Rochester, N.Y.-- It's a sweeping, dramatic change for health care in America and it's a decision that is likely to change every American's life.
On Thursday, the United States Supreme Court decided in a 5-4 vote that President Barack Obama's Affordable Care Act is constitutional.
The key vote was Chief Justice John Roberts, who was appointed by President George W. Bush. He joined the court's four liberal justices: Stephen Bryer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor in the outcome.
The decision was made that while Congress may not have the right to mandate the purchase of health insurance, Congress retains the right to asses a tax for people who don't purchase health insurance.
Most of the mandates in the law will go into effect January 2014.
On Thursday, the University of Rochester Medical Center, the area's largest employer and biggest medical center said that they are applauding the decision.
According to URMC's Chief Operating Officer Peter Robinson, the hospital spends about $70 million a year providing care to uninsured patients. The hospital calls this Charity Care.
Robinson says they expect to see some relief in emergency rooms as more people will start taking advantage of primary care, now that they will be required to have insurance.
Robinson says the hospital has been preparing for the law since it passed in 2010. Also, he says that while many other states may have sweeping changes to make, New York state does not.
"I think New York state is a bit ahead of the rest of the country on a number of fronts," says Robinson. "Providing insurance eligibility for students and children up to 26-years-old and to let them stay on their parents coverage, and provisions for pre-existing conditions are all embedded in the Affordable Care Act, but New York passed legislation on its own to do that."
Meanwhile in April 2010, Governor Andrew Cuomo issued an executive order to let the state start establishing a state insurance exchange-- or a marketplace where individuals and businesses can purchase affordable health care that fits under the federal guidelines.
Democratic Assemblyman Joe Morelle says, given the Supreme Court's decision, the exchange should now be a law in New York state.
"My belief and the belief of my colleagues is that we need to do it in law," says Morelle. "When we go back to special session, hopefully, the state will enact a New York State health benefit exchange."
However, there are some concerns among local business leaders. Sandy Parker, president of the Rochester Business Alliance says the law is burdensome for business owners who will now be required to provide government-approved health care coverage to their employees.
"We're a heavily mandated state," she says. "There are additional mandates that are a part of the Affordable Care Act that would be layered on top of what we already have to deal with. This is going to add another layer of worry to small business employers who look at health care costs as taking a bigger and bigger chunk of their operating budget."
According to RBA's poll of businesses in Rochester, 77 percent of business owners said health care costs is the top concern they have for their business.
Parker says that RBA is supportive of affordable and accessible health care, but feels that there has been no true answer as to how the reform would be paid for.
Under the Affordable Care Act, individuals will have to have insurance or be penalized. According to the Wall Street Journal, the penalties can start at $95 dollars a year or one percent of the person's income, whichever is greater.
For businesses with 50 full-time employees or more, the penalty is $2,000 per employee if the business chooses not to provide health care coverage.