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Countless opponents and critics of the Patient Protection and Affordable Care Act were hoping that at least certain elements of the law would be struck down, but [yesterday's] U.S. Supreme Court decision means the sweeping health care reform measure remains the law of the land.
Congress may revisit, revise or repeal the law at some future time, but many constituencies are either already facing the effects of the law or will soon be impacted.
Many agents and brokers, for example, are already feeling the adverse effects of the PPACA’s medical loss ratio requirements. The MLR mandates contained in the reform law have forced many health insurers to dramatically reduce compensation paid to producers. Additionally, many of these professionals have been compelled to reduce the range of services they provide or leave the health marketplace altogether.
As agents are forced to reduce or eliminate the level of service and advocacy that they provide, consumers will likely pay the price. 
The PPACA’s state health insurance exchange requirements are among the measure’s most notable provisions and are likely to become the object of significant attention in the weeks to come. State policymakers across the country must quickly decide whether to create their own exchanges or allow the federal government to establish and run these new marketplaces.
Many states—perhaps optimistic that the justices would eliminate the need to act—delayed any meaningful action or decision-making on these issues pending the Supreme Court’s decision.
State exchanges must be fully operational by Jan. 1, 2014, but state officials must assess how they will move forward in the very near future. States that wish to operate their own exchanges when the requirements take effect in 2014 must show that they will be operationally ready for the initial open enrollment period that begins Oct. 1, 2013, and secure approval from the Department of Health and Human Services in the coming months. A state seeking to operate its own exchange in plan year 2014 must submit an application to HHS for consideration by Nov. 16. 

Source: IIABA
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