The nexus of health reform and the law: few congressional bills have been as expensive, extensive or explosive as the protection and affordable care act of 2010. Will the landmark health reform legislation pass supreme court muster?

• Author: Ladd, Scott
• Position: Health care

Two years ago, a Congress bitterly divided along party lines passed the landmark Patient Protection and Affordable Care Act. The sweeping health reform overhaul bill, weighing in at roughly 2,000 pages, touched off a sustained national debate over the government's role in health care cost and delivery, whether individuals should be required to purchase insurance coverage and the potential impact on and cost to American businesses.

Later this month, the controversy lands on the doorstep of the U.S. Supreme Court, with the justices scheduled to hear arguments on the legality of the individual mandate and other aspects of the bill--or decide whether any adjudication of the law is premature, since the mandate doesn't take effect until 2014.

The stakes, industry observers and analysts say, are quite high--legally economically and politically. The cost of the legislation could near $1 trillion in additional costs over the next decade, according to the Congressional Budget Office. Experts on both sides of the health reform aisle say the decision could have a significant impact on constitutional issues related to public policy how companies conduct business and the political landscape in what is shaping up as a busy and potentially transformative electoral year.

Karen Harned, executive director of the Small Business Legal Center of the National Federation of Independent Business (NFIB)--one of the plaintiffs in the pending case--believes a decision to uphold the law would have severe consequences for business leaders.

"The economy cannot support a weak business sector that is crippled by further regulations and costs imposed by the mandate," she says. The complaint by NFIB, which represents 350,000 small businesses, is one of two cases the Court will consider. The second is a broad challenge led by the state of Florida.

Several key elements of the law have already taken hold, including tougher federal oversight of insurers. But the chief focus of criticism (the individual mandate) is nearly two years from going into effect. Still, regardless of how the Court rules, many national health care analysts feel the momentum of health reform won't be reversed.

"I think people have resigned themselves that the law is not going to be repealed," says Paul H. Keckley, executive director of the Deloitte Center for Health Solutions. "There may be some interesting constitutional arguments, but the bulk of the law will be implemented."

Carrie Valiant, a...