RENEE MONTAGNE, HOST:

The outlook on Medicare hasn't changed much in the past year, according to the annual forecast released yesterday by the trustees who oversee the federal health program, which doesn't mean that Medicare is in the clear. There are growing concerns that Medicare could suffer if the Supreme Court invalidates the Obama administration's health care law.

As NPR's Julie Rovner reports, those concerns are coming from voices on both sides of the health care debate.

JULIE ROVNER, BYLINE: During oral arguments before the court last month, Deputy Solicitor General Edwin Kneedler tried to explain to the justices how striking down the Medicare provisions of the Affordable Care Act could create a mess for Medicare.

(SOUNDBITE OF SPEECH)

DEPUTY SOLICITOR GENERAL EDWIN KNEEDLER: Congress made many changes to Medicare rates that have gone into effect for the Congress - for the courts to have to unwind millions of Medicare reimbursement rates. Medicare has - has covered 32 million - preventive care visits by patients as a result of this act.

ROVNER: The justices didn't seem to pay much attention to Kneedler's plea about what it might mean to have to undo what's already been done. But outside the court, health policy experts are just now realizing how dramatic the impact on Medicare could really be. Sara Rosenbaum is a professor of health law and policy at the George Washington University.

SARA ROSENBAUM: We could find ourselves as sort of a grand stopping point for the entire health care system.

ROVNER: That's because the law, as Needler pointed out, changed the payment rights for just about every type of health care professional who treats Medicare patients. For example, just this year, there's a half-billion-dollar cut in payments to home health care providers. But all of those payment rates are based on the law. So Rosenbaum says if the law is declared unconstitutional...

ROSENBAUM: You have agencies sitting on two years of policies that are now up in smoke. Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly closing the doughnut hole might not happen. We just don't know. The list goes on and on.

ROVNER: And many of those facilities serve not just Medicare patients, but the rest of the population, too. Hence, the spillover could affect the health care system as a whole. At best, the situation would be legally murky, says Dan Mendelson. He's a health care consultant and former Clinton administration health official.

DAN MENDELSON: In a lot of ways, it's a political never-never land. We have no idea, really, what this would look like because we don't have a precedent.

ROVNER: Actually, there's a very small precedent, says Gail Wilensky. She ran Medicare and Medicaid for the first President Bush. Wilensky says for the past few years, Congress's inability to fix a glitch in the formula for paying doctors for Medicare has more than once resulted in brief lapses in funding authority.

GAIL WILENSKY: We've had these kinds of smaller version of what-happens-if-Congress-does-or-doesn't-do-something. This would be much bigger, and it would be extremely disruptive.

ROVNER: Wilensky says she thinks it's unlikely a majority of justices will vote to strike down the entire law. More likely, they'd limit themselves to the mandate to have insurance. But she acknowledges that if the whole law goes down, Medicare will be directly in the line of fire.

WILENSKY: It seems like it takes every with it, including those aspects that are only very peripherally related to the expansion of coverage.

ROVNER: And what about the new benefits for patients, like savings on prescription drugs and preventive care? Consultant Dan Mendelson says seniors probably won't have to give money back for things they've already gotten.

MENDELSON: Well, you can't take a benefit away from a beneficiary, or at least it would be very difficult to do that.

ROVNER: But those benefits would certainly end if the law is struck down. And an even bigger problem, says Law Professor Sara Rosenbaum, is that Medicare officials not only wouldn't have the legal authority to proceed with what they've been doing. They also wouldn't have the legal authority to go back to the pre-2010 policies. They'd have to wait for Congress to act.

ROSENBAUM: They have to sort of sit there and wait to see what Congress wants to do.

ROVNER: Mendelson says the biggest problem is that the health law has fundamentally changed almost every aspect of the way the Medicare program now does business. And undoing that would be almost unimaginably difficult.

MENDELSON: I think it's more akin to "Alice in Wonderland," that we're going down the rabbit hole and nobody really knows what it's going to look like inside.

ROVNER: But come later this spring, they may find out. Julie Rovner, NPR News, Washington.

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