The six-person medical device firm in East Baltimore, which develops technology for prosthetics, used small-business tax credits provided under early provisions of the law to help pay for employee insurance. The savings for the company — about $3,000 — enabled it to hire an extra intern this summer.
And the company is looking forward to more savings, now that the Supreme Court has upheld the constitutionality of the law's key provision: requiring people to pay for insurance or face a penalty. The federal government can continue to roll out more health benefits to the uninsured, including increased tax incentives to small businesses, until the reform effort is implemented in 2014.
"After this year I hear the rebates will save us even more," Dan Schlattman, the company's chief operating officer, said Friday. "It's definitely been good for us."
Over the next several months, the Affordable Care Act will allow for expanded coverage of preventive-care services for little or no cost, increase funding to cover children not eligible for Medicaid, streamline hospital bills and improve access to Medicaid for poor adults. One-third of the 750,000 uninsured Marylanders will gain coverage in the first year the law is fully implemented.
Critics of the law, including 26 states and the National Federation of Independent Business, which challenged it in court, say it will be costly and burdensome to businesses. Some members of Congress have said they will try to repeal the legislation. And the issue will remain a point of debate during the presidential election.
The law mandates that everyone carry insurance through an employer, a government-sponsored plan such as Medicare or statewide exchanges. Individuals and companies would have to pay a penalty to opt out. The idea is to spread the cost of health care to everyone, while working on ways to deliver it more efficiently.
"Clearly, we're disappointed [in Thursday's Supreme Court ruling]," said Ellen Valentino, executive director of NFIB's Maryland chapter. "We think that the federal health care law passage is not the right direction for small businesses."
Small-business owner Eric Maynard is pessimistic about the law's impact.
He would consider paying the penalty rather than provide coverage to his employees if reform makes it unaffordable, as he predicts. He said the law unfairly puts a cost burden on small businesses like his own, which employs 26 people.
"Don't get me wrong," said Maynard, owner of the event production company Event Tech in Curtis Bay. "I care about benefits for my employees. I want to do what I can, but not at any cost."
Passed in 2010, the health reform law has already provided coverage for young adults up to age 26 on their parents' policies, insurance for children with pre-existing conditions, and financial help for drug costs to people on Medicare. It prohibited insurance companies from limiting how much they will cover.
Maryland had moved forward with implementation of health reform even as legal challenges raised questions about its future. But it was unclear, if the law was overturned, where the funding would come from to continue efforts — and if the federal and state governments would have the authority to enforce some provisions.
Insurance companies such as CareFirst BlueCross BlueShield and UnitedHealth Group had said they would continue to cover some provisions, such as free preventive care and keeping adults on their parents' plans even if the reform law had been ruled unconstitutional. But requiring insurers to cover pre-existing conditions would have been harder for Maryland to enforce.
In the 2012 General Assembly session, the state passed legislation outlining criteria for setting up the exchange where people will buy insurance on the open market. People will be able to shop for insurance on the exchange during open enrollment in October 2013.
Initial projections show 180,000 Marylanders could access insurance on the exchange in the first year and 84,000 through the expansion of Medicaid.
This summer will be spent continuing work on the exchanges, and crafting the criteria for services that will have to be included in all insurance plans in the state under reform, said Carolyn Quattrocki, executive director of the Governor's Office of Health Care Reform.
Hundreds of thousands of Marylanders have already taken advantage of available provisions of the health care reform law, she said.
About 52,000 young adults in Maryland have benefited from getting on their parents' insurance plans and 1.2 million residents have been covered by new policies that cover preventive services, Quattrocki said.
"We're pretty well under way, unlike some other states that were hanging back," she said. "We are working hard to implement the law and we feel good about where we are to bring full implementation of the law to Maryland by 2014."
Vincent DeMarco, president of advocacy group the Maryland Health Care for All Coalition, said the Supreme Court decision gives the uninsured hope once again.
"People can once again feel their health care is secure," he said. "That was in jeopardy before."