The Supreme Court upheld the individual mandate in President Obama's health care law that requires Americans to buy health insurance or pay a penalty. The mandate will have far-reaching implications in the world of business and impact about 26 million Americans, according to a recent study by the Urban Institute and an independent analysis by MIT economist Jonathan Gruber.
Here is a snapshot of the millions of Americans affected by the court's decision, from kids to college students, businessmen to busy moms.
Samantha Ames is grateful for a provision of the Affordable Care Act that allows dependent children up to age 26 to stay on their parents' family policy. Between graduating from college and beginning law school, Ames was uninsured. Ames suffers from loose joints and lived without medication for nine months, fearful that any little accident could ruin her life. After starting law school she took advantage of the student health plan, but then she fell and seriously re-injured an ankle. She was told she needed major surgery to fix the problem to be able to walk properly. Had she stayed on the student plan her insurance would have cost from $5,000 to $12,000 in cost sharing. Under the Affordable Care Act she was able to join her parent's policy and have the surgery.
She worried that the Supreme Court would strike down the law. "My fear is that things will not only go back to how they used to be, but that there is such animosity in the air right now toward something that is a basic human necessity. "
Reaction After Supreme Court's Decision: "I am incredibly, incredibly relieved. Huge sigh of relief," Ames said. "I am incredibly grateful that I can spend the foreseeable future in a position where a misstep won't bankrupt me."
-- Ariane DeVogue
Under the Affordable Care Act, the Raether family from suburban Milwaukee benefited from two of the changes, the elimination of lifetime coverage limits and a ban on insurers' excluding children with pre-existing conditions.
Six-year-old Mira Raether, who was born prematurely and with kidney problems, quickly exhausted the lifetime limit on her parents' insurance policy and was temporarily covered by Medicare because she had a kidney transplant. Under ACA, Mira was able to return to her parents' insurance and the family did not have to worry about exceeding lifetime insurance limits.
Had the Supreme Court struck down ACA, it could have meant financial ruin for the Raethers. Mira's medications alone costs $2,000 a month; with insurance, the out-of-pocket costs come to $200.
Reaction After Supreme Court's Decision: "I'm so excited, so relieved," said Sheryl Raether, Mira's mother. "It's security, peace of mind. A huge weight has been lifted off our heads. I was concerned about the mandate, but they fixed it and it makes complete sense to me."
Kurt Summers, a small business owner, hoped the court would strike down the law. Although he feels no impact from the provisions of the law currently in effect, he's worried about his planning for the future. He has 24 employees, added five last year and hopes to add six next year.
"As a small business owner the biggest impact is what we don't know. Quite honestly, if the health care impact goes up another 20 to 30 percent, I will have to rethink my hiring strategy. It's going to slow me down. "
His company, Austin Generator Service, installs generator systems for businesses and small homes.
Summers is no stranger to the controversy surrounding health care. Fifteen years ago his company had to stop providing major medical health insurance because of an economic downturn. "We had to face the decision: Do we provide jobs or go out of business?"
He says he considers his few employees as family. If he suffers another economic downturn, he might have to eliminate insurance just to survive. "It's not going to be good for my employees, but at least they'll have a job."
Summers' fears revolve around the unknown. He is not familiar with the ins and the outs of the law, but he's afraid of the government's stepping in and hurting his business. "This is not big corporate America."
Reaction After Supreme Court's Decision: "Stunned. Absolutely shocked. It was not expected," said Summers. "We expected a different result. It's very disappointing and I think from a business standpoint the immediate reaction is going to be one of caution. ... I still feel like this law is going to be very damaging, not just to the business community, but to the entire economy."
-- Ariane DeVogue
Opponents of the law say it will be devastating for small businesses. Dan Danner, the CEO of the National Federation of Independent Business, a group challenging the law at the Supreme Court, says it has the potential to drastically change the private-sector job market as we know it.
It is the unknowns associated with the law that concerns small business owners.
"The unknowns associated with the employer mandate have left many small-business owners trying to forecast how they will shift their workforce to avoid the financial penalties that will stem from offering 'affordable' coverage, as defined by Congress, to their employees. It's really quite shocking how President Obama can tout the economic importance of small business in speeches across the country at the very same time that his healthcare law threatens the very jobs that small business creates," says Danner.
"The health care law is financially devastating for small business," Danner said. "The employer mandate and health insurance tax will be job-killers, and have the potential to drastically change the private-sector job market as we know it. Our research foundation has projected that the private-sector job loss resulting from the health insurance tax could reach upwards of 249,000 jobs; small business will shoulder 59 percent of the jobs lost."
"NFIB is confident that the law will be overturned by the Supreme Court, but until that time, we continue to fight against this harmful policy in Congress by leading the charge to repeal the employer mandate and the health insurance tax before it is too late."
Reaction After Supreme Court's Decision: "This is different than what we were expecting. Our hope and guarded expectations were that the individual mandate would be found unconstitutional," Danner said. "Now the implementation of the law continues to go forward. We believe it's going to add costs, not lower costs for small business."
-- Ariane DeVogue
For Tracy Heiman the Affordable Care Act has brought peace of mind. She has a young son with a rare cancer and now she knows that down the road insurance companies cannot deny the family coverage because of his preexisting condition.
The health care law prohibits insurers from excluding coverage for children with pre-existing health conditions. In 2014 the bill will also prohibit insurers from excluding adults with preexisting conditions.
"His cancer is called chronic care. I spent years working on the issue of making sure kids aren't denied insurance just because they have a preexisting condition. Since the law went into effect I've been able to concentrate on other things such as working on the issue of cancer awareness," Heiman says.
Heiman's family currently has good insurance through her husband's job. But for years they worried, afraid if her husband had to change jobs there might not be insurance for their son.
"We are free to look for work at other companies or find work if we lose it because my son won't be discriminated upon with chronic cancer condition. That is a big sense of relief for our family."
-- Ariane DeVogue
Elaine Cornett feels the same relief. Her daughter has type one diabetes. Although they currently have health insurance they were worried for their future.
"If the entire health care law is struck down, if my husband should lose his job, or a wonderful opportunity were to come up that would mean a shift of insurance, we would have to think seriously about whether we could pursue the move or a new job."
She says, "It was a huge relief that I heaved when it was signed into law. It means for us we have more flexibility, we are lucky right now our coverage is good, but if anything changed it would be an enormous financial burden if we weren't able to get coverage."
-- Ariane DeVogue