"Conversely, or at least apparently conversely, the Court did show some states rights backbone and ruled that the Medicaid expansion could not be forced upon the states via the threat of withholding the states' entire Medicaid allotment from the federal government," he says. "How states will interpret that, how the federal and state governments will fund any of this, or how this truly impacts health care costs, remains to be seen.

"Now that the decision is in, states will have to scramble toward implementation, all while watching where November takes us," he says. "Just the right amount of uncertainty we've grown accustomed to in this whole process. The zombie apocalypse sounds pretty good right about now."

Scrambling to implement

Many individuals have been in a holding pattern, waiting to see which direction this was going to go before implementing any plans, explains Perry Braun, executive director of Benefit Advisors Network.

Plus, many had considered the law to be so convoluted and pieced out to occur over such a long timeline, that there's a considerable level of ambivalence over it, Danielle Kunkle, a Medicare adviser at Boomer Benefits in Fort Worth, Texas, told BenefitsPro.com in March.

A Harris poll conducted in the spring confirmed that Americans were largely confused about health reform. When asked about six important elements of the bill, large numbers of people (from 66 percent to 37 percent) weren't sure if they are or are not part of the bill.

So now that the law is upheld, "this decision raises more questions and issues that will have to be addressed," Braun says.

"How the state will comply by the timeframes outlined, how employers within that state will adjust their plans [and] how individuals will purchase health insurance products with an expectation that an exchange is available to them are just a few of the questions that fall out of this ruling," Braun says.

"For the consumers, there are several questions to triage through: One, what are my options? Second, how do I receive information to make an informed choice—through my employer, the insurance market, state government, or the federal government? Where should the consumer start?"

No cost control

But the real problem with passing the PPACA is the lack of cost control in the law. Though it has long concerned industry insiders, the public largely seems uninformed as to the price they will pay for reform, experts say.

"While the Supreme Court's decision about the Patient Protection and Affordable Care Act determined the outcome of one of the most significant judicial cases of the century, no one has yet addressed one of the most pressing issues facing our nation: the rising cost of health care," says Adam Bruckman, president and CEO of Digital Insurance. "Our country still does not have measures in place to control a system that is on an unsustainable cost trajectory. If we are to affect meaningful change, we are obligated to devise methods to curb rising expenses."

The National Association of Health Underwriters CEO Janet Trautwein shared the same sentiments, saying "we still have concerns that PPACA does not address the true drivers of health insurance costs in this country."

"The act was attempting to attack the rising cost of health care and is focused on only one side of the equation—supply of services and reimbursement," Braun explains. "Insurance market reform, reforming and regulating the distribution and marketing, as well as regulating the development of insurance premiums and how you reimburse and compensate providers, are not the only aspect of the cost equation. The act does not address the demand side of the equation, which is where an equal amount of attention should be given."

The law has a "huge and costly compliance burden on American employers," Trautwein says. Research from global insurance broker Willis Group Holdings out earlier this year confirmed that health costs continue to rise, and that PPACA is one of the significant reasons for the cost increases. In turn, employers are asking their employees to pay more for the coverage.

But regardless of personal feelings on health reform, brokers say they still have an important role.

"As insurance professionals, our job is to assure full-scale implementation of PPACA will continue and to help our individual and employer clients with the transition and compliance requirements the law entails," Trautwein says. "Our efforts to enroll individuals in high-risk pools, Medicare, Medicaid and CHIP programs will continue as we work to lower the number of uninsured Americans."

"There are still legislative actions that can be taken to fix parts of the law, and though we support many of these efforts, our focus is to help our customers transition to the regulations, policies and procedures the law outlines."