Closing arguments have concluded by the questions have just begun. Last week the Supreme Court heard 3 days of oral arguments about the legality of President Obama’s health care plan–the Affordable Care Act of 2010.

The Affordable Care Act was passed by Congress in March 2010 and signed into law by the President soon after. According to the White House website, the Affordable Care Act was intended to put in place “comprehensive health insurance reforms that will hold insurance companies accountable, lower costs, guarantee choice, and enhance quality health care for all Americans.” Implementation of the Act was to be phased in over 4 years, with the last of the major provisions set to become effective January 1st, 2015. Will the full Act ever be implemented as Obama intended is up in the air. The Supreme Court is expected to render their decision on the legality of the Act in June.

What Is At Stake?

President Obama’s plan requires most Americans to acquire health care insurance–the question is: Can the federal government require Americans to buy health coverage? CNN Supreme Court producer Bill Mears writes,”On the third day of oral arguments on legal challenges to the 2010 Affordable Care Act, the justices tackled the question of what would happen if they ruled that the heart of the law, the individual mandate that is its key funding mechanism, was unconstitutional.”

The federal government and the state governments has different powers to enact law. Massachusetts enacted a law in 2006 that requires denizens of the state to purchase health insurance, and said law was instituted under current Republican presidential hopeful Mitt Romney who was the governor of the state at the time.

If the Supreme Court decides in June that the individual mandate is unconstitutional then Obama’s health care law will be left as a toothless tiger, an amalgamation of various laws and provisions without much power to revamp the health insurance coverage landscape.

Not everyone is rooting for Obama’s health care plan; some don’t think the Act goes far enough to ensure that all Americans have health insurance and access to health care. Physicians for a National Health Program (PNHP), an organization of 18,000 physicians, students, and health care professionals, criticize Obama’s health care plan because it is not a single-payer scheme:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.
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In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

If the Supreme Court does decide to strike down the individual mandate and/or any other provisions of the Affordable Care Act, Physicians for a National Health Program will get a bite at the apple–with Obama’s Act largely out-of-the-way, perhaps the public and Congress might end up being more amenable to a single-payer plan. But there will still be the formidable issue of bounding over the legal hurdles of getting single-payer insurance mandated by a federal law. And you can bet that the same people who are attacking Obama’s law now will surely attack a single-payer mandate just as vigorously.

For now, the future of the American health care system is in the hands of the 9 Supreme Court judges.