President Barack Obama’s signature legislation of his first term, the Patient Protection and Affordable Care Act (ACA), remains the law of the land.

In late June, by a 5-4 vote, the Supreme Court upheld ACA as constitutional. The surprise vote was normally conservative Chief Justice John Roberts; he voted in the majority.

The court ruled that the government can’t force people to buy health insurance, but it can give them a tax penalty if they don’t. The court also limited the part of ACA that would have expanded the coverage to uninsured Americans through Medicaid.

“Today’s decision was a victory for people all across this country whose lives will be more secure,” Obama said at a briefing after the ruling. ACA fulfills a promise the president made to expand health care to a majority of Americans. Obama’s election to a second term in November ensures ACA will proceed as planned.

Here’s what has already taken place because of the law:

• 3.1 million young adults gained health insurance through a provision that allows them to stay on their parents’ policies until age 26.
• Nearly 62,000 Americans with pre-existing health conditions, who would otherwise be uninsurable, gained coverage through the government’s Pre-Existing Condition Insurance Plans. Those enrolled will be able to stay in the program until it expires in 2014. At that time, they’ll be eligible to buy health insurance through state-based insurance marketplaces scheduled to be up and running by fall 2013.
• Consumers have the right to appeal an insurer’s decision.
• Americans can receive preventive care with no co-pay.
• Children younger than 19 with pre-existing conditions have guaranteed insurance coverage.
• People on Medicare can get prescription drug discounts.
• There are no more lifetime limits on health insurance spending.
• Suspected unreasonable insurance rate increases will be reviewed.

Answers to Frequently Asked Questions About ACA

What happens in 2014, when the “individual mandate” takes effect?

Almost all individuals will be required to buy insurance beginning in 2014. Those who have insurance will be able to keep it. Those who don’t have insurance through an employer can buy it through the state-based health insurance markets.

What will happen to those who don’t buy insurance?

People without insurance will face tax penalties that will be phased in and increased over several years, starting with the 2014 tax filing. The penalty for the 2014 tax year will be $95 or 1 percent of taxable income, whichever is greater.

What if someone can’t afford insurance?

Tax credits will be available for those with incomes between 133 percent and 400 percent of the poverty level (up to $92,200 annually for a family of four in 2012).The law will also expand the number of people who qualify for Medicaid, the state and federal health insurance program for people with low incomes. An individual who makes less than $14,856, or a family of four that earns less than $30,657, will be eligible.

What remains unclear is whether these funds will be available to everyone. The Supreme Court’s ruling allows states to decide whether they want to accept additional federal money to help cover these costs.

How many additional people are expected to get insurance?

About 32 million Americans are expected to gain health insurance under the law when it takes full effect.

What will the states do? Are many of them likely to refuse the money to expand Medicaid coverage?

The answer to this question won’t be known immediately. Some states, including California, Florida and New York, are already having difficulty paying Medicaid costs.

What about Medicare? Will it be cut?

ACA reduces Medicare spending by a projected $428 billion over 10 years, mostly with reimbursement cuts to private insurers and health providers, and overpayments to private Medicare Advantage plans. This does not affect benefits in Medicare part A or B plans. The law means new, no-cost-sharing preventive services and new annual wellness visits with primary-care providers.