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Possible outcomes in pivotal health care law case

WASHINGTON (AP) - Some are already anticipating the Supreme Court’s ruling on President Barack Obama’s health care law as the “decision of the century.” But the justices are unlikely to have the last word on America’s tangled efforts to address health care woes. The problems of high medical costs, widespread waste, and tens of millions of people without insurance will require Congress and the president to keep looking for answers, whether or not the Affordable Care Act passes the test of constitutionality.

With a decision by the court expected this month, here is a look at potential outcomes:

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Q: What if the Supreme Court upholds the law and finds Congress was within its authority to require most people to have health insurance or pay a penalty?

A: That would settle the legal argument, but not the political battle.

The clear winners if the law is upheld and allowed to take full effect would be uninsured people in the United States, estimated at more than 50 million.

Starting in 2014, most could get coverage through a mix of private insurance and Medicaid, a safety-net program. Republican-led states that have resisted creating health insurance markets under the law would face a scramble to comply, but the U.S. would get closer to other economically advanced countries that guarantee medical care for their citizens.

Republicans would keep trying to block the law. They will try to elect presidential candidate Mitt Romney, backed by a GOP House and Senate, and repeal the law, although their chances of repeal would seem to be diminished by the court’s endorsement.

Obama would feel the glow of vindication for his hard-fought health overhaul, but it might not last long even if he’s re-elected.

The nation still faces huge problems with health care costs, requiring major changes to Medicare that neither party has explained squarely to voters. Some backers of Obama’s law acknowledge it was only a first installment: get most people covered, then deal with the harder problem of costs.

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Q: On the other hand, what if the court strikes down the entire law?

A: Many people would applaud, polls suggest.

Taking down the law would kill a costly new federal entitlement before it has a chance to take root and develop a clamoring constituency, but that still would leave the problems of high costs, waste, and millions uninsured.

Some Republicans in Congress already are talking about passing anew the more popular pieces of the health law.

But the major GOP alternatives to Obama’s law would not cover nearly as many uninsured, and it’s unclear how much of a dent they would make in costs. Some liberals say Medicare-for-all, or government-run health insurance, will emerge as the only viable answer if Obama’s public-private approach fails.

People with health insurance could lose some ground as well. Employers and insurance companies would have no obligation to keep providing popular new benefits such as preventive care with no copayments and coverage for young adults until age 26 on a parent’s plan. Medicare recipients with high prescription drug costs could lose discounts averaging about $600.

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Q: What happens if the court strikes down the individual insurance requirement, but leaves the rest of the Affordable Care Act in place?

A: Individuals would have no obligation to carry insurance, but insurers would remain bound by the law to accept applicants regardless of medical condition and limit what they charge their oldest and sickest customers.

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