children will remember when they go through it, just like your ancestors before you.

  • Report this Comment On June 21, 2012, at 10:08 AM, menudomighty wrote:

    Comments on comments:

    - while we do have the lead in medical equipment innovation, the U.S. has had one of the worst medical care systems in the developed world for many years; mostly wealthy people in this and from other countries can access them

    - Yes, the PPACA mandate was a Republican idea in '93; they are only against it because Obama is now for it

    - the PPACA is neither socialist or facist (see "the dumbing down of America" above)

    - the Supreme Court justices are all very intelligent, just not always smart

    - not all poor people are poor due to bad decisions unless you count how they picked their parents or where they were born or what state they were educated in

    - a big part of the massive increase of insurance premiums can be traced to when BC/BS lead the parade of medical insurance companies transforming from non-profit to for-profit; a return to non-profit medical insurance would solve a lot of coverage issues

    - a big part of the increases in the cost of medicines can also be traced back to when drug companies started advertising prescription drugs

    - insurance company overhead is in the range of 1-3% in other developed countries with a form of universal health care; the range in the U.S. is 20-25%

    - I'm all in favor of true capitalism; our current healthcare system gives it a bad name

  • Report this Comment On June 21, 2012, at 10:12 AM, r2d23333 wrote:

    What's not been addressed in these comments is the political problem that there's no agreement. Because of this, I oppose repealing Obama care until those who want to repeal it put forward their fix.

    To those focused on "fascism" and "socialism", please answer these questions: Does this mean you want the repeal of Medicare and Medicaid too? Do you think the free market can or will offer affordable health insurance to the elderly?

    Regarding the cost of medical care, the public needs to recognize that the wonderful technological advances over the past few decades have made medicine more effective and also far more expensive. New technology is not cost saving in the case of health care!

  • Report this Comment On June 21, 2012, at 2:57 PM, 48ozhalfgallons wrote:

    Single payer is best, and I mean the single payer is the one who requires the service. It is the most efficient concept. No middle men. No income redistribution. Health expenses would level to demand. No wait = high price or poor practice. Long wait = low price or best practice. Poor health will cost more as it does today. Having children will be more expensive than not having children as it is today. Birth rates among rapidly increasing population sectors would likely fall. Nearly all medical costs would fall, but never below market. Medical practitioners could charge what their talent and skills command in the market place. The rich would have abundant care as they have now. The poor will have less care as they do now. The only change will be that the percentage of GDP allocated to medical care will decrease. The other single payer plan is second best, but will require life style mandates from society. Third party payer is worst.

  • Report this Comment On June 21, 2012, at 3:29 PM, JF125780 wrote:

    1. Catastrophic illnesses and accidents should be paid for directly by the Fed. with no insurance company involved (expand V.A. to cover (predefined) what is deemed catastrophic).

    2. The then smaller health care insurors would write the private or group policies to cover routine physical exams, nonlife-threatening diseases, innoculations and low risk surgeries such as an appendectomy.

    3. Any person who is child bearing age should purchase a rider policy to to their general health care policy to cover prenatal care, delivery, and postnatal care since PREGNANCY IS NOT A DISEASE, BUT A CHOICE.

    4. Obama care is really not a workable option.

  • Report this Comment On June 21, 2012, at 3:41 PM, bastande wrote:

    Thanks guys for your opinions. As a Medicare benefits specialist and a Certified Senior Advisor and insurance broker out in the field, I see a little truth in all of this. While I work with veterans as well who have fallen through the cracks and despise the VA, I also see those that really benefit from it too. I work with Estate Planners because the smart ones know that Healthcare is an important part of your estate planning. I am a capitalist with a socialist leaning, since I sit at many tables in rural areas listening to widows cry about how to eat and have healthcare. What we have is not working. Medicare is working although it may be expensive to maintain. Healthcare costs is one culprit here. I also have to tell many people I can not find them affordable health insurance. The only alternative is the health department (government) or the emergency room. Either way costs are passed on to us the tax payer. There are so many being turned away by Medicaid and help for low income now because they may bring in $50 over the limit. While you may think bureaucracy is bad, I work with the free legal aide agencies and the other agencies whose staffs and budgets have been cut to the bone and who try to help an avalanche of desperate people. God bless the rural doctor, because I know they write off a lot of what they do. Of course, it is my commissions getting cut by the insurance companies to comply with mandates in the new law. I don’t see top brass salaries taking as big a hit.

    Reform needs to happen. Why not take this law and make it right? My fear is politics will always get in the way of what is truly best for our people.

  • Report this Comment On June 21, 2012, at 4:54 PM, saron1 wrote:

    While most new coverage will add costs to insurers, there are three big incentives for them to reduce prices...

    1) paying out a % of premiums

    2) Private exchanges where they must bid against each other on services and costs

    3) killing their incremental revenue stream on Medicare Advantage - so they must compete on the value of standard Medicare services

    The second is a version of getting insurance across state lines - which the republicans always wanted. The mandate also gives them 30 million new insured.

  • Report this Comment On June 22, 2012, at 4:43 PM, xetn wrote:

    The problem with the existing health care system:

    The AMA: which has the exclusive power to grant accreditation to medical schools with the effect that there are not enough which limits the number of doctors.

    The FDA which effectively draws out the time required to get new drugs approved (This could be replaced with private testing labs).

    50 States with 50 insurance commissions regulating all insurance products which requires massive amounts of insurance company personnel devoted to wading through the individual regulations.

    The inability to create separate risk pools which means that healthy people are subsidizing unhealthy people, which drives the cost of all policies up.

    There are many other problems that drives up the cost of medical care, too numerous to mention.

    In a free market, there would be no government regulations, no state insurance departments and no AMA limiting the number of doctors. I could go on and on but the simple fact is this country (US) has gotten addicted to government handouts and nobody wants to pay for themselves nor take personal responsibility for their mostly unhealthy lifestyles.

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