Michael Doyle and David Lightman

WASHINGTON: The future of health care hangs in the balance, as do some political fates, with the conclusion Wednesday of Supreme Court arguments that showed the justices divided but clearly willing to rule on the major questions at issue.

Longer than any since the 1960s, the arguments that ended Wednesday afternoon both clarified and clouded the potential outcome, with justices on the last day assessing whether most of the 2010 health-care law could survive even if its most controversial provision — the individual mandate — were struck down.

Over a total of nearly 6› hours this week, the justices suggested that:

•?They will almost certainly rule on challenges to the Obama administration’s signature health-care law, rather than punt on technical grounds.

•?They could very well strike down the health-care law’s central requirement that individuals must buy insurance, and the law’s dictate that states expand Medicaid coverage, or even the law in its entirety.

•?They will be sharply divided in whatever they do. And because opposing sides won’t be reconciled, it’s more likely that the court itself could become campaign fodder in the fall elections.

Taken together, the arguments foreshadow, by the end of June, a set of binding decisions on one of the country’s most ambitious social programs ever, rendered right in the middle of an election year.

“We cannot avoid decisions simply because the case has political implications,” Chief Justice John Roberts Jr. said Monday morning, speaking of another case but with an unmistakable nod toward the health-care cases.

The constitutional validity of the entire 2,700-page Patient Protection and Affordable Care Act was not in question this week. Instead, Florida and 25 other states as well as business groups were challenging several specific provisions concerning mandatory individual insurance coverage and Medicaid expansion at the state level.

On Wednesday, though, the court considered whether the entire law must fail if the central insurance coverage requirement were struck down. Several conservatives think so.

“My approach would say, if you take the heart out of the statute, the statute is gone,” Justice Antonin Scalia declared.

From the liberal side, Justice Elena Kagan suggested that often “half a loaf is better than no loaf,” while some of her colleagues agreed that the court should not move too drastically.

“It’s a question between a wrecking operation and a salvage job,” Justice Ruth Bader Ginsburg said. “And it seems to me the more conservative approach would be salvage rather than throwing out everything.”

Individual mandate

The 90-minute argument Wednesday morning will really matter only if the court decides, separately, that the health-care law’s so-called individual mandate violates the Constitution. At that point, justices also would have to decide whether the damage to the law can be contained or whether the whole ship necessarily must sink.

“If the individual mandate is unconstitutional, then the rest of the act cannot stand,” insisted attorney Paul Clement, representing Florida and other states challenging the law.

The Obama administration agrees that a few additional provisions of the law are inextricably tied to the individual mandate and must live or die with it. One is the ban on denying coverage to those with pre-existing conditions. Without an individual insurance-buying mandate, this requirement would drive up rates.

But with many provisions of the law already in effect, the administration and advocates maintain that total repeal would throw many Americans for a dangerous loop.

Twenty-six different provisions took effect in 2010, the law’s first year, and 17 went on the books last year, according to the Kaiser Family Foundation. Nine new provisions are taking effect this year.

Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions took hold.

Among the most popular is a temporary program to provide health care to people with pre-existing conditions who have lacked coverage for at least six months. Another widely praised provision, which took effect in September 2010, allows parents to keep children on their insurance policy up to age 26.

“Think of the millions of Americans whose children are on their parents’ policies,” said Sen. Tom Harkin, D-Iowa, the chair of the Senate Health, Education, Labor & Pensions Committee, at a news conference this week. “They’ll take away this benefit for them?”

Even Senate Minority Leader Mitch McConnell, R-Ky., who insists he will try to repeal the health law given a chance, conceded “there are a couple of things that you’ll be able to point to” in the sweeping law that might be popular.