In the wake of the verdict: the U.S. Supreme Court's ruling on the federal health law leaves lawmakers working out what it means for their states.

• Author: King, Martha
• Position: Health Care Act

The months of speculation and uncertainty about the constitutionality of the federal health law ended June 28. The U.S. Supreme Court upheld the law, with the exception of the provision that would have allowed the federal government to withhold all federal Medicaid funds from states that don't expand their Medicaid programs.

The complexities of the Patient Protection and Affordable Care Act (PPACA) confound even seasoned policy experts, with provisions covering myriad programs and topics. The Supreme Court case, however, related primarily to the law's key mechanisms to provide health coverage to about 32 million of the nation's 50 million uninsured, beginning in 2014. Those include:

* Individual mandate. The court upheld this provision, which requires most people to have coverage. People may purchase coverage through insurance exchanges with sliding scale subsidies for those with incomes between the federal poverty level and four times the poverty level. In 2012, for a family of four, that would be between $23,050 and $92,200.

* Medicaid. The law expands eligibility for the program to most people with incomes up to 138 percent of the poverty level. The court let the expansion stand as a voluntary program separate from the rest of Medicaid, and prohibits the federal government from cutting off existing Medicaid funds for states that choose not to participate in the expansion.

The Implications

So what does the ruling mean for states?

The question could elicit more than 50 different answers, depending on the state, not to mention the variety of viewpoints within states.

States that put their insurance exchange planning on hold, awaiting the court's ruling, have some quick decisions to make. States already faced daunting challenges in developing exchanges by 2014, including these deadlines.

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* By September 2012, states must determine the "essential" health benefits for insurance plans sold in the exchanges, or federal officials will determine the benefits for them.

* By mid-November 2012, states must submit plans to the federal government stating whether they want to run their own exchange or adopt a state-federal model. Otherwise, federal officials will run it.

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"I'm not sure how the ruling will affect Oklahoma's exchange plans," says Representative Mark McCullough (R), NCSL's Health Committee co-chair. "Oklahoma does not want the PPACA. Period. We may just let the federal government come in and...