A sign is held up that reads 'ACA Is Here To Stay' front of the US Supreme Court after ruling was announced in favor of the Affordable Care Act. June 25, 2015 in Washington, DC.
A sign is held up that reads 'ACA Is Here To Stay' front of the US Supreme Court after ruling was announced in favor of the Affordable Care Act. June 25, 2015 in Washington, DC. - 
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Now that a federal judge has ruled the latest challenges to the Affordable Care Act can proceed, it means another round of legal uncertainty that the giant healthcare sector will need to grapple with. 

Carnegie Mellon economist George Loewenstein, who has spent a lot of time with health insurance executives lately, says they are not a very happy crowd, he says.

“To a person, they seem stressed out. Like, severely stressed,” he says.

Loewenstein, also a psychology professor, says that makes perfect sense. First the Affordable Care Act passed, which fundamentally changed the business of health insurance. Then, the U.S. House has voted to repeal the law more than 50 times. And you’ve got the lawsuits, which keep coming.

The upshot of all that, says UCLA’s Jill Horwitz, is a lot of noise that distracts insurers.

The insurance companies need to be spending time figuring out whether the law is going to be there, rather than just figuring out how it ought to be applied,” she says.

There’s a belief that if insurers could operate in a more predictable climate, they could deliver a better product. But while the court cases have presented theoretical threats to the industry, health economist Gail Wilensky says more immediate concerns have executives reaching for the Pepto-Bismol.

“The uncertainty about how sick or healthy the people who would come to buy their insurance are has been harder for insurance companies than the uncertainty about what the courts would decide,” she says.

Wilensky says insurers knew the passage of the ACA meant bumpy roads lay ahead, and it’s on the companies to find ways to thrive no matter how rough the ride. Two recent mega-mergers in this sector suggest the industry is betting the ACA is here to stay

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Follow Dan Gorenstein at @dmgorenstein