Charleston , Kanawha County , West Virginia

With a long awaited decision from the Supreme Court on the Healthcare Act, comes a race to the finish for states all across the nation. The states are now responsible for making health care reform a reality and they have to do it by 2014.

"A lot of people waited until this point to see if the Supreme Court would uphold it," Democratic Governor Earl Ray Tomblin says.

West Virginia is better prepared than most most states. The mountain state is one of only 14 states to pass legislation which clears the way for a healthcare exchange. Exchanges are meant to be a one- stop-shop for health insurance. But with the law in limbo, the work hasn't gone much further than that. Those health care insurance markets are slated to open for business on January 1, 2014. If states aren't ready, the federal government will step in and run things.

Governor Tomblin says he plans to meet with key departments immediately to figure out where to go from here.

"Our DHHR, health department people will be involved heavily our insurance commission will be involved so it involves many branches of our state government so we'll have the appropriate people in to start our discussion on the direction we will be taking," Tomblin says.

The decision also gives a green light to insurance providers, who are considered much more prepared than the states.

Greg Burton, the President and CEO of Brickstreet - which provides workers compensation insurance - says they were in a bit of a holding pattern, awaiting the decision but now it's a matter of how much the Affordable Healthcare Act will cost.

"Just have to put it in our rates, which may pass that onto the employer community in West Virginia and other states we're in. Rates may go up if healthcare costs rise, hopefully, based on what you read, this is supposed to make it go down but I think its going to be a while before you actually see that," Burton says.

But for Burton the healthcare law is two-fold. He also runs a business. And for the past several months, they've been trying to figure out what the law means for supplying health insurance to employees.

"You have to have a certain level of cost associated with the plans you have for your employees so we have to make sure we're under those costs or we are going to end up having to pay a penalty so we're going to be digging into that. We were thinking about going self-insured but there may be some ramifications as an employer if you're self-insured so again I think its going to take some time to figure out what's really going to happen," Burton says.

And with all the uncertainty, for the time being, increasing the workforce isn't likely.

"It will probably deter us from adding some staff until we really figure out what's happening, what's our true cost down the road," Burton says.

A decision finally made, but a lot of questions and work still remain.

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