While those in health care generally were supportive of the Supreme Court ruling that upheld the president's health care reform law, business associations said they have concerns over what insurance will look like — and cost — under the Affordable Care Act.

"Today's decision removes a great deal of the uncertainty surrounding the federal health care law," said Philip Kirschner, president of the New Jersey Business & Industry Association, in a statement. "But the issue of very high health insurance costs remains, and until it is addressed in a meaningful way, it will continue to be a drag on our economy."

Kirschner said his association has been an advocate of reforms that could help control costs, as over the last 25 years, member businesses have consistently identified the cost of health insurance as their most troublesome problem.

"For decades, the rising cost of health insurance has been the single biggest concern facing employers in New Jersey," Kirschner said. "It is employers who have been paying the bill, so they have a big stake in the success or failure of the Affordable Care Act."

In his statement, Kirschner said provisions in the law could force premiums to rise even more. He said health insurance coverage in 2011 cost an average of more than $7,000 for individual employees and $15,000 for family coverage, according to a survey by the Kaiser Family Foundation and Health Research and Educational Trust — double the rates of 10 years ago.

John Sarno, president of the Employers Association of New Jersey, said the most important impact to his constituents of the upheld law is that the action "shifts to Trenton" to implement the regulations at the state level — and Christie's veto of the exchange bill, he said, offers a glimpse of what's to come. Sarno said he expects Christie's national notoriety to force him to delay a lot of the implementation until after the presidential election in November.

The misgivings of business advocates were reflected by Gov. Chris Christie. In a statement released shortly after the decision, Christie called the ruling "disappointing," and said "the wrong approach for the people of New Jersey, who should be able to make their own judgments about health care."

"The Supreme Court is confirming what we knew all along about this law — it is a tax on middle-class Americans," Christie said.

"This is the beginning now, this is certainly not the end," Sarno said. He added that he believes the ruling will encourage more small businesses to look at the Affiliated Physicians and Employers Health Plan created by the EANJ to address some of the costs of ensuring more people on to employers.

"I'm going to paraphrase Bob Dylan: You don't need a weatherman to know which way the wind is blowing — for insurance premiums," Sarno said.

In a statement, Laurie Ehlbeck, state director of the National Federation of Independent Business, said the ruling guarantees New Jersey residents will have their most personal health care decisions made by politicians in Washington and in other states whom they've never met — and whom they'll have a hard time influencing in the future.

"Small businesses here will be overwhelmed by mandates, taxes and burdens imposed on them by people whom we cannot as easily hold accountable," she said.

However, in a statement, the New Jersey Policy Perspective said the ruling will be a win for the decision makers at small businesses.

"Many New Jerseyans who don't have health insurance will now be able to get it, while people who already have employer-based insurance will no longer have to worry about losing health coverage if they lose their job, as so many have," said Raymond Castro, senior policy analyst for NJPP. "It also greatly benefits New Jersey's small businesses, which increasingly have been dropping unaffordable insurance plans for their employees."

John Fanburg, managing partner and head of the health care group for the law firm Brach Eichler, said he sees the "diametrically opposed" opinions on the ruling as a representative of health care providers, as a consumer and as a businessman.

Fanburg called the law good for consumers, scary for providers worried about a drop in reimbursement, and difficult for employers that will have to increase their diligence to find appropriate and affordable health care for their employees.

Contributing: Joe Arney