Members of the general public line-up to enter the U.S. Supreme Court to listen to decisions on June 21, 2012 in Washington, D.C.
Members of the general public line-up to enter the U.S. Supreme Court to listen to decisions on June 21, 2012 in Washington, D.C. - 
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Jeff Horwich: It's hard to find an example of the Supreme Court tossing out a law, where more had already been done to implement it. If even part of health care reform is tossed out, insurers and regulators face a huge task deciding what to undo, and how.

Sara Collins researches health care reform with the Commonwealth Fund. Nice to talk with you, Sara.

Sara Collins: Nice to talk to you.

Horwich: Insurance companies have already made a lot of changes since the law was passed. Let's just take a few of these one by one: They can't exclude people, for example, right now with pre-existing conditions. What happens if that requirement goes away?

Collins: Well actually, it will be applicable to everybody starting in 2014. This is a hugely important provision. We know from our insurance surveys at the Commonwealth Fund that more than 30 percent of people who said they tried to buy a health plan in the last three years didn't end up buying a plan because they were either turned down, charged a higher price, or had a condition excluded because of their condition.

The other aspect of the law that addresses people who are uninsured who have pre-existing health problems are the pre-existing condition insurance plans that are available in all 50 states right now. About 62,000 people have enrolled in these plans since the plans were rolled out, so this is also a hugely important bridge provision in the law that will get people with pre-existing conditions through this period where we're waiting for the major reforms to start in 2014.

Horwich:Under the law, parents can now keep their kids -- up to age 25 -- on their policies. And we've heard some large insurance companies say that, regardless of what the Supreme Court decides, they plan to keep that as a part of their business. Why would they want to keep that?

Collins: This has been just an enormous benefit for young adults. Insurance companies are in line with this provision; states across the country have written this into their insurance laws and regulations. So this feels like a provision that's here to stay. It's a relatively inexpensive thing for employers to do; it does not increase premiums -- this is a young and health population. And so, this is now a benefit for employers and you would expect it to continue.

Horwich: Finally, states and the federal government have put in tremendous energy designing these health insurance exchanges, which is supposed to improve access and prices for individuals shopping for plans. Could all that work have been for nothing?

Collins: So this train is certainly well out of the station, in terms of both states and also the federal government. And we would expect to see that continue under various scenarios. If things change, many states are already so well along.

The federal financing is obviously going to be very important; about $500 billion in federal tax credits will flow through the exchanges for people. It's very important that states have these federal subsidies to help their citizens gain affordable insurance coverage options.

Horwich: Sara Collins with the Commonwealth Fund. It's going to be a wild couple of days for you, whatever happens. Thanks for talking with us.

Collins: Thank you.


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Follow Jeff Horwich at @jeffhorwich