AUGUSTA – Rachel Sukeforth of Litchfield would be sorry to see the Affordable Care Act go away.

She was 25 when the federal law took effect in 2010, and a provision in the law allowed her to enroll in her mother’s health insurance plan. It was good timing. A medical exam showed pre-cancerous cells on the lining of her cervix. She had surgery to remove them.

“The insurance covered the procedure,” Sukeforth said. “I wouldn’t have been able to afford that.”

After three days of legal arguments and probing questions this week, the U.S. Supreme Court is expected to decide in June whether to strike down part, or all, of the Affordable Care Act.

Maine is one of 26 states that sued to overturn the law. The states want the entire law struck down, arguing that a core requirement, that most individuals buy insurance starting in 2014 or pay penalties, is unconstitutional.

Maine Attorney General William Schneider said in a recent interview that there are popular parts of the law — including coverage for people as old as 25 under their parents’ plans — that Congress could reinstitute later.

It’s anyone’s guess whether the court will uphold the law, strike it down or remove pieces such as the mandate for individuals.

Striking down the federal law entirely would not affect Maine as much as many other states. That’s because Maine has state laws that are similar. Maine law, for example, says parents can add children to their insurance until they turn 25, under certain conditions.

Still, there will be some big changes here, immediately and in the future, if the law is struck down.

Maine senior citizens would once again pay co-pays for preventive care and spend more on prescription drugs, for example. Free preventive care and drug discounts are two provisions of the federal law that have taken effect.

The biggest pieces of the Affordable Care Act will take effect in 2014, if the law survives.

Thousands of Mainers who don’t have insurance would be required to buy it, or pay penalties. However, they would be able to shop for coverage through a government-run exchange that provides more bargaining power and subsidies for people who qualify.

Less than 10 percent of Mainers are uninsured and stand to be directly affected by the individual mandate. But a court ruling to strike down that piece of the law would have ramifications for everyone in the state.

If nearly everyone has coverage, insurance companies will no longer be able to turn down people who have pre-existing conditions or cut people off if they have serious, long-term illnesses that cost too much to treat. Those pieces of the law might not survive without the individual mandate requiring younger, healthier people to buy insurance.

Supporters of the law say that achieving nearly universal health coverage would ultimately save everyone money.

Without it, the numbers of uninsured Mainers will grow as the state cuts MaineCare coverage and others drop out of the increasingly expensive private insurance market, said Joe Ditre, executive director of Consumers for Affordable Health Care.

“People losing coverage will now turn to their hospital emergency rooms for care, which insured people and businesses will have to pay,” Ditre said. “Or they will forgo care altogether until their conditions worsen and care gets more expensive.”

Critics maintain that the individual mandate and other parts of the Affordable Care Act would ultimately increase the cost of care and insurance. A decision to strike it down would allow Maine and other states to return to a market-based approach, said Joel Allumbaugh, a health insurance agent and policy analyst for the Maine Heritage Policy Center.

“There are a number of provisions in the Affordable Care Act that would increase the underlying cost of coverage,” Allumbaugh said. “It hasn’t addressed the underlying (health care) cost issues. If anything, it exacerbates them.”

Allumbaugh said he works with employers, for example, who worry about how they will be able to afford insurance for employees, including seasonal workers, when the mandates take effect in 2014.

Deregulation — such as a law passed in Maine last year — holds more promise of reducing costs in the long term, according to Allumbaugh.

But, he said, there are portions of the law — including coverage for adult children — that are not controversial and will likely be revived if the law is struck down. In some cases, insurers might simply keep those features even if the requirement goes away, he said.

Sukeforth is now 26 and, once again, uninsured. She will be among the Mainers who are required to buy health insurance in 2014, if the law survives.

She still wants to keep the law. Sukeforth said she’s confident that the new health insurance exchange would make buying insurance simpler, and that she would be able to join with other consumers to get a more affordable, group rate.

“I’m actually looking forward to it,” she said. 

State House Writer John Richardson can be contacted at 620-7016 or at [email protected]