Obama may not be able to salvage Obamacare if the Supreme Court invalidates its tax credits. [View all]

[herding cats]

The fate of Obamacare will again be in the hands of the U.S. Supreme Court next year -- and if the conservative justices rule to invalidate tax credits offered through the federal HealthCare.gov, dealing a punishing blow to the law, it isn't at all clear that the White House will have the legal and practical leeway to save it.

That was the conclusion of three academics in a new analysis published in the New England Journal of Medicine which outlined the challenges that the Obama administration would face in that worst-case Supreme Court scenario. The most obvious solution to an adverse Supreme Court ruling is to turn every exchange into a state exchange, allowing the law's tax credits to flow again -- but how easy will it be for the administration to do that?

"We're quite pessimistic. The operational, legal and political challenges here are immense," Nicholas Bagley, a University of Michigan law professor who co-authored the article, told TPM in a phone interview on Thursday. "The more I've looked at this, the more alarmed I've grown."

The problem is three-pronged: Legal, because the Affordable Care Act sets some very specific requirements for state-based exchanges; practical, because states might not have time or authority to act after the Court ruling comes down in June, as expected; and political, because Republican intransigence against Obamacare is currently one of the defining elements of American politics.

An adverse Court ruling in the King vs. Burwell case would invalidate the law's tax credits, received by nearly 90 percent of Obamacare enrollees in 2014, in at least 34 states that are using the federal website. Health coverage would likely then become unaffordable for many enrollees, and those who choose to keep paying the higher price are more likely to be sick and more costly, potentially sending the law into a dreaded death spiral.

That is why, as TPM reported in the past, health policy wonks expect the administration will do anything it can and exercise any discretion to keep the law afloat. But, as NEJM's legal scholars laid out in their new analysis, that won't be as easy as it might sound. Here are the three problems the administration would face.

Full article: Saving O-Care From SCOTUS Might Be A Whole Lot Harder Than It Sounds