The Supreme Court is expected to rule this week on President Obama’s signature legislative achievement, the Affordable Care Act or Obamacare, and lots of people who are in the know are predicting it’ll be struck down. If that happens, conservatives will be happy that they scored points against an incumbent president, but the rest of the country is going to quickly realize that maybe life without Obamacare isn’t as satisfying as they might have thought. State governments in particular are in for a rough ride should Obamacare vanish.

Much of what the law actually does isn’t the flashy mandates that infuriate Tea Partiers and small-government types, but little things that make living with our awful insurance-based system a little bit better. Here’s an example: according to a White House release, Connecticut consumers will save over $12 million this summer thanks to the law’s 80/20 rule, which requires insurers to spend 80 percent of consumers’ premiums on health care instead of administration costs. What happens if the whole law gets stuck down? Do we rely on insurers to keep that going? Have you ever met an insurance company?

Obamacare also does a lot to help states cover health care expenditures. If the law is struck down, states like Connecticut will lose millions in federal funding. What will we do at that point? We’ll basically be on our own. After all, does anyone trust Congress to craft and actually pass a new health care act? Seventy-seven percent of us want a new bill to happen, according to a recent AP poll, but it’s unlikely anything will budge during the gridlock of an election year.

If Obamacare falls, it’s impossible to say what’s going to rise in its place, if anything. In 2009 I went to a town hall meeting on health care in East Hartford with then- U.S. Sen. Chris Dodd and other major political figures. Health care reform was just getting underway at that point, and all options were theoretically on the table. But the audience was in a bad mood. People told stories of getting screwed by insurance companies. They described their loved ones suffering and dying because insurers wouldn’t pay. Reform this mess, they demanded. For God’s sake, do something! The problem was, no one could really agree on what that something ought to be.

We still don’t know. A 2011 Gallup poll showed that 57 percent of respondents said that the health care system had “major problems,” and 78 percent were dissatisfied with the total cost of health care. The public’s appetite for reform is still there, but we have no idea what we want out of our health care system. Do we want a single-payer health system like the UK’s and Canada’s, with all the benefits and pitfalls those have? Do we want a hybrid system, like Chile’s? Do we want something that looks like Obamacare without the individual mandate? Ask a dozen people, and you’ll get a dozen answers.

But if Obamacare is overturned, and absent any kind of miracle in Washington, both the added costs and the responsibility for sorting things out will fall squarely on the states. If that happens, we’ll have some hard questions to ask ourselves. For instance, so much energy in health care reform is taken up with trying to cudgel insurance companies into some kind of shape that will both allow them to remain solvent and provide care to people who can’t afford it. It’s a fundamental incompatibility, and we may need to finally admit that we’ve pushed the insurance-based system as far as we can.

Vermont, a state that is often ahead of the rest of us when it comes to innovative and just policies (think civil unions), is experimenting with single-payer health care. They have a lot of hurdles to get over, but if the Supreme Court strikes down the Affordable Care Act all eyes will likely swing to the Green Mountain State. Like it or not, there’s innovation happening up in Vermont, and Connecticut should be paying attention. Connecticut has made a few steps in this direction in the past, including Gov. Rell’s Charter Oak Health Care plan and SustiNet, which aims to cover 98 percent of Connecticut residents by 2014. Obamacare or no, we should be working towards creating health care in this state that really is second to none.

Susan Bigelow is an award-winning columnist and the founder of CTLocalPolitics. She lives in Enfield with her wife and their cats.

Susan Bigelow

Susan Bigelow is an award-winning columnist and the founder of CTLocalPolitics. She lives in Enfield with her wife and their cats.