They may applaud or be appalled by the Supreme Court's decision Thursday.

But area business owners say its ruling that the Patient Protection and Affordable Care Act is constitutional doesn't end confusion and uncertainty over the act itself.

"I think the political questions remain," said Bradford Jones, who chairs the Fredericksburg Regional Chamber of Commerce's legislative affairs committee.

Jones, a partner in PBGH accounting firm's Fredericksburg office, said he wondered how this will impact the upcoming presidential election and what steps Congress will take to possibly repeal the act.

"[Speaker of the House John] Boehner said he still intends to repeal it, and the Romney camp is against it," he said, adding that the fate of the act probably won't become clearer until the first quarter of 2013.

Julie Irving, who owns Clear Day Healthcare Staffing in King George County, said she was surprised by the court's 5-to-4 decision.

She personally thinks it was good for a number of reasons, including the fact that her small company will likely be busier than ever as more people get insurance and seek health care.

The downside is that Irving will need to figure out the logistics of paying health insurance for those among the 100 temporary health care providers on her staff who qualify for it beginning in 2014.

"The American Staffing Association is fighting this because we're unique employers with a high turnover," Irving said. "Someone could work for a week and then not work again for six months."

She said that what may happen is that temp agencies will be required to provide insurance only for those who work an average of 30 hours a week for a month. Some agencies may decide that it's less expensive to pay the penalty than to provide insurance.

"We've got a year and a half before we have to worry about it," Irving said.

Joe Wilson, who owns PermaTreat Pest and Termite Control and represents small business on the governor's Virginia Health Reform Initiative, said that the federal government needs to do something about health care, but is concerned about what the ruling could mean for the future.