WASHINGTON, DC-On Monday, the US Supreme Court began hearings on arguments whether the health-care law passed in 2010 is constitutional or not. The three-day marathon of arguments and counter arguments will then be followed by the Supreme Court’s decision, expected sometime in June.

That could go a number of ways. It could affirm the law and its constitutionality. Or, it could decide that the mandate for individuals to buy health insurance, the heart of this very complex piece of legislation, is unconstitutional and strike that down, leaving the rest of the legislation intact. But there’s a third choice as well, and the Court could find that the individual mandate is unconstitutional and because it is so closely linked to the rest of the legislation, strike it all down.

The last option is the least likely, if only because the Supreme Court tends to issue very narrow rulings on specific points. It is an open question whether the Court will strike down the individual mandate, but even if it does, one participant in the space says, it doesn’t matter—at least as far as investments in health care real estate go.

“Economics now drives the shape of health care real estate now, not this legislation,” Jeffrey H. Cooper, executive managing director of Savills US and an attorney specializing in medical office property investment, tells Globest.com. “And that won’t be impacted no matter what the Supreme Court decides.” Granted, a period of uncertainty (depending on how significant any changes are made by the Court) will no doubt follow the decision. But the roadmap in the larger picture is clear: reimbursement with or without the mandate is on the decline, and that will continue whether or not individuals are required to buy health insurance, he says. “For health care real estate, that means a growth in outpatient or ambulatory facilities.”

Cooper isn’t alone in this conclusion. Rasesh Thakkar, senior managing director of the Tavistock Group told NAREIT that he predicts the health care industry will be investing more in outpatient services.

In a separate interview with NAREIT, Todd Lillibridge, president and CEO of Lillibridge Healthcare Services and executive vice president of medical property operations for Ventas, made similar observations. “There’s been an extraordinary amount of pressure on reducing the amount of inpatient care,” Lillibridge said. “As a result, we see a whole new revenue stream and percentage of revenue around the outpatient more often today than ever before.”

Cooper points in particular to the tremendous downward pressure on reimbursement levels in both private sector insurance and by the government as the main driver. “If a procedure can be done on an outpatient basis it will be,” he said. “There’s a growing focus on results-oriented medicine, in which insurers and Medicare aren’t reimbursing facilities if a patient needs to be readmitted because of an infection related to a procedure.”

By the same token, if the individual mandate is upheld, Cooper doesn’t necessarily think it will lead to an even greater demand for medical office buildings or outpatient facilities. “Look to Massachusetts and Mitt Romney’s health care plan,” he says. “Providers there will tell you that an individual mandate has made no difference in terms of forcing providers to offer more health care. What it has done is change the reimbursement structure.”