ZeroHedge has a pretty fair Q&A on the ACA, the Supreme Court’s options, and the likely fallout. Here’s the part I agree with most:
Congress seems unlikely to quickly intervene to “repair” whatever changes the Supreme Court might order. The most important obstacle is political–the original law was passed when Democrats held the White House and both chambers of Congress, including a 60-seat majority in the Senate for most of the time the legislation was considered. This allowed them to make policy changes beyond the scope of what appears likely in the foreseeable future, when neither party appears likely to have much more than a slim majority in either chamber of Congress and a divided government is very possible. A second obstacle is fiscal–if the court strikes the mandate or even the entire law, it seems likely that lawmakers will be more interested in deficit reduction and less focused on coverage expansion than they were when the legislation was first drafted in 2009.
The front loading of revenues and the back loading of costs also means that any adjustments will be done with real numbers and therefore will be more difficult to pass. The fraud of shifting costs years into the future has significantly played out and is no longer available to the political branches.
I am assuming repeal with no replace. I have never seen Republicans do deficit reduction when they hold the presidency. Oops, not true. Debt, as a percentage of GDP did drop a bit under Ford and Nixon and Ike.
Steve