The waiting game is over for consumers, employers, health care providers and insurers. Thursday's Supreme Court ruling that upheld the 2010 health care law means ongoing trends will continue, and those who waited on the sidelines for the court will now have to implement their parts of the law.
For consumers, that means that those intimidated by what opponents called the overly complex part of the law will have to learn what will affect them, particularly if they have to buy their own insurance or pay a penalty for skipping it.
Employers who fought the law as a job killer will now have to come to grips with it and minimize the parts they don't like.
Hospitals have moved forward with electronic records, but not necessarily with the health care teams needed to prevent mistakes that can lead to penalties for care that falls below quality standards.
Insurers need to dig deep to pay rebates to consumers for premium money not spent on health care.
The states that balked at creating health care exchanges from which their residents can compare and buy health insurance must create them — or wait for the federal government to do it for them.
Because many of the law's provision kick in during 2013 and 2014, that leaves precious few months for the various groups to get to work.
"It's full speed ahead on implementing the law," says Alissa Fox, senior vice president for the Blue Cross and Blue Shield Association. She says insurers worry that a health insurance tax will increase premiums for families or cause rates to go up for young people, but concerns about the law will no longer hold back implementation. "We've had two-plus years of implementing legislation, and we'll continue."
Although "nothing will change tomorrow," some consumers will see big changes by Jan. 1, 2014, when more aspects of the law take effect, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Those changes include:
•Insurers will no longer be allowed to turn anyone down because of a pre-existing medical condition, such as cancer, Pollitz says.
•More patients will be eligible for Medicaid, a federal insurance program administered by the states that serves the poor and disabled. Today, people can qualify for Medicaid only if they are poor, pregnant , disabled or a child. Each state sets different financial standards to qualify for Medicaid, and some states have required that people be not just poor but "subpoor," with incomes substantially below the federal poverty level.
By 2014, however, people will become eligible for Medicaid based only on their incomes, Pollitz says, meaning single adult men with incomes up to 130% of the federal poverty level will also qualify.
•Also by 2014, the "working poor" — many of whom are eligible for employer-sponsored health care but can't afford the monthly premiums — will be eligible for subsidies to help them pay for their health insurance, said Mary Grealy, president of the Healthcare Leadership Council.
•Federal standards for health insurance plans will eliminate "junk" plans with huge deductibles that provide little to no real benefits for consumers, Pollitz says. That means consumers will have more confidence that any plan they buy on the private market will provide at least a minimum standard of quality that includes drug coverage, hospital care, maternity care and other essentials.