Health care ruling expected today

WASHINGTON, D.C. - As the nation awaits the Supreme Court ruling on President Barak Obama's health care overhaul, states across the country are considering how they will respond to the historic decision.

Some Democratic-led states vow to push ahead with various provisions no matter what happens. In some Republican territories, elected officials insist they will try to hold off on implementing the law, even if the court upholds it.

And most states are bound to miss key deadlines if the law or even pieces of it survive.

Millions of people already have received new benefits under the law. But those could disappear of it is struck down, and many states are trying to figure out what to do if that happens.

Minnesota Gov. Mark Dayton, a big supporter of the federal overhaul, extended Medicaid coverage last year to 84,000 vulnerable adults. But Dayton has said little publicly about the implications of the Supreme Court's ruling for Minnesota. That leaves many unanswered questions about the fate of the people Dayton switched to the joint federal-state Medicaid program from less generous state-funded programs.

A ruling against the law also would threaten other planned expansions, such as in Washington state, which received $128 million to help set up its insurance exchange and an additional $200 million for its preexisting-condition insurance pool. Officials are uncertain whether that money could stay with the state or would have to be returned.

In Michigan, the law has brought widespread benefits: More than half a million seniors have received some free preventive health care services this year. And 1.8 million residents now receive preventative services with no co-pay. Another 57,000 young adults in Michigan are on their parents' health insurance plans.

Last week, U.S. Health and Human Services director Kathleen Sebelius visited Detroit to announce grants for six Michigan health centers to help expand access to care under the law. Officials there aren't sure what they'll do if that money disappears.

Funding for North Dakota's 15 community health centers may be jeopardized, and three other planned centers might not be built if the federal law is overturned.

So if the court upholds the mandate to establish exchanges, many states will have to scramble to get their plans approved by January and the programs running a year later. As of March, only 13 states and Washington, D.C., had adopted plans for exchanges.