The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.
The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
For more reaction to the health care law
The law tells almost everyone they must have health coverage and guarantees it will be available to them even if they are already ill or need hugely expensive care. It helps the poor and many middle-class people afford coverage.
In the Philadelphia region the decision was hailed as a victory by some while others viewed it as reaffirmation of what they think is wrong with so-called "Obamacare."
Chief Justice John Roberts announced the court's 5-4 judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.
The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness,” Roberts said.
The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.
It's still not exactly clear how the court's decision will affect local health care providers and insurance companies as well as regular folks looking for access to health care.
Some health care advocate groups called the decision a mixed bag.
"It is a dual edged sword in that Americans have better access to coverage, but fewer plans are being offered and because there is a mandate, insurance companies are raising prices because Americans 'must' purchase health insurance," said HealthCare Advocates, Inc. president Kevin Flynn.
"We are pleased that this decision will make health care insurance available to most Americans," said Pennsylvania Medical Society president Dr. Marilyn Heine in a statement. "However, it continues not to address two important issues, including medical liability reform and Medicare payment reform. These two issues have plagued health care in the past, and will continue to do so in the future. By ignoring these two elements, the ACA is only a partial fix for what ails health care access."
Democrats hailed the decision as a victory for American's seeking health coverage.
"By upholding the individual mandate, they assured that more Americans will be covered than were before the Act was passed," said U.S. Congressman Bob Brady (D-Pa.) in a statement. "Moreover, insurance companies can no longer discriminate against patients with pre-existing conditions and seniors will be able to afford the medicines they so desperately need."
U.S. Congressman John Carney (D-Del.) called the decision "good news for America."
"The Affordable Care Act, while not perfect, is designed to lower the trajectory of health care costs moving forward," Carney said in a statement. "But there is more work to do. I look forward to working with my colleagues to continue improving the Affordable Care Act as we implement its provisions in the coming years."
The other side of the aisle disagrees with the decision.
"I am extremely disappointed," said U.S. Sen. Pat Toomey (r-Pa.) in a statement. "Today’s decision is a jarring blow to our 200-year-old tradition of constitutionally limited government and personal liberty. The Supreme Court’s decision doesn’t change the fact that President Obama’s health care law is a terrible policy that will impose new taxes, increase the cost of health care and cost our country jobs."
"It is clear –- and the Supreme Court today agrees –- that President Obama’s health care law is, in fact, a tax increase on the American people," said U.S. Congressman Frank LoBiondo (R-N.J.) "Given how fragile our economy is and the unrelenting financial hardship South Jersey families and small businesses are already facing, the American people cannot afford and do not need another tax."
Governors of area states reacted to the ruling though they aren't exactly sure yet how the new health plans would be implemented on the state level:
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The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.
Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.
“The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding,” the dissenters said in a joint statement.
Republican campaign strategists said presidential candidate Mitt Romney will use the court's ruling to continue campaigning against “Obamacare” and attacking the president's signature health care program as a tax increase.
“Obama might have his law, but the GOP has a cause,” said veteran campaign adviser Terry Holt. “This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history.”
When the law was before Congress, Obama and Democrats avoided calling its penalty for going uninsured a "tax." But the administration argued before the Supreme Court that the law was constitutional as a federal tax. The court rejected two other Obama administration arguments for the law but accepted the tax one.
In 2016, after the law is fully in place, about 4 million people will pay the penalty to the Internal Revenue Service for being uninsured, the Congressional Budget Office has estimated. They would pay $695 per uninsured adult or 2.5 percent of family income, up to $12,500 per year.
The IRS can't prosecute violators or place liens against them, however. Its only enforcement option may be withholding money from refunds.