The Supreme Court announced its decision on June 28, 2012 to uphold the entire Affordable Care Act in a vote of 5-4. There were many possible outcomes.
Either extreme could have happened. Instead of ruling that the entire law is constitutional, the Supreme Court could have struck down the entire act.
It seemed more likely, though, that the majority of the law would have remained intact, while parts of it — the individual mandate, Medicaid expansion — were found unconstitutional.
The parts that were most likely to be voted unconstitutional are significant, and if repealed, would have had a substantial ripple effect. For example, forcing private insurers to provide coverage to enrollees with preexisting conditions without implementing an individual mandate could have incentivized people to purchase insurance only after they get sick.
Ultimately, in accordance with the Anti-Injunction Act, the courts may not rule on the constitutionality of the government penalizing those who don’t purchase insurance until the penalties have been collected, meaning they could have chosen not to rule until after the mandate goes into effect in 2014 and taxes are assessed in 2015.
What Would Have Happened to the Affordable Care Act (ACA) If a Republican President Had Been Elected in 2012?