Here's what some local leaders said about Thursday's decision upholding the law.
Gov. Corbett said he was "disappointed" by the ruling but "respect for the law and for the process of the law - even when we disagree - is part of our democracy." He pledged to do "all we can to ensure the negative impact of this law affects the lives of Pennsylvanians as little as possible."
U.S. Sen. Bob Casey (D., Pa.), who is running for reelection against a health-reform foe, said in a statement: "The fact that this law was upheld means that Pennsylvanians will not lose their coverage due to preexisting conditions, young adults will be allowed coverage under a parent's plan, and older Americans will not have to face dramatic increases in prescription drug costs."
Gov. Christiepanned the ruling. "The Supreme Court is confirming what we knew all along about this law - it is a tax on middle-class Americans," he said in a statement. "I do not believe a one-size-fits-all health care program works for the entire country. Each governor should have the ability to make decisions about what works best for their state."
Ralph Muller, chief executive officer of the University of Pennsylvania Health System, called the decision a "pleasant surprise." He said, "I think the act should have been upheld and I'm glad that it was."
If the law had been thrown out, he said, "it would have been pure chaos out there."
The health insurance exchanges created in the law will lead to more uniform benefits, and that will simplify billing, Muller said.
Larry Kaiser, who leads the Temple University Health System, said he "really thought the individual mandate was going to go." But, he said, his organization has been "making plans based on full implementation of the act."
David F. Simon, executive vice president and chief legal officer at Jefferson Health System, expressed concern about bringing new patients into the health-care system when the law is reducing Medicare and Medicaid payments. Instead of expanding Medicaid, he said, subsidized insurance coverage may be a better option, since low payments have led many providers to refuse Medicaid patients.
David Grande, a health policy researcher at the University of Pennsylvania, said, "One of the things that the ruling does is just provide a lot more clarity and certainty for everyone . . . Having things in limbo is toxic to getting things done." The Supreme Court decision, he said, "helps hospitals. It helps doctors. It helps patients know what the future is going to look like."
As implementation moves forward, it will be more difficult for Republicans to repeal portions of the law, he said. "The Republicans may try to nibble away at the margins of some of the provisions of the law," he said. "They've been doing that for the last year, but the overall impact on the Affordable Care Act has been minimal."
Mark Pauly, a health economist at the University of Pennsylvania's Wharton School, said administrative changes that have been put on hold while awaiting the Supreme Court decision will now move forward. One likely future political issue - the cost - may not emerge until full implementation of the bill in 2014. Pauly estimated the cost of expanding Medicaid and subsidizing lower-income people in the private market at $200 billion a year.
Ezekiel Emanuel, a University of Pennsylvania bioethicist and former White House policy adviser, said an analysis by the President's Council of Economic Advisors found that most states would save money by expanding Medicaid. States now pay for the cost of poor uninsured patients by compensating hospitals for uncovered care, among other things. The states "might, for ideological reasons, say no to expanding Medicaid," he said, "but from an economic standpoint, they should do it."
Donald F. Schwarz, the Philadelphia health commissioner, said the court's ruling on Medicaid is of particular relevance in Pennsylvania because the state is paying the full cost of medical coverage for 70,000 people in one state program. They could be covered by the expanded Medicaid program in the reform law. The federal government would then foot all of their insurance bill.
"It is a good deal," Schwarz said. Still, he said, "I worry that politics, partisan politics, would stand in the way. I hope that it wouldn't."
Carolyn F. Scanlan, president and CEO of the Hospital and Healthsystem Association of Pennsylvania, said more people with health insurance will lead to a healthier population and leave hospitals with fewer unpaid bills.
Betsy Ryan, president and CEO of New Jersey's hospital association, said the ruling would "allow the much-needed reform of our health care system to continue."