By Richard Wolf, USA TODAY
For most Americans, the Supreme Court's ruling next week on President Obama's health care law will be largely an academic exercise with political fallout - but not yet personal implications.
For millions of people, however - some young, some old, some sick - the law already is affecting their pulse rates and pocketbooks, and a decision to strike it down could come with a medical or financial cost.
Among the decisions the justices might render, such as upholding the law or striking down the mandate that most Americans get health insurance, tossing out the entire law could have the greatest impact.
That's because the law's Democratic authors purposely ensured that many popular provisions, such as covering young adults, would kick in first. Most of the $500 billion in new taxes and fees, reductions in Medicare payments to hospitals and other health care providers and mandates that individuals get health insurance become effective in 2013 and 2014.
Some insurers have said they would retain popular provisions such as keeping young adults on their parents' policies, but a court ruling that strikes down the law would eliminate both its legal basis and its funding. Though few expect the ruling to be applied retroactively, little will be guaranteed looking ahead.
"I'm just devastated that they could throw that out," says Judy Lamb, a cancer patient in Golden, Colo. "There are just so many people that need it - people like me."
Lamb, 59, has benefited from the law's ban on lifetime limits in health insurance policies. After battling breast cancer that spread to her bones and liver, she was close to hitting the $2 million limit on her husband's employer-provided plan.
Two of her children, 25 and 23, have taken advantage of the law's provision that enables young adults to stay on their parents' policies until they turn 26.
That's a crucial provision for Terrance Black, 23, an unemployed Cincinnati resident with diabetes who was without insurance until the law allowed him to get back on his mother's policy.
Black's medical expenses for insulin, syringes and testing strips were high, forcing him to accumulate debt for what his mother, a bus company clerk, couldn't pay.
"I was working overtime like crazy just to be able to afford his medicine," Marian Black says. If the law gets thrown out, she says, "I would be paying for all the medicine again."
Another beneficiary is Steven Giallourakis, who will turn 22 next month. He has been in and out of college while dealing with leukemia. At 19, he was forced to return to school soon after a bone marrow transplant, just to get health coverage.
Like Lamb, Giallourakis came close to his $2 million lifetime limit. The Cleveland resident hopes to complete college and choose a job based on interest, not insurance.
"I'm praying that it doesn't get thrown out," he says. The government has "an obligation to take care of the people who are ill and the young people who are going to be the future of the country."
Consumers, businesses face loss
In Chicago, Dan Morgridge has been helped by a provision of the law that created a temporary high-risk insurance pool for people who had pre-existing conditions for at least six months.
Morgridge, 28, spent years uninsured until severely injuring his knee, which required physical therapy. Fearing expensive surgery, he joined the law's temporary high-risk insurance pool.
As a result, he pays $192 a month and a $500 deductible, but his co-payments are capped at $2,850. Without the law, he might be unable to get insurance at all.
Despite that, Morgridge is no fan of the law's impending mandate that most people get insurance - the provision most endangered by the upcoming court decision. Once healthy, he would prefer to avoid thousands of dollars in premiums.
"I really don't have the extra funds to be putting money into a system that I'm not taking much out of," he says.
Perhaps the biggest group of beneficiaries under the law are Medicare recipients with high prescription-drug bills who fall into their plans' temporary coverage gaps. The law is gradually reducing the amount they have to pay.
Helen Rayon is among them. At 72, the Philadelphia woman was paying about 75% of the cost for her diabetes medicines - money that "could have paid for the gas for my car." Now she gets a 50% discount. She also takes advantage of free annual wellness exams and preventive screenings in Medicare.
"It gives you peace of mind to know that we have this coverage," she says.
Small-business owners are cashing in on the law's tax credits, which go up to 35% of their health insurance premiums. Starting in 2014, the credits will rise to 50%.
In Chattanooga, Tenn., John Sweet used them to offer health coverage to all 25 employees at Niedlov's Breadworks, rather than just the managers. If the law is killed, he says he won't renege on that deal.
"I don't want to take a step backward in what I am offering my employees," Sweet says.
In Lincoln, Neb., Dan Nelson and Cory Lyons used the tax credit to pay half of their employees' health premiums, rather than just offering $50 a month.
"It puts about $20 every two weeks into each employee's pocket," Nelson says. If the law is overturned, he says, they may have to revert to the lesser contribution.
Taxes, regulations may be erased
Not everything about the law has been positive. A court ruling striking it down would wipe out the taxes, regulations and potential insurance premium increases that critics cite as reasons to oppose the law.
•Taxes and fees: Only a few of the $500 billion in new taxes and fees have become effective, and far more are scheduled to kick in next year. But some drugmakers already are paying higher fees, and corporations and oil companies also have seen their taxes rise.
"The vast majority of these revenue raisers have not gone into effect yet," says Robert Laszewski, a private health care consultant. "They tend to parallel the time stakeholders will be getting new offsetting revenue when the 30 million more people show up with insurance cards in 2014."
•Regulations: States and private employers have had to comply with federal regulations and prepare for the introduction of new products and policies, including the health insurance "exchanges" scheduled for 2014.
"The regulatory burden has been real," says Douglas Holtz-Eakin, president of the conservative American Action Forum, who led a group of economists in filing a brief opposing the law in the Supreme Court.
•Insurance premiums and cancellations: The insurance market changes have caused health insurers to raise premiums by an average of 1.5%, according to Aon Hewitt, a human resources consulting firm. Some insurers have left the market rather than deal with new rules that reduce allowable overhead to 15%-20% of premiums.
If the court strikes down the law, many insurers "will maintain important patient protections," says Karen Ignagni, president of America's Health Insurance Plans, the industry trade group. "Consumers and employers will continue to have the option of purchasing coverage that includes many of the benefits they have today."