Q Now what? The law is upheld, so where does it go from here?
A The scramble to carry out the law continues. By Jan. 1, 2014, states must have set up health insurance exchanges, where people can buy coverage. Insurers will have to offer policies to anyone who applies, including people with medical conditions. And people who do not qualify for exemptions based on income or religion will be required to have minimum insurance coverage or pay a penalty.
Q In what way was the Medicaid expansion "limited"?
A It means that the Medicaid expansion is now an option for states. If states do not participate, experts have speculated that it could create a subset of people who earn too much to qualify for Medicaid, but not enough to qualify for the tax credits that would help them pay for insurance. States will not have to pick up the added costs of the Medicaid expansion until 2016. After that, the federal government will gradually reduce its contribution until it reaches 90 percent of the costs by 2020.
Q I'm unemployed. What does this ruling do for me?
A Beginning in 2014, the law expands Medicaid to cover people who are younger than 65 and earn income up to 133 percent of the federal poverty level, or $30,657 for a family of four in 2012. Families who make between 100 and 400 percent of the federal poverty level -- or $92,200 for a family of four in 2012 -- will be eligible for tax credits for insurance plans that are purchased through state-run exchanges.
Q Any figures for those who have health insurance through our employers already? What does this mean for us?
A The law imposes tax changes that would affect some people who are covered through their employers, especially those in higher tax brackets. Beginning next year, the law increases the Medicare tax by 0.9 percent on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly. It also imposes a 3.8 percent tax on unearned income for high-income households.
Q Does the ruling that allows states to reject the expansion of Medicaid allow states to reject all expanded care?
A No. The rest of the law stands. For example, states must continue to set up health insurance exchanges or the federal government may step in operate the exchanges itself.
Q What sort of penalties will I face if I don't have health insurance?
A Taxpayers will be required to indicate on their tax returns whether they have health insurance that meets minimal benefits standards, according to the Commonwealth Fund. If consumers do not have insurance by 2014, they would owe $95, or 1 percent of taxable income, whichever is greater. The penalty rises to $325, or 2 percent of taxable income in 2015, and then $695, or 2.5 percent of taxable income in 2016, up to a maximum of $2,085 per family.
Q What does the law mean for retirees on Social Security?
A The law shrinks the Medicare drug coverage gap known as the "doughnut hole" by requiring pharmaceutical companies to give a 50 percent discount on brand-name drugs. Federal subsidies will gradually fill in the rest of the gap until it is closed by 2020.
Q I am now being covered by a plan that covers people with pre-existing conditions. It ends December 2013. What will happen?
A The high-risk pools that cover people with pre-existing conditions are intended to be temporary until the rest of the law takes effect. Beginning on Jan. 1, 2014, insurers are no longer allowed to turn away customers with pre-existing conditions, and they must charge them rates that are comparable to other healthy people their age.
Q What about small-business employers?
A Businesses with fewer than 50 employees are exempt. Small businesses with fewer than 25 workers and average wages of less than $50,000 will get tax credits to help cover their workers.
Q Will my insurance premium go up?
A The Congressional Budget Office estimates that private health insurance premiums will increase by 5.7 percent each year, on average, from 2012 until 2022. But premiums would be getting more expensive with or without the law.
NEW YORK TIMES