The decision shifts much of the burden of implementing the law to the states, which are responsible for the lion's share of getting people without insurance covered under the health law. States also now have to make a decision about expanding Medicaid coverage to their poorest people.

Five states have said they will not expand Medicaid in the week since the Supreme Court's decision ruled the administration's health law could not be used to force the change. Low-income people who aren't poor enough to qualify for Medicaid now may be left high and dry.

Gov. Rick Scott says he's concerned about how much expanding Medicaid under the Affordable Care Act would cost. But after he was charged with exaggerating, his administration released a new study with much lower estimates.

Even as Florida leads the Supreme Court challenge against the federal health law, a private and a public hospital both prepare for an influx of new patients if the law's Medicaid expansion survives.