The Supreme Court decision to uphold the health care reform law affects not just the 30 million or so Americans without health insurance, but also those already covered. Factors that could determine how coverage might be affected include: If the person has health insurance or not, how many people per household, adjusted gross household income, and marital status. The law expands the eligibility rules for Medicaid, but states cannot be penalized if they decline to comply with the expansion. This is the one part of the law that the Supreme Court did not uphold. This is significant as it raises questions about how effectively the federal government will be able to implement it.