The Obama administration maintains that its Affordable Care Act is a complex construct that’s endangered if the Supreme Court finds its central feature — the requirement that all Americans buy health insurance — unconstitutional. It’s certainly true that eliminating the “individual mandate” will immediately expose the plan as unworkable. It can only succeed by creating a broad, universal insurance pool that collects big premiums from the young and healthy. If the young and healthy aren’t required to sign on, they won’t. Hence, the pools won’t be remotely large enough to pay for the older, sicker folks who get the best deal, and are bound to flock to the state exchanges.
In reality, the reform plan’s success doesn’t depend on the Supreme Court’s decision at all. Its faulty design virtually guarantees that all the things the administration warns will happen if it loses will happen anyway. Even if it stands, the legislation will spawn insurance plans crowded with high-cost folks, driving premiums higher, hobbling competition as carriers abandon the exchanges, and leaving tens of millions of Americans uninsured.