Thursday’s Supreme Court decision upholding the Affordable Health Care Act brought more uncertainty to local health care businesses.

The Court upheld the “individual mandate” in a 5-to-4 ruling. This was an essential part of the law, and the Court declared it was constitutional since Congress has taxing authority.

Beginning in 2014, the new law requires those who are currently without insurance to obtain insurance or pay a fine.

The government would provide financial assistance for those who cannot afford the insurance.

Andalusia Regional Hospital CEO Mark Dooley called the Supreme Court’s ruling “a big hurdle to get over from the Affordable Care Act, but it could still be in jeopardy depending on the results of the November election.”

“From a health care standpoint, I think the impact remains to be seen – there’s still much uncertainty,” he said. “Obviously for hospitals, having more people insured would be a tremendous benefit, but it also raises the question of where will the money come from to pay for the care.

“Medicaid programs here, and in many other states, are already struggling to make ends meet, and with thousands to millions more added to the rolls, how will states be able to afford that,” he asked. “I don’t have the answer, but that is a huge question out there.”

Dooley touched on the penalty that those must pay if they don’t have insurance by the mandated time.

“As for the tax penalty issue, Chief Justice Roberts, the deciding vote, stated that the individual mandate was constitutional because it was a tax rather than a penalty,” Dooley said. “It appears at this point there are no consequences for failing to pay, so unless that changes the impact there may not be as substantial as some think.”

The ruling also states that states with existing Medicaid funding will not lose their funding if they choose not to participate in the expansion.

Alabama was one of the 26 states that sued to overturn the law.

Gov. Robert Bentley said he was “disappointed in the decision.”

“I am deeply disappointed by (Thursday’s) Supreme Court decision,” he said. “The health care law is an overreach by the federal government that creates more regulation, bureaucracy and a dramatic increase in costs to taxpayers.”

Bentley called the ACA the “single worst piece of legislation to come out of Congress.”

“This law must be repealed,” he said. “People need more choices, not fewer choices. Bigger government is not the answer. Market-based solutions are the best choices to giving the public the most affordable options.”

What exactly does the ruling mean for the average resident, one might ask?

• Since the penalty for not purchasing minimally sufficient health insurance is a tax, the Supreme Court ruled it was constitutional. According to the Urban Institute, 18.2 million Americans will be required to purchase coverage; 10.9 million low-income people will be eligible for federal assistance to help cover the costs of premiums; and 7.3 million people will need to purchase new coverage and won’t receive aid to purchase the new coverage.

• Many may wonder if they will be required to pay more for health care, and whether or not their premiums will increase. The White House has maintained that the section of the law that covers insurance reform will cap out-of-pocket expenses and require preventative care to be fully covered without out-of-pocket expense. The Obama Administration has said this will lessen the amount families are required to pay.

However, The Wall Street Journal reports that most consumers should expect to see their premiums increase due to rising health care costs and expanding coverage because of ObamaCare.

• What changes are still in place for insurance companies? You cannot be denied coverage for pre-existing conditions; small business owners will be eligible for billions of dollars in tax credits to help employees pay for coverage; preventative care and immunizations are required and at no cost; dependent children can receive coverage up to age 26; an appeals process will be allowed for consumers to appeal decisions made by insurance companies; it will be against the law for insurance companies to impose excessive premium increases; lifetime limits on coverage will cease; and companies can no longer drop coverage while a patient is ill.