Fifty-fifty. Those are the odds given by a prominent Atlanta attorney that the Supreme Court will uphold the 2010 health reform law. He gives...

Fifty-fifty.

Those are the odds given by a prominent Atlanta attorney that the Supreme Court will uphold the 2010 health reform law.

He gives the same odds that the justices will strike down the Affordable Care Act (ACA) in its entirety or part of the law that includes its controversial mandate for most individuals to purchase health insurance.

“The case is truly difficult,’’ said attorney Bruce Brown of McKenna Long & Aldridge, at an Atlanta conference this week held by the Georgia Charitable Care Network, an organization of charity clinics serving the uninsured in the state.

Brown, whose legal experience includes clerking for the late Chief Justice Warren Burger, said he believes the justices ‘‘will really grapple with’’ the complex law.

The court’s decision is likely to come in late June.

The stakes for Georgia and other states are high. The law, if upheld, would extend Medicaid coverage to 650,000 Georgians and private insurance to thousands more. The state’s current rate of uninsured is 20 percent, one of the highest percentages in the nation.

And a new study shows access to health care is a big problem in Georgia.

Adults in nearly every state saw their access to health services worsen during over the past decade, with Tennessee, Florida and Georgia having the greatest increase in people reporting having an unmet medical need, according to a study released Tuesday.

Kaiser Health News reported that the three states had at least a 9 percentage point jump in the proportion of adults under 65 who said they had medical needs that were unmet due to cost, according to the study released by the Robert Wood Johnson Foundation, which was conducted by researchers at the Urban Institute.

Meanwhile, the health care industry is anxiously awaiting the Supreme Court’s decision. Many ACA provisions have already taken effect, such as compelling health plans to accept children on their parents’ policies up to age 26.

Funding for many health system improvements has already been awarded through the 2010 law, including awards announced Tuesday for health care innovations. Emory University received a $10.7 million grant to build a network supporting intensive care units in rural and underserved North Georgia. It will combine specialty training for nurse practitioners and physician assistants with telemedicine intensive care services.

Emory Healthcare will partner with Saint Joseph’s Health System, Northeast Georgia Health System, Southern Regional Medical Center, and telemedicine provider Philips Healthcare to bring telemedicine ICU services into community hospitals to allow remote support, advice and supervision by experienced critical care doctors and nurses.

It’s unknown what will happen to such funding if the Supreme Court strikes down the ACA. Georgia is one of 26 states challenging the law before the court.

Brown said Monday it’s difficult to predict which way Chief Justice John Roberts and Justice Anthony Kennedy will vote. Four justices are likely to uphold the law, and three will vote against it, Brown said.

The main problem in the White House’s arguments, he said, is that there is ‘‘no clear limiting principle.’’ In other words, if the federal government can compel the purchase of health insurance, what can it not compel?

The states’ main problem is that health care is different from other markets, Brown said. “No one is young or healthy for very long,’’ and everyone needs health care at some point, he noted.

“The court, in very good conscience, could go either way,’’ he said.

Elizabeth Carpenter, a senior adviser at McKenna Long & Aldridge, presented scenarios if the law is upheld, or rejected in part or as a whole.

Even if upheld, the ACA faces an uncertain future, with changes expected if President Obama is re-elected, Carpenter said. If Mitt Romney wins, she said, the GOP focus would be on repealing the law or gutting it.

“There will still be gaps in the [health care] system’’ if the court upholds the law, she said.

But if the mandate is voided, health insurers ‘‘would be in turmoil,’’ Carpenter said. That’s because of Affordable Care Act provisions that require people with pre-existing conditions to be offered insurance at the same price as healthy people.

Insurers would have to still honor the new pre-existing condition rules, but without the addition of  young, healthier — and less costly — people required to purchase a policy under the individual mandate.

The court, though, could also throw out those insurance provisions as well, she said.

If the entire law is struck down, Carpenter said, Republicans would be empowered by the victory. But they would also face increased pressure to come up with a reform proposal of their own, she said.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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