Health law ruling: how companies will fare

If President Barack Obama's health care overhaul is repealed by the Supreme Court, will insurance and health care companies rejoice?

Not all of them.

For many companies, overturning the law could mean less profit, not more. Certain health care insurers and hospitals could no longer expect to get payments from millions of newly insured patients.

What's more, health care experts say many big companies want to see the law upheld because they've worked hard to adapt to it, and fear legislation replacing it might prove more costly to them.

"There's no guarantee that Washington wouldn't come up with something more disruptive," says Matthew Coffina, a health care analyst at Morningstar, a research firm. "You have to worry about what comes next."

The Supreme Court is expected to rule on the law, called the Affordable Care Act, this week. The justices will decide whether Congress went beyond its authority in the Constitution in passing it. They could throw out all of the convoluted law, part of it or decide to keep it intact.

Here is how some companies will win or lose under four possible rulings by the high court.

If the court throws out the mandate for individuals to buy insurance but keeps the rest of the law, hospitals could find themselves in the sick ward.

Hospitals have to foot at least some of the bill when uninsured patients show up for treatment. The law would help put an end to that by requiring most people to get coverage. Cut the requirement, and hospitals would have to continue paying out of pocket. Plus they would still have to swallow Medicare cuts in the law.

If the court repeals the individual mandate and the new coverage rules, insurers would win.

They wouldn't have to worry about people signing up for coverage only after they got sick. They could just reject them. And the tax credit and Medicaid expansion would remain. Experts expect many uninsured would take advantage of those incentives to get coverage, and insurers would make more money.

If the court repeals the entire law, insurers focused on Medicaid recipients could lose. Of the estimated 30 million people gaining coverage under the law, more than half are expected to benefit from the expansion of eligibility requirements for Medicaid, the federal-state program for low-income families. Take away the law, and you take away those new customers.

One winner could be drug companies. Under the law they have agreed to pay a fee and cut the price of some medicines.

If the court keeps the law, health care companies, and their investors, win. Insurers and drugmakers, however, know the problems and costs of the law and have already spent time and money complying with it, and so many don't want it thrown out.

Plus, they fear that the vacuum that a repeal would create could be filled with a more restrictive, more costly overhaul in the future.