The Affordable Care Act is expected to bring coverage to about 30 million uninsured people. Overall, more than 9 in 10 eligible Americans will be covered.

An estimated 26 million people will remain without coverage once the law is fully implemented, including illegal immigrants, people who don’t sign up and choose to face the penalties instead, and those who can't afford it even with the subsidies. That number could be higher, depending on whether states like Idaho refuse a planned Medicaid expansion.

While some of the law’s key features don't kick in until 2014, the law has already altered the health care industry and established some consumer benefits.

I don’t have health insurance. Under the law, will I have to buy it? What happens if I don’t?

Right now, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a penalty to the IRS. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.

For families, the penalty would be $2,085 or 2.5 percent of household income, whichever is greater by 2016 and beyond. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.

In his majority decision, Chief Justice John Roberts suggested that the law’s penalties for not obtaining coverage may not be enough to compel the uninsured to buy it.

“Some people will definitely pay the penalty instead,” said Linda Blumberg, a health economist and senior fellow in the Urban Institute’s Health Policy Center. “But I think people would also like to spend their money and get something in return, rather than spending it and getting nothing in return, which is what the penalty is.”

However, the IRS can’t prosecute people or place liens against people who don’t pay the penalty. Its only enforcement option may be withholding money from refunds.

A recent study by the Urban Institute, a nonpartisan research center, found that if the law had been fully implemented last year, 93 percent of the population under age 65 wouldn’t have faced a penalty or had to buy insurance under the mandate.

In fact, only 6 percent of Americans, about 18 million people, would have to “newly purchase” insurance under the law, the study found. And of this group, roughly 11 million would be eligible for subsidies to help buy their coverage from new insurance marketplaces, or “exchanges,” created by the law.

Some people not eligible today will qualify for Medicaid, the federal-state health insurance program for low-income and disabled people.

I get my health coverage at work and I’d like to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?

If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.

You may have seen some law-related changes already. For example, most plans now ban lifetime coverage limits and include a guarantee that an adult child up to age 26 who can’t get health insurance at a job can stay on her parents’ health plan. A government report found 3.1 million young adults gained health coverage because of that provision. From September 2010 to December 2011, the percentage of young adults ages 19 to 25 with health insurance increased from 64.4 percent to 74.8 percent.

Are any other parts of the law already in place?

Yes. You are likely to be eligible for preventive services with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.

Health plans can’t cancel your coverage once you get sick — a practice known as “rescission” — unless you committed fraud when you applied for coverage.

Children with pre-existing conditions cannot be denied coverage. This will apply to adults in 2014.

Insurers have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care. About 32,600 people in Idaho will get rebates on their 2011 health insurance premiums from two companies this summer, the Centers for Medicare and Medicaid Services said. That’s an average $70 for each of the 16,000 affected families. Regence BlueShield of Idaho has said it is one of the companies. The other hasn’t been identified.

Some existing plans, if they haven’t changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these “grandfathered” plans can still charge beneficiaries part of the cost for preventive services.

If you’re currently in one of these plans and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.

I want health insurance but I can’t afford it. What will I do?

Depending on your income, you might be eligible for Medicaid. Currently, in Idaho and most other states, nonelderly adults without minor children don’t qualify for Medicaid. But beginning in 2014, the federal government is offering to pay the cost of an expansion in the programs so that anyone with an income at or lower than 133 percent of the federal poverty level (which, based on current guidelines, would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid.

However, the Supreme Court said that states cannot be forced to make that change. The Idaho Legislature must determine whether to take part. The full federal funding lasts only a few years, after which the state must contribute if it takes part. If the Legislature refuses, some low-income Idahoans could remain uninsured.

The law provides the nation’s 1,100-plus Community Health Centers with $11 billion in new funding over five years, which would double the number of patients served to 40 million. The money will build new centers and modernize and expand others. By providing cost-effective preventive care for the urban and rural poor, health centers save money for the entire health system by reducing costly hospitalizations and emergency room visits. One study estimated the law will save up to $122 billion in health care costs from 2010 to 2015.

What if I make too much money for Medicaid but still can’t afford to buy insurance?

You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.

These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current poverty guidelines).

Idaho stands to get a federally administered exchange unless the state wins certification for a state-run exchange by Jan. 1. Because of legislative opposition to the law, Idaho this year refused a federal grant to set up a state-run exchange, betting that the court would overturn the law. Other states are also behind on exchange planning, so a delay in the 2014 startup is possible.

“Except in a few states, it’s impossible to do this in the time allowed — it’s going to have to slip,” said Joseph Antos of the conservative American Enterprise Institute.

Will it be easier for me to get coverage even if I have health problems?

Insurers will be barred from rejecting applicants based on health status once the exchanges are operating.

I own a small business. Will I have to buy health insurance for my workers?

No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm’s first 30 workers would be excluded from the fee.

However, if you have a firm with fewer than 50 people, you won’t face any penalties.

In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with fewer than 25 full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.

I’m over 65. How does the legislation affect me?

The law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That’s when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.

That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs.

The law also has expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.

The health law reduced the federal government’s payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships that they now provide.

Will I have to pay more for my health care because of the law?

No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.

The Congressional Budget Office estimates that private health insurance premiums will increase by 5.7 percent each year, on average, from 2012 until 2022. But premiums would be getting more expensive with or without the Affordable Care Act. The budget office has estimated that, relative to what would happen in the absence of the law, premiums in the individual insurance market will be a little higher, employer-sponsored insurance premiums for big companies will be a little lower, and employer-sponsored insurance premiums for small companies will stay about the same.

There are some new taxes and fees. For example, starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 will pay a Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.

Starting in 2018, the law will also impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits the most generous plans.

Has the law hit some bumps in the road?

Some aspects have not worked out as well as its authors intended.

For example, a long-term care provision of the law is dead for now. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials effectively suspended the program even before it was slated to begin, saying they could not find a way to make it work financially.

The Idaho Statesman, The Associated Press, McClatchy Newspapers and The New York Times contributed.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.