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Health care: What the Supreme Court's ruling means for US consumers

The US Supreme Court ruling to uphold Obama's health-care reform law affects households across America. Millions without insurance are on track to get it. But costs are an unresolved issue.

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Employer-based coverage

The law coaxes employers to maintain or expand insurance for their workers – with fines of about $2,000 per worker for firms that don't offer coverage and that have more than 50 employees. The law also offers tax credits to help small employers to offer insurance.

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But one unanswered question is how many employers would cease to offer coverage, paying the fine instead. Republican presidential candidate Mitt Romney, commenting on the court ruling, warned that up to 20 million people may "lose the insurance they want" under the ACA. He also cited one survey in which businesses said the law "makes it less likely for them to hire people."

Obama, by contrast, responded to the court ruling by saying that "if you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance – this law will only make it more secure and more affordable."

The law also imposes a steep tax, starting in 2018, on firms offering expensive "Cadillac" health plans, in a bid to discourage escalation of health costs. The law defines these as plans with premiums of $10,200 or higher for an individual, $27,500 for a family, indexed to inflation.

Insurance for children

The law provides that children can be covered as dependents up to age 26 in all individual and group policies. That provision, already in effect, is helping several million Americans, Obama says.

Security of coverage

One of the ACA provisions that garners the strongest support, in public opinion polls, is the requirement that insurers must be willing to take all comers. This "guaranteed issue" of insurance means that firms can't deny coverage, or drop it, because of someone's medical condition.

The law also prohibits individual and group health plans from putting a lifetime cap on their coverage for an individual.

Personal taxes

One way the ACA pays for its expansion of coverage is by imposing a range of tax hikes. Some are on businesses (everything from pharmaceutical suppliers to tanning salons), but many fall on individuals. Major ones include a 0.9 percent hike in the Medicare payroll tax for households earning over $250,000, and a 3.8 percent tax on investment income for higher-earning households.

The law also sets a new limit for contributions to a flexible spending accounts used for medical purposes ($2,500 per year as of 2013, adjusted annually by the cost of living). And it ratchets down a tax deduction on unreimbursed medical expenses. For someone to claim the deduction, the expenses must exceed 10 percent of that individual's adjusted gross income, as of 2013, up from 7.5 percent currently.

And wait, there's more

The law has a range of other provisions that affect ordinary folks. Notably, it aims to improve America's health by promoting various "wellness" concepts, and by improving the quality of information used by doctors, patients, and insurers.

Some of the actions center squarely on what goes on in hospital settings. But here's one example of the law's wider reach: The law requires that food sold in vending machines and at chain restaurants come with nutritional labeling.

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