How will yesterday's Supreme Court decision impact the road ahead? Ezekiel Emanuel can offer some insight. He was a special health care advisor to President Obama. The New York Times describes Emanuel as "a bioethicist who has come to personify the most intense attacks on the president's health care plan." Emanuel is also chair of University of Pennsylvania’s Medical Ethics & Health Policy Department.

"By 2020, because of this law, we will have a much better healthcare system," Emanuel says. "All Americans will benefit from it."

The physician notes three main effects that he believes the Affordable Care Act will have: an opportunity for every American to have health insurance, longterm cost control, and improvements in quality of care. These could include fewer hospital infections, errors, and readmissions, as well as increased efforts to help people with chronic diseases like diabetes stay out of the hospital. 

"We are already seeing moderation of cost," Emanuel says. "Many of us see in the future that we're going to see more cost control." One of the methods that Emanuel suggests is competitive bidding, which has raised concerns that quality of care suffers when medical equipment is purchased based on the lowest price. A recent pilot program found that competitive bidding on equipment such as wheelchairs and oxygen devices saved $202 million, and, according to Jonathan D. Blum, deputy administrator of the Centers for Medicare and Medicaid Services, "there have been no negative health care consequences to beneficiaries as a result of competitive bidding."

Emanuel also responded to the claims of opponents to the Act, who argue that the law provides government an opportunity to intrude on citizens' affairs, and that the law merely reforms health insurance and not health care itself. "The government is not in your healthcare decisions," Emanuel says. "Individuals through the exchange get to decide who their health insurer is. They choose who their doctor is, they choose which hospital they want to go to, and we've actually reduced the financial barrier."  

One of the greatest challenges that Emanuel sees is the implementation of the law, as most of the states are not going to have the mandated health insurance exchanges by the federal deadline of January 1, 2014. "The federal government is going to have to implement the exchanges," Emanuel says, "and that's going to be a big challenge with not a lot of time left to go."