By Jack Fink & Jay Gormley, CBS 11 News

FORT WORTH (CBSDFW.COM) – When the U.S. Supreme Court decision upholding a large portion of the Affordable Care Act was announced Thursday, it was broadcast on computers and smart phones, televisions and radios.

The ruling will impact every American from Wall Street to Main Street, regardless of age. By 2014, small businesses with more than 50 full-time employees must offer them health care or pay penalties.

All Americans will have to buy insurance or be fined –– those who cannot afford it can apply for government subsidies.

Nevertheless, business owners and residents alike across the region are expressing concern while others offer adulation in the face of the decision. There are those like Kareen Momo of Fort Worth, who knows all too well the dire feeling of fighting for his life without insurance.

He was only 20 years old when his heart began to fail him. A week after this discovery, he was set to leave for basic training in the Army National Guard.

“The right side of my heart was basically declared dead,” he said. “The left side of my heart was pumping at five percent.”

He was placed on a list for a heart transplant, but his medical condition forced him to leave his job at a local hospital and Momo lost his health insurance. “We prayed a lot,” he said. “We kept our faith.”

With no insurance, Momo was taken off the transplant list. He was eventually put back on, but was moved to the very bottom.

“We really didn’t know what to do,” he said.

Even though he had a pre-existing condition, Momo was able to get onto his mother’s insurance and five weeks ago, he finally got his new heart at Baylor Medical Center in Dallas.

President Barack Obama’s health care reform prevents insurance companies from dropping those who suffer from a pre-existing condition and allows young adults to stay on their parent’s health plans until they’re 26.

But much concern regarding the reform among others is related to costs: Will they increase? If so, who will be affected?

Dr. Christopher Crow is a co-founder of Plano-based Village Health Partners. It has 15,000 patients and is one of the largest family medicine practices in the country. Crow said now that the law has been largely upheld, there soon will be more patients than ever before.

They started with two doctors nearly a decade ago. By the end of the summer, they’ll have 18.

“Going forward, we realize there’s going to be a shortage of us and a lot more of patients,” Crow said. “So we have to learn to scale ourselves more so we can take care of more people.”

When more people are in the health care system, Crow says, “Costs will go up, and you can expect the insurance carriers to pass those on to the employers and then down to the employees.”

At Romco Equipment Company in Dallas, CFO Craig Burkert says they’ve already seen their health insurance premiums jump after the reform law was signed two years ago.

He said they increased 30 percent last year, 25 percent this year and another 12 percent next year.

“That was a shocker,” Burkert said.

Experts say health care costs have risen for decades, but Burkert said the higher rates came more recently.

“It’s pretty clear to us because of the sudden and dramatic change in the direction of things that the health care changes have had a significant effect,” Burkert said.

He says he’s worried about the Affordable Care Act, but that he hopes the worst of the cost increases is over.

Patient Evelyn Fuentes-Brown said she is pleased with the ruling, but is also worried about rising costs down the road.

“I’m sick, my daughter is sick, what are our bills going to be like? Because we do have to work, we do have a lot of expenses, including daycare,” she said. “That is a concern for me.”

Momo, who suffered from the heart condition, said he couldn’t be happier with the Supreme Court’s ruling. He remembers “our backs against the wall; it was really hard.”

The now 21-year-old says he now knows that life and death can sometimes comedown to two words: “Health insurance.”

During a speech shortly after the ruling, President Obama said he didn’t push Congress to enact the Affordable Care Act to get a boost in the polls.

“I didn’t do this because it was good politics,” he said. “I did it because I believed it was good for the country.”

Republican challenger for President Mitt Romney, however, said he would push to repeal the law if he was elected into office. He said he believes the American people should have the right to choose what best fits them without potentially being mandated otherwise.

“Obamacare was bad policy yesterday,” he said Thursday, “it’s bad policy today.”

House Republicans have already vowed to repeal the law when they reconvene in July, although that vote isn’t likely to pass the Democrat-controlled Senate. Health Care Reform Coverage:

North Texas Politicians, Advocacy Groups Respond To Supreme Court’s Ruling
Could Preventative Care Be The Future Strategy Of The Industry?
The Supreme Court Largely Upholds Affordable Care Act 5-4

Follow Jack Fink on Twitter at @cbs11Jack, follow Jay Gormley on Twitter at @cbs11Jay