And though the law has divided the nation, it's ultimately really confused them, too. Many had considered the law to be so convoluted—and pieced out to occur over such a long timeline—that there's been a considerable level of ambivalence over it, says Danielle Kunkle, a Medicare adviser at Boomer Benefits in Fort Worth, Texas.

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

Regardless, there's been positive numbers coming out regarding how health reform is affecting Americans.

For example, more than 3.1 million Americans ages 19 through 25 are now covered by their parents' medical insurance policies due to the law's young adult coverage provision, up from 2.5 million in December.

"This policy doesn't just give young adults and their families peace of mind, it also gives them freedom," HHS Secretary Kathleen Sebelius has said. "It means that as they begin their careers, they will be free to make choices based on what they want to do, not on where they can get health insurance."

Sebelius also recently announced that 12.8 million Americans will benefit from $1.1 billion in rebates from insurance companies this summer, because of the law's 80/20 rule. These rebates will be an average of $151 for each family covered by a policy.

But there's also some bad news: Doctors warn that consumers will suffer because there won't be enough doctors to handle all the new patients under health reform. And health insurers have warned the law may result in higher costs for patients.

photo: Emily Weinstein, 23, hasn't been able to make much money, which has put health insurance out of reach. (AP Photo/Rick Bowmer)

Doctors

Those in the medical profession haven't been excited about the Patient Protection and Affordable Care Act. That's because, according to the Doctor Patient Medical Association, doctors say that it will have little impact on patients' access to medical care and only create bureaucratic hoops.

"Doctors on the frontlines clearly understand what Washington does not," says Kathryn Serkes, DPMA Chairman. "Government-mandated 'coverage' is not the same thing as actual medical care. We'll still have millions who need medical care."

About three out of four doctors say that the individual insurance mandate does not improve access to actual medical care. One family doctor surveyed commented, "The major problem is the politicians equating health insurance with health care."

"Doctors think that the individual insurance mandate and the massive expansion of Medicaid in PPACA are the government version of bait-and-switch tactics—promising something that you know you can't deliver," Serkes says.

"What PPACA does is increase patients' access to a piece of paper—that says they are 'covered' by insurance or 'enrolled' in Medicaid or Medicare," she says. "But paper promises don't translate to actual medical care when doctors can't afford to see patients at the lowball payments, and patients have to jump through bureaucratic hoops set up by the government."

Another survey of U.S. primary care physicians by MDLinx taken following the Supreme Court ruling confirmed the same findings. It found most doctors don't believe the law will achieve its objective of 100 percent health care coverage for Americans.

And, for the most part, doctors fear there won't be sufficient numbers of primary care providers to meet the increased demand of new patients.

photo credit: basketman

Insurers

For insurers, health reform, in some ways, was happening regardless of the ruling. In June, prior to the ruling, insurance giants UnitedHealth Group, Humana and Aetna said they would keep the popular provision that allows kids 26 and younger to stay on their parents' health insurance plans—and some other popular parts of Obama's health overhaul—even if the Supreme Court killed the law.

After the Supreme Court ruled the law constitutional, insurers expressed their willingness to comply and work with the law, but most carriers said it doesn't change their business strategy and commitment to consumers. Many also said the PPACA falls short of fixing the flaws of the country's health care system—and work still needs to be done.

"We are prepared for the changes ahead and will continue to fully comply with the requirements of the Affordable Care Act," Aetna said. "At the same time, we know that much more must be done to fix the problems that remain in our health care system. We believe there is still time—if people can come together in a bipartisan way—to improve quality and affordability. That security is what Americans want and need."

Other carriers questioned the "affordable" part of the PPACA, saying the law doesn't address the key problems of cost and affordability.

"The health care reform law falls short in controlling the underlying cause of our nation's health care crisis: costs that are too high and rising too fast," Humana said in a statement. "Affordable and stable coverage must be our top priority. "Several significant reforms will take effect in 2014 such as guaranteed coverage, rating restrictions and exchanges. Humana believes there must be a gradual transition to new rating and benefit requirements, which threaten to undermine the goals of access and affordability. And, costs will jump unfairly for small businesses and many seniors, unless something is done about the health care law's premium tax."

photo: A sign for Aetna insurance is seen in Hartford, Conn. in this Feb. 9, 2006 file photo. (AP Photo/Douglas Healey)

Politicians

Not surprisingly, reform has been another political battle.

After the Supreme Court ruling, Democrats cheered, as the decision finally meant it was full-steam ahead with the mandate, the linchpin of the law that will have both immediate and long-term ramifications for almost all Americans, but mostly for the nation's 50 million uninsured.

And it was an obvious relief for the Obama administration, which had been fighting for the law—every word in its 2,400 pages—even before it was signed more than two years ago. Mitt Romney further aggravated the administration when he spoke to a crowd before the ruling and told them that if the court tossed the law, Obama's term would be a waste.

In theory, it might have been true. But Obama celebrated what he called a "victory for the American people." In remarks following the ruling, the president promised "insurance companies can no longer impose lifetime limits on the amount of care you receive. They can no longer discriminate against children with pre-existing conditions. They can no longer drop your coverage if you get sick. They can no longer jack up your premiums without reason."

But as the winners celebrated, the losers mobilized. Republicans started a repeal rally cry. Romney wasted no time slamming the law and the Supreme Court.

"Let's make clear that we understand what the Court did and did not do," he said. "What the Court did today was say that Obamacare does not violate the Constitution. What they did not do was say that Obamacare is good law or that it's good policy. Obamacare was bad policy yesterday. It's bad policy today. Obamacare was bad law yesterday. It's bad law today."

[Read The Romney battle cry]

photo: AP Photo/Charles Dharapak, file

Employers

Employers are still caught in a waiting game for reform. According to the International Foundation of Employee Benefit Plans, more than half of single-employers and corporations who were in a wait-and-see mode for health care reform planning and implementation also are awaiting the outcome of the 2012 presidential and congressional elections.

"We're at the beginning of the process, much like when ERISA (Employee Retirement Income Security Act) was enacted in 1974, and almost 40 years later we're still working through that process and modifying that law," Wilson says. "I would expect the health care law to undergo the same process and we will probably still be working on it in 30 years."

But in the meantime, employers are struggling with rising health costs, which won't be helped by the PPACA. Instead of driving down costs, the law has a "huge and costly compliance burden on American employers," argues NAHU President Janet Trautwein.

[Read Employers confront costliest reform provisions]

"Clearly what we're talking about at this point in time is really trying to manage health care costs, and address controlling and decreasing costs in the future," says Paul Hackleman, International Foundation Health Care and Public Employer Analyst.

We will also see if employers will begin to drop coverage or not for their employees. Reports have varied on numbers, and a March Congressional Budget Office report cited a "tremendous amount of uncertainty" about the effect of the law on employer-sponsored coverage, estimating as many as 20 million fewer Americans will get insurance through their employer by 2019.

photo credit: nokhoog_buchachon

Brokers

Brokers—many of whom worried the law would jeopardize their livelihoods—were never a fan of the health reform law.

[Read Will reform create a zombie wasteland?]

After the ruling, many began asking questions. Some were confused by the new definition of the mandate as a tax, and others expressed their discontent with the law in general.

"As an agent, I'm aware the health care industry and insurance market have had major changes many times over the last 30 years," explains Kunkle. "I don't fear it from that perspective. There will be something for us as agents—supplemental plans to sell, or places for us in the exchange to play a role."

But as a consumer of health insurance, Kunkle says, she's terrified.

"I worry about rationing and how this will change the quality of health care in America forever," she says. "I'm horrified by the enormity of the impact that this legislation will create over 'We the People.' This law overreaches the boundaries of power intended by the Founding Fathers of this nation and will be the most sweeping form of government control that this nation has ever seen."

photo credit: vichie81