WICHITA — Many small-business operators in Kansas and nationwide have been in "wait-and-see" mode for two years pending the Supreme Court's ruling on the health reform law, which was narrowly upheld today.

But ongoing political opposition to the law and other factors still leave plenty of unknowns, according to a leading Kansas business consultant.

"Businesses have survived new expenses and new mandates in the past. What bothers and concerns business owners the most is the unknown," said Brad Bechtel of Allen, Gibbs and Houlik, Wichita's largest business consulting and accounting firm.

Business owners have long shared a common concern, he said.

"When I ask them: 'What keeps you up at night, what makes you concerned, what are you worried about?' Every single client said 'health care,'" he said. "And when I asked specifically, they said 'The unknown.'"

With today's ruling, the unknowns are fewer. The court upheld all provisions in the Patient Protection and Affordable Care Act, which has been under fire since before it was signed into law March 23, 2010.

The challenge to the law was brought by 26 states, including Kansas.

Among the remaining unknowns: Will the law survive the coming elections?

Republicans promised to repeal the law and rewrite health reform if the court did not strike it down entirely. Among them was U.S. Sen. Pat Roberts, R-Kan.

“It’s now up to the Congress to repeal and replace this law with step by step, common-sense, cost-cutting solutions that work for Kansans and all Americans, and that’s what I will work to do in the Senate," Roberts said in a prepared statement soon after the court's decision was released today.

“Stopping ObamaCare is now in the hands of the American people. It begins with electing a new president this fall," said Kansas Gov. Sam Brownback, a Republican who won office vowing to fight the law "every step of the way."

The ongoing political contention may continue to hinder long-term planning for many Kansas business owners, Bechtel said.

"Heaven only knows what's going to happen now," he said. "Given the political climate and what we're hearing from the Republican Party, there's no doubt going to be a push to modify and change it. They plan on repealing it and rewriting it. So, we're back to a wait-and-see, to see if they're successful in doing that. And sadly, Congress has not really proven itself in being able to hit deadlines.

"A lot of businesses are holding a lot of cash, not doing a lot of hiring. Until they better understand what the future is and what those costs are going to be, their hands are in their pockets," Bechtel said.

Another uncertainty is how the health insurance exchanges will unfold. The law requires that each state have an operational exchange by Jan. 1, 2014. The exchanges are expected to be one-stop, online shopping places where low- and moderate-income people, including many small-business employees, can find affordable health coverage. For those who cannot afford health insurance on their own, the exchanges will provide subsidies or tax credits.

"We don't know how many individuals will go to the exchange," Bechtel said, "or how many employers will decide they don't want an employer-sponsored (health) package. We don't know that. We have estimates, but the price — the ultimate cost — is still highly unknown."

When businesses can't accurately forecast operating costs, "that causes a lot of trepidation," Bechtel said. "And as a result, I think they tend to hold back. That's exactly what we've been seeing in Kansas and in the U.S. in general."

Officials at the National Federal of Independent Business — a small-business association closely allied with the Republican Party, and which was among the parties to the lawsuit decided by the court today — said they would continue to push for the law's repeal.

“Small-business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses," NFIB officials said. "We will continue to fight for the repeal of PPACA in the halls of Congress; only with PPACA’s full repeal will Congress have the ability to go back to the drawing board to craft real reform that makes reducing costs a number one priority."