The Patient Protection and Affordable Care Act is law, but its impact on individuals and businesses depends on one of two events, either the U.S. Supreme Court’s ruling on the law’s constitutionality, or 2014, when the bill’s full provisions take effect.

“Right now, there are a lot things that are still unclear and still being worked out,” Doug Henley, central region sales director for Blue Cross Blue Shield of Mississippi, told members of the Vicksburg- Warren County Chamber of Commerce Wednesday.

“We won’t know how people will be affected until the regulations take effect in 2014,” he said. “And things could change, depending on how the Supreme Court rules (on the law).”

He said 26 states, including Mississippi, and the National Federation of Independent Businesses are suing to have the bill’s mandatory insurance provisions struck down. He said some court rulings have supported the act, and some have struck the law or some of its provisions down, setting up the Supreme Court hearing.

Henley said the health care reform act, which was passed on March 23, was driven primarily by rising health care costs.

“Health care expenses totaled $2.5 trillion in 2009, and $2.6 trillion in 2010,” he said. “They are expected to reach $4.1 trillion by 2018, which would be 20.3 percent of the gross domestic product. In 2009, $8,160 per person per year was spent on health care in the U.S. It is expected to go to $13,100 per person per year in 2018.”

Also, he said, insurance premiums have increased 131 percent since 1999, with businesses paying premiums of $5,049 per year per employee for single coverage, and $13,770 per employee for family coverage.

The premium increases, he added, are driven by the cost of health care, caused by aging population and a younger population developing serious health problems caused in part by poor lifestyles.

An additional factor is the development of new medical treatments, which can encourage poor lifestyle choices.

“We want to do what we want to do, and when we get in trouble, we go to the doctor to bail us out,” Henley said. “We have all kinds of new drugs, and they are expensive.”

He described the initial parts of the bill that went into effect after it became law as “feel good” items — things aimed at protecting consumers, such as eliminating annual benefit limits and pre-existing condition requirements, coverage of dependents to age 26 and rebates for senior citizens who hit gaps in their Medicare prescription drug coverage.

He said 2014 is when most of the regulations involving insurance mandates and other requirements take effect.

Among those regulations, Henley said, uninsured people will be required to buy health insurance or face fines, insurers will be prohibited from establishing annual spending caps, and the poverty level will be raised from 125 to 133 percent to qualify for Medicaid.

Raising the poverty level in Mississippi, he said, will add 300,000 to 400,000 more people to the state’s Medicaid rolls.

He said uninsured people will be required to purchase health insurance from one of three benefit plans, labeled, platinum, gold and bronze. He said federal officials are trying to develop a series of essential benefits that will be common to all health insurance plans.

Also in 2014, companies employing 50 or more people will have to provide insurance for all employees, and states that have not passed legislation for insurance exchanges, which help people find a health insurance plan, will fall under the federal plans. So far, Henley said, 25 percent of the states have passed exchange laws.