How the US Supreme Court rules Thursday on the health-care reform law will have a profound impact on millions of American families. Here's a look at potential rulings and their respective outcomes.
When it hands down its major ruling Thursday, the US Supreme Court will render judgment on an issue that carries a direct impact for millions of American families.
Skip to next paragraphThe matter in question is President Obama's health-care reforms, often known as the Affordable Care Act, or ACA.
The law seeks to expand health insurance coverage by requiring individuals to purchase it, and requiring insurers to offer coverage to all comers.
Will the Supreme Court find that mandate on individuals to be unconstitutional? Will a portion of the law that would extend Medicaid to more low-income families be axed? Will the entire law be struck down?
The answers that will come Thursday will have a broad impact on households across the nation, although the repercussions will vary greatly by family circumstance.
For the roughly 50 million Americans who are uninsured, the court's ruling has the biggest implications. For the majority of citizens who currently have insurance, the ruling could mean some important changes as well, such as to their health plans or their personal tax rates.
Here are some scenarios to consider:
Individual mandate is struck down

Even if the individual mandate is ruled unconstitutional, millions of the uninsured would still gain health-care coverage if the ruling leaves the rest of the law intact.
That's for two big reasons. One, the law contains a major expansion of Medicaid for low-income households – those with incomes up to 1.3 times the official poverty level. The second factor is the law's system of tax subsidies, designed to help more Americans afford health coverage.
Consider a working-age family of four, with an income of $60,000 and no earner covered by an employer-based health plan. According to a "health reform subsidy calculator" created by the Kaiser Family Foundation, which tracks US health-care policies, this family would reap a tax subsidy of $9,308 if they buy insurance in 2014. That would cover most of a total premium cost of $14,245, perhaps putting health insurance within the family's financial reach.
But without the "stick" of an individual mandate, this "carrot" wouldn't prompt all households to fully insure themselves. To take the family in the example just given, they would still face a sizable premium (nearly $5,000), plus the prospect of additional out-of-pocket expenses, capped for this family at $6,250.
For comparison, the typical US household in 2010 had total spending of $48,109, with $3,157 of that for health care, according to a survey by the US Labor Department.
But the subsidies would nudge more families to get insurance. (The law provides for people who don't have an employer-based plan to shop for insurance on "exchanges" set up at the state level, with coverage plans ranging from "bronze" to "platinum." The Kaiser Family Foundation's calculator focuses on the cost of a "silver" plan.)
Note this: The subsidies are designed to phase out as household income rises, so the family of four would see the cost of health-insurance jump once their income exceeds about $93,700 – making them ineligible for federal subsidies.
Individual mandate is upheld, along with whole law

If the court upholds the individual mandate, the overall number of insured Americans would rise more broadly, compared with the scenario above. The law would push families to either pay for coverage (generally with help from the tax subsidies) or pay a fine.