Today, the Supreme Court will hear arguments about the critical centerpiece of President Obama’s healthcare reform bill: the individual mandate. Lawyers challenging the law on behalf of 26 states will argue that it is unconstitutional for the federal government to penalize individuals who do not buy health insurance; the Obama administration will maintain that the mandate falls squarely within Congress’s power to regulate interstate commerce. Hanging in the balance is Obamacare’s most sweeping promise: to provide health insurance to more than 30 million Americans who do not currently have coverage.

At the New York World, we wondered how the Court’s decision will affect New York City, and what areas will see an impact if access to health insurance is widened. We want to know: Which neighborhoods have the most at stake in the Supreme Court case on the Affordable Care Act?

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What we found

Many New York City neighborhoods have high rates of uninsured residents – the central problem that Obamacare was created to solve.  The communities with the greatest percentage of people without health insurance are Jackson Heights (with 32 percent uninsured), Bushwick and Elmhurst/Corona, according to a report last year by the United Hospital Fund.

Click map to see share of uninsured residents in each New York City neighborhood. Source: United Hospital Fund, "Health Care Insurance in New York, 2009."

But it’s hard to determine how many of these people would be covered under Obamacare, or conversely, how many would lose the chance to get insurance if major parts of the law were struck down. Bob de Luna, a spokesman for the United Hospital Fund, noted that some of the highest rates of uninsured are in neighborhoods with significant populations of undocumented immigrants. Their ability to purchase health insurance would not be affected by the health care overhaul.

De Luna said New York has already enacted robust public health insurance coverage at the state level, meaning that Obamacare would not affect the eligibility of significant numbers of people for public health insurance plans. But he estimated that some 750,000 New Yorkers are now eligible for public insurance but still unenrolled. “The bigger impact is through the mandate and the creation of a health benefit exchange for New York that would facilitate the purchase of insurance for eligible New Yorkers who are not insured,” de Luna said.

It was precisely that individual mandate to buy health insurance that was subjected an onslaught of tough questions from the Supreme Court’s conservative majority today – suggesting that the roughly 750,000 New Yorkers who are eligible but unenrolled may not be able to expect that Obamacare’s central provisions will survive to change their plight.