"It's still the law of the land," said William Hoagland, vice president for public policy at health insurer Cigna. "We'll continue to proceed with its requirements, and (the ruling) will not slow that down. We have no other choice until this thing is resolved one way or the other." Insurers spent millions to block passage of the law.
Health care accounts for about one-sixth of the economy, and many players in the sprawling sector have a love-hate relationship with Obama's remake. There's dissatisfaction with core provisions, and a sense that parts may be unworkable. But at the same time, it's seen as a way to start addressing problems of cost and quality.
"I don't think people are going to hit the stop button," said Paul Keckley, executive director of the Deloitte Center for Health Solutions, a research arm of the consulting firm. "You probably don't make the big bets right now, but you make the incremental investments in case you have to make the big bets six or 12 or 18 months down the road. Everyone proceeds with an informed approach."
Monday's ruling by U.S. District Judge Roger Vinson in Florida had been expected to go against the Obama administration. But the scope of the decision in a lawsuit by 26 of the 50 states took some by surprise.
Vinson struck down the entire law after saying its requirement that nearly all people have health insurance was unconstitutional. A different judge who reached the same conclusion in a separate case voided the individual insurance requirement and left everything else in place.
The administration plans to appeal both rulings. Judges in two other cases have upheld the law. It's generally expected that the U.S. Supreme Court will get the last word, but that could take a year or two more.
During that time, the government will write thousands of pages of federal rules covering hospitals, doctors, states, insurers and others. Among the topics are new models for hospitals and medical practices to band together, and rules for operating state insurance markets called for in the law. It adds up to thousands of jobs and tens of millions of dollars.
Florida Republican Gov. Rick Scott said Tuesday he plans to put the brakes on the state's role in putting the law into place, but not everyone feels that states can afford to sit on the sidelines.
"The ruling does not change the urgent need for state-based reforms, nor should it derail efforts in the states targeted at fixing a broken and unsustainable system," said Alabama state Rep. Greg Wren. A Republican who says he agrees that the law is unconstitutional, Wren is nonetheless helping to lead a national task force on implementing it.
Presuming that the Supreme Court will ultimately rule against the law "is too risky a strategy," said Wren. For example, if states don't act, the federal Health and Human Services Department could step in to run the new insurance markets in their backyards.
According to preliminary figures compiled by the National Conference of State Legislatures, lawmakers have introduced more than 250 bills relating to states' role in the overhaul. About 50 propose challenges to the law or say states should refrain from carrying out particular provisions. More than 70 deal with insurance changes, and more than 40 address how to establish the state markets where people can buy coverage.
After trying to block passage of the law, insurers might have to defend the requirement that people must get coverage. Not only that, the industry wants stiffer penalties for those who don't enroll.
Starting in 2014, the law bars insurers from turning away people with medical conditions. Unless there's a way to force as many healthy people as possible into the pool, premiums could rise sharply.
Without the mandate that the judge in Florida ruled unconstitutional, "it's a house of cards," said Cigna's Hoagland.
Associated Press writer Bill Kaczor in Tallahassee, Fla., contributed to this report.