As the nation awaits the U.S. Supreme Court decision on President Barack Obama’s health care reform, it is hard to say how Maryland would be affected if all or some of the federal law were struck down, state policymakers say.

Some provisions of the Patient Protection and Affordable Care Act have been in effect for more than two years, while others are scheduled to be phased in through 2020.

Many state residents already benefit from aspects of the law, Maryland Health Secretary Dr. Joshua Sharfstein said Thursday. The beneficiaries include seniors who are getting prescription drugs because of federal aid tied to the law; young adults now eligible to remain insured under their parents' health plans; and high-risk patients who otherwise would not qualify for insurance.

It's not easy to know what the court might do — the justices are expected to issue their ruling by the end of June — or what the state would be facing, including if federal funding for health exchanges gets cut, said Sharfstein, a physician. Regardless of the court's decision, "there's a broad commitment to see expanded access [to care] and to improving quality [of care] and outcomes" in Maryland, he said.

Separate bills approved in Maryland's House and Senate would establish a health benefit exchange and a process for contracting with insurance carriers to sell essential health benefit plans, which the federal law would require most individuals to purchase if they are not covered by another plan.

Each bill is yet to be acted on in the other chamber.

Maryland legislation defers until next year the decision on whether state funds would be used for the plan, Sharfstein said.

"It has been our goal to be where we need to be but not further ahead," he added.

If the court throws out the federal law's mandate that almost everyone must buy insurance — which is fundamental to spreading the risk and financing the plan — that could create a problem for a state health benefit exchange, said Del. Kirill Reznik (D-Dist. 39) of Germantown.

It could tempt some who buy insurance now to wait until they were sick and needed coverage, because they could, Reznick said.

Although physicians' concerns about how the exchange would work in Maryland mostly are addressed in the state's proposal, undoing any part of the federal law would add even more "uncertainty in the marketplace" for doctors, including how to equip and run their practices, said Gene M. Ransom III, CEO of MedChi, the Maryland State Medical Society. Physicians still are depending on temporary patches to offset scheduled cuts in Medicare reimbursements, he added.

Only a handful of Democrats voted against the plan to set up a Maryland health benefit exchange. Most opposition came from Republicans, who have said there's no reason, except Democrats' desire to support Obama in his re-election bid, to pass legislation in Maryland with the court still weighing the fate of the federal law.

"It's ironic, the same people [conservatives] who are against [the individual mandate] now for political reasons" offered the idea in the 1990s as a way to maintain private health care delivery, Reznick said.

mhyslop@gazette.net