The Supreme Court's decision affirming the constitutionality ofU.S. healthcare reform removes much uncertainty and clears the wayfor employers to prepare for various requirements of the law thattake effect next year and in 2014.

Some uncertainty still exists. In response to the SupremeCourt's decision, Mitt Romney and Republican congressional leaderspromised to overturn healthcare reform, making it clear the lawwill be a major issue in the November elections.

“There's no question that this is an issue that will beamplified in the months between now and November,” says PaulDennett, senior vice president of health care reform at theAmerican Benefits Council. “Really it moves from a decision by ninemembers of the court to the American voter to decide what happensnext.”

The GOP would have to win the White House and majorities in bothhouses of Congress in order to overturn the law, Dennett says.

For companies, the next step is clear: getting set for thechanges required under the PPACA.

“Those employers that have been reluctant to move forward withimplementing those reforms until the court ruling will now have tomove forward,” says Amy Bergner, a partner in HR consulting firmMercer's Washington resource group. “A tremendous amount of newmandates are taking effect in 2014 and there's a lot of planningand strategizing that needs to be done.”

Of course, many companies have been making preparations allalong. Consultants say employers are in good shape when it comes tonear-term changes, which include the requirement to report thevalue of the health coverage the company provides on employees' W-2forms, a change that will show up on the 2012 W-2s companies handout next year. And in 2013, companies must provide new summaries ofbenefits to employees and put in place a cap on the amountemployees can contribute to healthcare flexible spendingaccounts.

There's more concern about requirements that kick in 2014 andlater years, in part because regulators have yet to provideguidelines on many points.

“For 2014 provisions and any effective beyond that, wehave no guidance at all,” says the American Benefit Council'sDennett, pictured at right. “We have some pre-regulatory guidancein the form of bulletins that provide a range of possible optionsthat the agencies have asked for comments on, but nothing that'smoved to the rulemaking stage.”

For example, under PPACA, companies must provide coverage thatmeets certain requirements to full-time employees. “One key issueis how employers count their full-time employees,” Dennettsays.

While that's not a problem for companies whose employees workregular hours, other companies have many part-timers or employeeswith flexible schedules, he says. “To create their strategy formeeting that mandate, they need more guidance—that's a prettysignificant need.”

In 2014, companies also face the requirement that theirhealthcare coverage meets a minimum value test. “That's another keydesign consideration companies have to work on that they don't haveguidance on,” says Mercer's Bergner.

Farther down the line, companies will have to beginauto-enrolling employees who fail to make a decision about healthinsurance into the plan. Dennett says the government recentlyannounced that rulemaking on this point won't be complete until2014, so the requirement isn't likely to take effect until 2015 atthe earliest.

PPACA also mandates that states set up healthcare exchangeswhere unemployed people and workers at smaller companies can obtaincoverage. A number of states have held off on setting up theirexchange as they waited for the Supreme Court's decision.

Pat Haraden, a principal in the employee benefits consultingfirm Longfellow Benefits in Boston, notes that by Jan. 1, 2013,states have to certify to the Health and Human Services Departmentthat their exchange will be up and running by the start of 2014.“We expect only a few states will be ready to certify by then thatthey'll be ready in a year,” he says. “That will cause issues,because if the mandate [for universal coverage] is still Jan. 1,2014, there won't be any place for these people to go to buyinsurance. Our sense is the mandate will be delayed somewhat.”

The federal government has said it will provide an exchange ifstates are unready or unwilling to do so. But Haraden questionswhether the federal government will be ready to step in and providean exchange for states that aren't ready themselves.

Dennett says the state exchanges aren't an issue for most largeemployers, because they will continue to provide coverage to theiremployees. For big companies that do deal with the state exchanges,the situation is likely to be complicated, he says, with each stateexchange set up differently, and exchanges run by the federalgovernment set up differently as well. Dennett notes that somestates may even provide only limited services themselves and letthe federal government do the rest, an approach the Health andHuman Services Department has said is allowed.

To read about the Supreme Court's decision, seeCourt Upholds Healthcare Reform.

For earlier stories about what companies will have to do tocomply with healthcare reform, see Coming Decisions on Healthcare and TweakingHealthcare Reform.