(CBS News) The Supreme Court's monumental decision to uphold the Affordable Care Act, President Obama's health care overhaul, left some people crying tears of joy today and others sighing in fear for their future.
The range of emotions from people across the country today illustrates how the ongoing political debate is so intensely personal -- driving some to get engaged in politics like never before. Four Americans with different points of view from different parts of the country shared their stories today with CBSNews.com.
A doctor whose patients are more optimistic
Cheryl Bettigole, a family physician in southern New Jersey, learned about the Supreme Court ruling today in an email from a fellow doctor.
"I am really thankful at this moment," said Bettigole, who is the Chief Medical Officer of Complete Care Health Network, a group of community health centers. "No one thinks [the law] is perfect. But I, for so many years, took care of people who didn't have insurance or had plans that didn't cover that much... For my patients, it means they actually have a chance to get insurance."
"One of the things about being a doctor in this country and especially working in clinics, you see people die from a lack of health insurance, and it's really disturbing," she said. "The thing that gets to me is when they consciously make the decision that they're not worth the cost to their family."
One patient, Bettigole said, had a tumor "the size of a grapefruit" who chose not to treat it. "He said, 'I've worked my whole life so my family could have a little something,'" she recalled. "He didn't have to die."
A patient like that should benefit from a provision in the Affordable Care Act that bars insurers from limiting lifetime coverage.
"I think there has been a lot of skepticism of whether [the law] would really be there, and I think this is going to change that," Bettigole said of the Supreme Court ruling.
As some provisions have kicked in -- like the rule allowing children up to 26 years old to stay on their parents' insurance -- her patients have grown more optimistic.
"Starting in 2014 it will really be there for them," she said. "I've seen an increase in a lot of people saying, 'Ok, I can hold on 'til then."
A senior worried for his future and his country's
Joe Dugan, a senior citizen and Tea Partier from South Carolina, doesn't think the nation has time to wait -- for better health care or a reformed economy.
At the heart of the Affordable Care Act is the individual mandate, the requirement for all Americans to acquire insurance or pay a fine. The court today said the mandate is constitutional, so long as the fine is considered a tax.
"Allowing insurance payments as a tax -- I was a little bit shocked," Dugan said.
"I think that this is really, really going to hurt our economy," he continued. "Our GDP is based about 75 percent on consumer spending, and over the past three years we've seen no increases in salaries, yet taxes and fees go up. People are scrambling to get by, and I don't see how we can recover when we keep adding taxes and fees."
Dugan said he was personally "devastated" to learn that as fees are established to pay for other health care investments, the Affordable Care Act cuts $500 billion from Medicare, the government program for seniors. Dugan pays for a supplementary policy, but he says the 15-to-20 percent premium increases would clearly be too expensive for most seniors on limited incomes.
"It's like we've thrown our elderly to the dogs," he said.
A cancer patient feels reassured
Spike Dolomite Ward, a nonprofit director from Los Angeles, was also critical of the Affordable Care Act -- until she was diagnosed with Stage 3 breast cancer.
"The first thing I heard about was the individual mandate, and I was really unhappy about it because my husband and I were self-employed and couldn't afford health insurance -- we assumed we would have to go back to paying $1,500 a month for insurance," she said. "Then two months later I found out I had breast cancer."
Ward soon learned she qualified for the Pre-existing Condition Insurance Plan created by the new health care law. By 2014, the same benefits, making insurance available even to those with pre-existing conditions, will be available to everyone through state-based exchanges.
"I understand what the mandate means now," she said. "It means we can all afford it if we all get it."
Ward said she couldn't sleep Wednesday night -- in part because she was so anxious about the looming court decision and in part because she underwent a double mastectomy just nine days ago, after five months of chemotherapy.
Upon learning of the ruling, "I cried tears of joy," she said. "This is such an unbelievably great day for everybody, whether they understand this or not."
A small business owner with higher premiums and no relief
Mike Graham was far from crying tears of joy Thursday. He hasn't seen the relief from the Affordable Care Act that he thought he would receive.
Graham owns a restaurant called Jukebox Junction nestled in the mountains of North Carolina, about 30 miles west of Asheville. Graham has 11 full-time employees and 11 part-time employees. "I pay well above industry standards because I don't like to have a lot of turnover," he said.
It turns out, however, that Graham saw a limited benefit from the tax credit, since it doesn't apply to the owner of the small business or the owner's relatives. Graham employs six relatives at his restaurant.
"I'm still upset because the president touted that before the law was passed," he said. "My argument is it's discriminatory against small family businesses. We're stuck paying the higher premiums, watering down coverage or canceling all together."
Graham said he decided to pay higher premiums "because I was thinking I was going to get a tax credit. Then [the insurance agent] pulled up the fine print... A lot of small businesses are family run... but we don't have a strong voice with lobbyists up in D.C."
Graham said he could "deal" with the rest of the law but would like some recourse for family-run businesses. "It's basically a tax -- sure, we pay insurers, but it goes to other benefits they didn't have to provide before, and I pay for it," he said. "Restaurants aren't giant profit centers."