Health insurers braced for an unfavorable Supreme Court ruling on the health care law largely took a low-key approach after the justices announced their opinion Thursday. And with the law intact, they pledged to continue working with the administration and Congress on their industry’s problems.

The sector, whose executives and lobbyists felt vilified by President Barack Obama and Congressional Democrats during the health care debate, dodged a potential worst-case scenario.

Companies most feared a decision striking the mandate compelling most Americans to carry health coverage while keeping in place insurance market reforms, including a prohibition on denying coverage based on a pre-existing medical condition.

But even though health plans were handed essentially the status quo, the sector still faces uncertainty as the fight over the health care law becomes an increasingly important talking point in the upcoming elections.

“This issue is going to be relitigated again at the polls in November,” said lobbyist Andy Rosenberg, whose clients at Thorn Run Partners include health plans and medical enterprises.

Rosenberg, a Democrat, spent much of Thursday discussing the ramifications of the case with his K Street colleagues and clients, a scene common all over downtown D.C. on decision day. And along with Michael Gottlieb, a member of Orrick, Herrington & Sutcliffe’s Supreme Court practice, the lobbyist was planning a conference call for today billed as a “Post-Game Analysis of the Supreme Court’s Decision.”

One likely topic on the call, Rosenberg said, “came out of left field” and wasn’t one he and Gottlieb had expected. It involved the court’s decision to allow states to opt out of a Medicaid expansion.

“This was the only area that was a meaningful policy divergence from the status quo,” Rosenberg said.

Another health insurance lobbyist called the much-watched decision a “ho-hum” moment in what promises to be an ongoing process.

“We move on to the next round, which is in November,” this lobbyist added.

Karen Ignagni, president and CEO of America’s Health Insurance Plans, said the industry trade group remains concerned about the law’s unintended consequences that would raise costs.

“Now we think it’s very important for Members of Congress to focus very specifically on issues that decrease, rather than increase, costs,” she said in an interview.

She’s looking at tax reform legislation, likely a major issue next year, as an opportunity to solve the insurers’ problem with a “premium tax,” she said.

Ignagni added that “while the cost for people over 50 may decline, the cost for people under 30, under 35, will significantly increase, and those are the people you need to have in the pool for insurance reforms to work.”

Insurers want the buffer of younger, healthier customers to balance out the cost of caring for older people whose medical bills are typically higher.

When it comes to Republicans’ reinvigorated calls for a full repeal — the effort has become a rallying cry on Twitter with the hashtag “FullRepeal” — Ignagni said she is staying out of the political fray.

“We’ll let the politicians talk about the political aspects of all this,” she said. “We’re going to talk about what we know.  So wherever we have diagnosed problems, we’re going to bring solutions.”

While AHIP represents about 1,300 members, the five biggest companies have, since the health care reform debate, begun quietly meeting among themselves.

Known as the group of five, Aetna, Cigna, Humana, UnitedHealth and WellPoint are expected to continue to assess their own post-decision, pre-election strategies, sources familiar with the effort said. The companies remain part of AHIP.

AHIP isn’t the only group with concerns about health care costs. The National Coalition on Health Care — which represents unions, physician groups, insurers and employers — noted in a press statement that the court’s decision does not settle a “$7.3 trillion fiscal cliff looming at the end of the year.”

“The court battle over the Affordable Care Act may be over,” group President and CEO John Rother said in the statement, “but when it comes to curbing health costs, the real work has only just begun.”