!I know there’s a lot of anxiety about the upcoming Supreme Court decision on healthcare reform. But figuring out how to deal with the impact starts with understanding what, exactly, the court might decide.

Basically, there are five likely scenarios. Since I’m CEO of our insurance company and Freelancers Union is the sponsor of new, reform-funded, nonprofit, member driven health CO-OPs in Oregon, New York, and New Jersey, I’ve been thinking about this a lot – and about how we can make sure freelancers get best served regardless of the outcome.

Here is my sense of the paths the court is likely to take:

  • Uphold the entire Affordable Care Act (ACA)
    • Individual mandate begins in 2014
    • All other ACA insurance market reforms begin in 2014
    • State exchanges begin operating in 2014
    • CO-OP funding remains
  • Court defers decision until 2014
    • Individual mandate begins in 2014
    • All other ACA insurance market reforms begin in 2014
    • State exchanges begin operating in 2014
    • CO-OP funding remains
  • Individual mandate struck down but all other provisions of ACA upheld
    • No individual mandate
    • All other ACA insurance market reforms begin in 2014
    • State exchanges begin operating in 2014
    • CO-OP funding remains
  • Individual mandate and insurance market reforms struck down but all other provisions of ACA upheld
    • No individual mandate
    • No federal guaranteed issue (aka the "pre-existing conditions" clause) or other ACA insurance market reforms in place. But New York's guaranteed issue rules continue to apply.
    • State exchanges begin operating in 2014
    • CO-OP funding remains
  • Entire ACA struck down
    • No individual mandate
    • No federal guaranteed issue (aka the "pre-existing conditions" clause) or other ACA insurance market reforms in place. But New York's guaranteed issue rules continue to apply.
    • State exchanges do not begin operating
    • Additional CO-OPs will not be funded (though CO-OPs that have already been awarded funding, like the ones sponsored by Freelancers Union, will continue to move ahead)

No matter what, enrollees of Freelancers Insurance Company will be OK. They are largely insulated from the reforms and we have spent months and years ensuring their care will remain affordable, accessible, and patient-focused.

The nonprofit health CO-OPs that Freelancers Union is sponsoring in Oregon, New York, and New Jersey are also expected to move ahead regardless of the Supreme Court decision. The federal Department of Health and Human Services assured me that we have an executed document that ensures funding of the CO-OPs regardless of the court outcome.

Basically, we just plan on forging ahead. And so should you. Because the truth is our healthcare system is failing -- it’s isolating, it’s focused on short-term profit, and it is not focused on the patient.

We need a new model that echoes the origin of insurance – people joining together to make sure they have each others’ backs when times get tough.

Freelancers recognized this early on. It was only when they joined together as a group that they could leverage their own power.

Solidarity works. And that is our touchstone moving ahead.

If you have other questions, please tweet me at @Sara_Horowitz and I’ll answer the questions as best as I can. Not everything will be clear immediately upon release of the court’s decision, but you should know we’re looking out for you.

Quick glossary of terms: