With the Affordable Care Act now locked in stone - through the fall election, anyway - businesses and government entities continued the scramble to get processes and perspectives in place for October 2013, when consumers will select plans in advance of a January 2014 implementation date.
In Connecticut and elsewhere, those plans will be funneled through online health insurance exchanges designed to simplify gauging a plan's cost and coverage.
"This is a gigantic win for the people of Connecticut, the 500,000 people that would have been in position to lose coverage," said Gov. Dannel P. Malloy in Hartford late last month. "If the whole law had been struck (down), lots of things that we now take, just a couple of years later, for granted would have been lost or could have been lost. Actually, a gigantic tax cut just for members of the middle class with respect to the cost of health care is now in place and will come about in 2014.
"I understand that within the health insurance industry, there is some disagreement - some companies are happier than others," Malloy added. "There probably will be a shrinkage including a penalty paid if the spread is too wide between the costs being charged and the actual expenditure on health care. But that's one of the things you had to do to make sure that we started to save the money."
Malloy said the number of residents with access to health care insurance has already gone up in Connecticut and will continue to do so through 2014; and that the state will be able to offload additional costs by then to the federal government.
The National Federation of Independent Business, which was a plaintiff in the Supreme Court case, responded by publishing an itemized list of various costs and incentives under the Affordable Care Act. In 2013 alone, they include:
* a 2.3 percent excise tax on medical devices;
* an increased threshold at which medical expenses are deductible, from 7.5 percent of income to 10 percent;
* a 0.9 percent "Medicare" surtax on salary income earned by individuals who earn at least $200,000 working for limited liability companies and partnerships, or applicable joint filers who make $250,000;
* a 3.8 percent "Medicare investment tax" on investment income for LLCs, partnerships and other businesses that pass profits through to owners, at identical dollar income triggers; and
* a cap on Flexible Spending Account contributions at a maximum of $2,500 annually.
Also as of January, new health plans dubbed CO-OPs (consumer operated and oriented plan) will be allowed to start selling policies, with the Connecticut State Medical Society having won federal authorization for such a plan.
The National Association of Health Underwriters, which represents insurance brokers, said many aspects of the Affordable Care Act remain unclear to brokers and their clients, including changes to pricing and standards of coverage; employer responsibilities; tax provisions; and state exchanges.
If businesses are still absorbing all the implications of the Affordable Care Act, so are government agencies charged with implementing the new regime, according to U.S. Sen. Joe Lieberman.
"Now that the constitutional debate surrounding the ACA has been resolved, Congress should closely monitor the implementation of the law to ensure that it is fiscally sustainable in the future," Lieberman said in a statement following the Supreme Court decision. "There are many outstanding issues surrounding this law that will demand Congress' attention in the years ahead, including the accommodation of religious concerns and sticking to commitments to cut health care delivery costs."