MIAMI (CBSMiami) – As President Barack Obama’s signature accomplishment, health care reform, appears to be poised to be struck down by the U.S. Supreme Court; the question over what to do about health care has reemerged.

President Obama’s approach, which included an individual mandate to purchase health insurance, appears to be going down at the Supreme Court. The mandate seemed to be the heart of the problem for the administration in oral arguments.

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The purpose of the mandate was to even the playing field overall by having everyone pay to have insurance or pay a penalty for not having it. States argued that there was no other situation where people were being forced to pay for something they may or may not use in the future.

As a few of the more liberal justices pointed out, how exactly is the mandate different from Social Security? The Social Security program taxes the young and working to help pay for older Americans, which is akin to how a mandate would have people pay into the health insurance market when they are healthy so the costs don’t become so catastrophic when they become ill, according to the justices.

And while Obama and Congressional Democrats proposed the massive health care reform which may or may not survive, if it doesn’t, the only thing being heard from Congressional Republicans and the GOP candidates for presidents have been the sounds of silence.

Senate Minority Leader Mitch McConnell, who said at the beginning of the Obama Presidency that he had one goal of defeating every Obama proposed law, said Republicans would only offer incremental fixes for health care instead of a large-scale approach.

McConnell told New York Magazine that two areas Republicans would look at would include allowing people to purchase health insurance across state lines and medical-malpractice tort reform. Of course as health care costs have expanded in Florida which has strict medical malpractice limits, tort reform may not be the best place to start.

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Likely Republican Presidential nominee Mitt Romney, who institute a health care bill the national bill was based on, has sought to distance himself from Romneycare. But, he’s facing the dilemma of how to address health care without endorsing any government help for health care.

On the Tonight Show with Jay Leno, Romney said that people can’t wait until they get sick before buying insurance, instead saying they must buy it when they’re healthy to be covered when they’re ill. Basically, arguing for an individual mandate for health insurance.

“If they’re 45-years-old and they show up and they say, ‘I want insurance because I’ve got heart disease,’ it’s like ‘Hey guys, we can’t play the game like that. You’ve got to get insurance when you’re well, and if you get ill, then you’re going to be covered,” Romney told Leno.

The problem for Romney is what to do to help the uninsured Americans, the working poor who can’t afford insurance and those with pre-existing conditions do to get health insurance to start.

Ironically, the states’ attorneys that argued their position before the Supreme Court, were asked during the hearings if a public option would have been legal under the states’ view. The states answered affirmatively that a public option would have been legal.

The public option was never seriously considered by the Obama Administration and Republicans vowed to never let it pass if it had been pushed in the Affordable Care Act.

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The White House has not expressed any policy plans either if the Affordable Care Act is ultimately ruled unconstitutional.