It was just a few weeks ago that the long debate that haddivided a country, terrified brokers, and confused many Americansfinally ended—at least, technically speaking.

On the morning of June 28, the last day before the Supreme Courtended its current session and headed into break, the court spoke:The Patient Protection and Affordable Care Act stays. And in asurprising twist—one that still has political pundits talking—itwas Chief Justice John Roberts’ decision that rescued the law’smost controversial piece, the individual mandate, from itspredicted death, by declaring it a tax.

After the court’s announcement, emotions ran high.

Democrats cheered, as the decision finally meant it wasfull-steam ahead with the mandate, the linchpin of the law thatwill have both immediate and long-term ramifications for almost allAmericans, but mostly for the nation’s 50 million uninsured. And itwas an obvious relief for the Obama administration, which had beenfighting for the law—every word in its 2,400 pages—even before itwas signed more than two years ago. Mitt Romney further added toanxiety for the administration when he spoke to a crowd before theruling and told them that if the law was killed, Obama’s term aspresident was a waste. In theory, it might have been true.

But Obama was able to celebrate what he called a “victory forthe American people.” In remarks following the ruling, thepresident promised “insurance companies can no longer imposelifetime limits on the amount of care you receive. They can nolonger discriminate against children with pre-existing conditions.They can no longer drop your coverage if you get sick. They can nolonger jack up your premiums without reason.”

But as the winners celebrated, the losers mobilized. Republicansstarted a repeal rally cry. Romney wasted no time slamming the lawand the Supreme Court.

Health insurers questioned the “affordable” part of the PPACA,saying the law doesn’t address the key problem of cost andaffordability. And brokers—many of whom worried the act wouldjeopardized their livelihoods—began asking questions.

Some were confused by the new definition of what was once calledthe mandate. (The whole thing seemed to confuse even those at theWhite House. Hours after the ruling, Obama said again that itwasn’t a tax. Romney admitted it was, contradicting a seniorcampaign adviser who days before said the Republican presidentialcandidate viewed President Barack Obama’s mandate as anything but atax.) Others expressed their discontent with the law ingeneral.

“While it may on the surface appear courageous to uphold themost unpopular provision of the unpopular law—the individualmandate—the court did so by citing Congress’ taxing power, and notby expanding an already overreaching commerce clause power,” saysTom Blomberg, a former lawyer and regional vice president at TheIHC Group based in Minneapolis.

Some are more concerned about the bigger picture.

“As an agent, I’m aware the health care industry and insurancemarket have had major changes many times over the last 30 years,”said Danielle Kunkle, a Medicare adviser at Boomer Benefits in FortWorth, Texas.

“I don’t fear it from that perspective. There will be somethingfor us as agents—supplemental plans to sell, or places for us inthe exchange to play a role.”

But as a consumer of health insurance, Kunkle says, she’sterrified.

“I worry about rationing and how this will change the quality ofhealth care in America forever,” she says. “I’m horrified by theenormity of the impact that this legislation will create over ‘Wethe People.’ This law overreaches the boundaries of power intendedby the Founding Fathers of this nation and will be the mostsweeping form of government control that this nation has everseen.”

Kunkle’s concerns echoed those of most Americans.

[See "Your guide to health reform"]

For the most part, Americans didn’t want this verdict. In an NBCNews/Wall Street Journal survey released the week of the ruling,just 28 percent of Americans said they wanted the PPACA to be ruledconstitutional, compared to 37 percent who said they’d be happywith an unconstitutional ruling.

Of course, the individual mandate has been the major bone ofcontention with the PPACA, with poll after poll echoing thesame sentiment: Americans don’t like it. Most recently, a Harrispoll found two-thirds of the public disapproved of the individualmandate.

Even Democrats didn’t like it. Gov. Howard Dean, a staunch universal health care supporter,told brokers at the Benefits Selling Expo in May that theadministration should never have included the mandate in the law,calling it the “major blunder” of the PPACA.

“There has been so much public outcry against it, and yet theyare forging forward with it, whether the people want it or not,”Kunkle says. “This is the part that scares me, because we arelosing our grasp on the very thing that has made so great a nationfor the last 230 years.”

Moving ahead

But strong aversion to the mandate didnt' stop the public fromliking other parts of the law: For example, four in five U.S.adults agree neither children nor adults should be denied healthinsurance if they have a pre-existing condition, and three-quartersof Americans agree tax credits should be offered to individuals whobuy their own health insurance.

Some parts of the plan were so popular—namely the provision thatallows kids 26 and under to stay on their parents' health insuranceplans—that virtually everyone liked them. In June, prior to theruling, insurance giants UnitedHealth Group, Humana and Aetna evensaid they would keep that provision—and some other popular parts ofObama’s health overhaul—even if the Supreme Court killed thelaw.

“This policy doesn’t just give young adults and their familiespeace of mind, it also gives them freedom,” HHS Secretary KathleenSebelius has said about the law. “It means that as they begin theircareers, they will be free to make choices based on what they wantto do, not on where they can get health insurance.”

Other numbers suggested health reform was moving ahead: Thenumber of accountable care organizations across the United States,for example, has grown 38 percent over the past six months,according to a report from health care business company LeavittPartners.

States already have been at work implementing measures of thelaw, and many have argued killing it could have messy rippleeffects.

“The industry quite frankly should have done a lot of this along time ago,” Anne Sperling, a broker at Daniels Insurance Agencyin Santa Fe, N.M., said at the National Association of HealthUnderwriters’ annual conference in June. “That’s why they aren’tgoing back on this.”

So it seems that despite the ruling, reform in some way ishappening. But for many, the Obama plan doesn’t solve all theproblems.

Waiting game

The Supreme Court ruling was supposed to give peace of mind tothose who were anxiously awaiting the decision. But instead, it'signited a whole new roster of questions.

"How states will interpret [Medicaid expansion], how the federaland state governments will fund any of this, or how this trulyimpacts health care costs, remains to be seen," Blomberg says.

"Now that the decision is in, states will have to scrambletoward implementation, all while watching where November takes us,"he says. "Just the right amount of uncertainty we've grownaccustomed to in this whole process. The zombie apocalypsesounds pretty good right about now.”

If there’s been one major theme that’s come out of the healthreform debate, it’s uncertainty and confusion. Many individualsremain stuck in a holding pattern, waiting to see which directionthe court was going to go before implementing any plans, explainsPerry Braun, executive director of Benefit Advisors Network.

Plus, many considered the law to be so convoluted—and pieced outto occur over such a long timeline— that there’s a considerablelevel of ambivalence over it, Kunkle says. A Harris poll conductedin the spring confirmed Americans were largely confused abouthealth reform.

When asked about six important elements of the PPACA, largenumbers of people (from 37 percent to 66 percent) weren’t sure ifthe provisions were even part of the bill. So now that the law isupheld, “this decision raises more questions and issues that willhave to be addressed,” Braun says.

“How the states will comply by the timeframes outlined, howemployers within that state will adjust their plans [and] howindividuals will purchase health insurance products with anexpectation that an exchange is available to them are just a few ofthe questions that fall out of this ruling,” Braun says.

“For the consumers, there are several questions to triagethrough: One, what are my options? Second, how do I receiveinformation to make an informed choice—through my employer, theinsurance market, state government, or the federal government?Where should the consumer start?”

Just the beginning

But there's something to agree on: The debate isn't over. Insome ways, it's just the beginning.

Democrats will keep fighting for the law, praising its goodintentions, and trying to convince Americans to embrace it. Romneyand other key Republicans will work on its repeal.

Employers who had been waiting for the ruling will now waituntil November.

And those who know the industry best, though they have largelybeen left out of the national conversation, will continue totalk.

According to a Doctor Patient Medical Association survey, forexample, doctors say the law won’t have much impact on patients’access to medical care.

“Doctors on the frontlines clearly understand what Washingtondoes not,” says Kathryn Serkes, DPMA chair. “Government-mandated‘coverage’ is not the same thing as actual medical care. We’llstill have millions who need medical care.”

“What PPACA does is increase patients’ access to a piece ofpaper that says they are ‘covered’ by insurance or ‘enrolled’ inMedicaid or Medicare,” she says. “But paper promises don’ttranslate to actual medical care when doctors can’t afford to seepatients at the lowball payments, and patients have to jump throughbureaucratic hoops set up by the government.”

What about the cost?

But the real problem with the PPACA is the lack of cost controlin the law, experts say. Though it has long concerned industryinsiders, the public largely seems uninformed as to the price theywill pay for reform.

"While the Supreme Court's decision about the Patient Protectionand Affordable Care Act determined the outcome of one of the mostsignificant judicial cases of the century, no one has yet addressedone of the most pressing issues facing our nation: the rising costof health care," says Adam Bruckman, president and CEO of DigitalInsurance. "Our country still does not have measures in place tocontrol a system that is on an unsustainable cost trajectory. If weare to effect meaningful change, we are obligated to devise methodsto curb rising expenses."

Immediately following the ruling, a handful oforganizations—from Humana to NAHU and America’s Health InsurancePlans—slammed the law for its lack of cost control.

[See Cost(out of) control]

“The law expands coverage to millions of Americans, a goalhealth plans have long supported, but major provisions, such as thepremium tax, will have the unintended consequences of raising costsand disrupting coverage unless they are addressed,” AHIP said.

“The act was attempting to attack the rising cost of health careand is focused on only one side of the equation—supply of servicesand reimbursement,” Braun explains. “Insurance market reform,reforming and regulating the distribution and marketing, as well asregulating the development of insurance premiums and how youreimburse and compensate providers, are not the only aspect of thecost equation.The act does not address the demand side of theequation, which is where an equal amount of attention should begiven.”

The law has a “huge and costly compliance burden on Americanemployers,” NAHU President Janet Trautwein says.

Research from global insurance broker Willis Group Holdingsearlier this year confirmed that health costs continue to rise, andthat the PPACA is one of the significant reasons for the costincreases. In turn, employers are asking their employees to paymore for coverage.

Then again, that doesn’t include the employers who will dropcoverage to their employees due to the law.

[See One in 10 employers to drop health coverage]

Reports have varied on numbers, and a March Congressional BudgetOffice report cited a “tremendous amount of uncertainty” about theeffect of the law on employer-sponsored coverage, estimating asmany as 20 million fewer Americans will get insurance through theiremployer by 2019.

But regardless of what does develop, and despite their personalfeelings about health reform, brokers say they still have animportant role.

“As insurance professionals, our job is to assure full-scaleimplementation of PPACA will continue and to help our individualand employer clients with the transition and compliancerequirements the law entails,” Trautwein says. “Our efforts toenroll individuals in high-risk pools, Medicare, Medicaid and CHIPprograms will continue as we work to lower the number of uninsuredAmericans.”

“There are still legislative actions that can be taken to fixparts of the law, and though we support many of these efforts, ourfocus is to help our customers transition to the regulations,policies and procedures the law outlines.”