The U.S. Supreme Court’s pending decision on the federal health care law is being billed as its biggest decision in 50 years. It could completely throw out the law, keep parts and throw out others, or let it go ahead as written. 

CPR Health Reporter Eric Whitney checked in with Colorado doctors on what the future looks like to them, with or without the health care law in place.

Here is a transcript of Eric’s story:

Reporter:  If you think that the law the court is considering, the Affordable Care Act, is big and complicated and confusing, you’re not alone. Even doctors, who are intimately familiar with the health care system, have lots of questions about it. Over the weekend the state’s biggest physicians’ organization, the Colorado Medical Society held their annual spring conference in Vail, and they invited a panel of legal and health policy experts to answer their questions about the law. 

Dr. Michael Pramenko: Are we on? Yeah.  Law questions, because I’m just a doctor. Does the supreme court consider downstream effects of their decision, should they throw out the individual mandate…(fade under and out)

Reporter: That’s Grand Junction Doctor Michael Pramenko, arguably one of Colorado’s sharpest minds when it comes to health policy, and if he’s got questions about the future, that says something. 

The president of the Colorado Medical Society, Dr. Brent Keeler says nobody knows what will happen if the Supreme Court strikes the law down. But if it upholds it, the future isn’t exactly clear, either.

Keeler: A lot of the Affordable Care Act has not actually started to happen, and so we don’t know for sure how it’s going to affect physicians, patients, the public, government. We don’t know how it’s going to have an effect in all those areas, because not all of it has unfolded yet.

Reporter: Keeler says that the dominant feeling about the law among doctors is uncertainty. He says opinion is split in the state’s medical society about whether it will make health care better or worse. Those opinions are colored both by doctors’ personal analyses of the law’s known provisions, but also their personal politics.

Dr. David Ross:  I think that while well-intended it would not accomplish the goal of making health care better.

Reporter: David Ross is an emergency room doctor in Colorado Springs. He’s fundamentally opposed to one of the law’s central planks: The requirement to buy health insurance that starts in 2014. To him, that’s obviously unconstitutional.

Ross:  I do think though, that there are some good things about the Affordable Care Act, and I would hope that they would carry on

Reporter: Among those things are the law’s provisions to help middle class Americans buy health insurance by giving them tax credits.  And Ross likes that the law forbids insurance companies from denying people coverage for pre-existing conditions.  

But Ross, and doctors on the opposite side of the political spectrum are unsure that the law’s strategies to expand health coverage are going to work.

Ebert-Santos: My name is Christine Ebert-Santos, I’m a pediatrician in solo private practice in Frisco, Colorado.

Reporter:  Dr. Ebert-Santos says that about half of her patients pay with Medicaid, the government subsidized health program for the poor. 

Ebert-Santos: Well, insurance is too expensive for most people, the young adults and the young families really can’t afford insurance.

Reporter: While Ebert-Santos thinks every American should be able to get affordable health care , she’s skeptical of one way the health care law aims to make that happen: By opening the door wider to Medicaid. That is, letting people make more money and still qualify for the benefits.

Ebert-Santos:  My patients who are now on private insurance, and probably struggling to buy private insurance, will then qualify for Medicaid. So another 20% of my patients switch over from private insurance to Medicaid, I don’t know whether that’s going to be better or worse for me.

Reporter: Dr. Ebert-Santos says that right now, she doesn’t make any money serving Medicaid patients, in fact, she figures she loses at least $5 for every one she sees. 

The health care law includes an initial bump in Medicaid payment to doctors, but Ebert-Santos worries that government debt problems could mean payment reductions in the future.

Beyond Medicaid, there’s another big issue for doctors: That they can only get paid for doing procedures - that frustrates a lot of doctors. They want payment reform that rewards them for keeping people healthy in the first place. The Affordable Care Act contains a lot of payment reform strategies.  But Colorado Medical Society president Dr. Brent Keeler says there’s a sense among doctors that payment reform won’t go out the window, even if the Affordable Care Act does.

Keeler: Payment reform, in one way or another, is already happening, and it is going to happen, whether or not the supreme court rolls this back.

Reporter: Colorado’s medical society hasn’t taken an official position on whether the federal health care law is good or bad. That’s unlike their parent organization, the American Medical Association, which has endorsed the law. Docs in Colorado say they’re committed to improving health care here, whichever way the Supreme Court rules.