The decision might help businesses finally make some personnel and other moves, giving the economy a much-needed kick, economists say.

That includes hiring health care personnel to meet the increase in demand sure to come with increased preventive care, said Dan Seiver, an economist at San Diego State University. The decision will also increase demand for schools providing health care worker training, he said. "There's going to be a huge increase in demand for all kinds of medical services," said Seiver. "That's a good thing and a bad thing. A lot more people are going to get preventive care, but there will be costs."

Those costs are what motivated the National Federation of Independent Business to join states in the lawsuit against the Affordable Care Act. Other business groups, including the U.S. Chamber of Commerce, continue to oppose the ruling, while the Small Business Majority lauded it as a first step to increasing choices for workers.

Businesses with more than 50 employees will, starting in 2014, have to provide insurance for employees or pay a penalty, said Gerry Wedig, an economist with the University of Rochester's Simon School of Business. That will increase their costs, which they will likely pass along to employees. But that's not until 2014.


The court opened the door to widening disparities between red and blue states on who gets health care. Under the ruling, states will be free to decide not to cover all their poor residents through their Medicaid programs.

That may mean that liberal states that have embraced the law such as California, Massachusetts and Maryland will in 2014 effectively offer all their residents health coverage, a key goal of the law President Obama signed two years ago. But conservative states such as Florida and Texas, which have refused to implement the law while they challenged it in court, could reject federal aid, leaving millions of their residents without medical insurance.

For example, Wisconsin Gov. Scott Walker quickly announced that his state "will not take any action to implement Obamacare" and held out hope for a victory by Republican Mitt Romney in November.


Hospitals: Hospitals perhaps could have the most to gain from the law. The 30 million or more people expected to gain health insurance in 2014 will reduce the number of uninsured patients showing up at hospitals needing urgent care, often for conditions that could have been treated much more cheaply early on. Such charity care has been a big drag on hospitals, and those costs should drop sharply.

Insurers: Insurers will get millions of new customers thanks to tax credits that will help middle class people pay for coverage on the individual market, and the state-federal Medicaid program will still expand. But the health insurance sector also will pay annual fees starting in 2014. They total $8 billion that first year and then climb in subsequent years.

Medical device makers: They will have to start paying a 2.3 percent tax beginning in January on their sales of devices such as pacemakers and CT scan machines. Experts disagree on whether those companies will see much of a jump in business in a couple years.