WASHINGTON - The Supreme Court on Thursday upheld the heart of the Affordable Care Act requiring citizens to obtain health insurance, a striking victory for President Barack Obama on his signature legislative achievement.
Chief Justice John Roberts disappointed conservatives by joining the liberal bloc to write the much-anticipated 5-4 decision, which he read to a packed courtroom as partisans on both sides demonstrated outside with signs, posters and flags.
The ruling upheld the law's requirement to get insurance or face a tax as constitutional under Congress' taxing power. But the decision said Congress cannot require people to buy insurance under its power to regulate commerce.
It also limits federal power to withhold Medicaid funds from states to make them expand eligibility to cover uninsured people.
The court's action allows the most sweeping federal health law since Medicare to move toward implementation, with its promise to transform insurance and health care delivery while covering 30 million of the uninsured at a cost of $1.1 trillion over the next decade.
Yet the ruling, coming four months before the Nov. 6 election, did little to quell the political divide over a law that has limited public support and remains an issue in the presidential race.
Obama: We'll go forward
Speaking from the East Room of the White House, Obama acknowledged the debate over the law has been divisive.
"The highest court in the land has now spoken. We will continue to implement this law," Obama said.
"But what we won't do, what the country can't afford to do, is refight the political battles of two years ago, or go back to the way things were," he said.
"I agree with the dissent. What the court did not do on its last day of the session, I will do on my first day as president of the United States," he said.
The GOP House leaders on Thursday also set a July 11 repeal vote, which they expect their solid majority to pass.
The decision by Roberts was accompanied by a separate opinion by liberal justices and the conservative justices' dissent -- 193 pages in all.
Roberts wrote that he found the mandate constitutional by interpreting what the law calls a "penalty" for not getting insurance as a "tax." He also said he was deferring to the judgment of the elected leaders who passed the law.
"It is not our job to protect the people from the consequences of their political choices," he wrote.
The ruling also limited the law's Medicaid expansion.
Roberts wrote that Congress can offer funds under the law to expand health care access, but that Congress cannot "penalize states that choose not to participate in that new program by taking away their existing Medicaid funding."
Roberts' four fellow members of the court's conservative bloc joined in a broad dissent written by Justice Anthony Kennedy. "In our view, the act before us is invalid in its entirety," Kennedy wrote.
The decision came as bit of a surprise to lawyers and advocates on both sides, after conservative justices grilled lawyers defending the law, and Justice Antonin Scalia suggested the entire law should be struck during arguments in March.
"Today's Supreme Court decision is a clear, unambiguous and complete victory for long-overdue health care reform," said Ron Pollack, executive director of Families USA, an advocacy group that worked to pass the Affordable Care Act.
But Northwestern University law professor Stephen Presser, a constitutional expert for the National Federation of Independent Business and the group of 26 states that sued to overturn the law, said, "This is a tremendously disappointing decision."
Another legal expert for the groups, Ed Whelan of the conservative think-tank Ethics and Public Policy Center, assailed Roberts' interpretation that what the law called a "penalty" for not getting insurance was actually a "tax," so the mandate would fall under Congress' taxing power. He called it a "massive bait and switch."
The bill never would have passed Congress in that form, he said. "This act would not have been adopted if folks had to defend this as a tax," he said.
"The bottom line is that we expected better of the chief justice," Presser said.
Sen. Charles Schumer (D-N.Y.), who has criticized Roberts as a conservative activist judge, defended the chief justice Thursday as he hailed his ruling.
"This decision preserves not only the health care law," Schumer said, "but also the Supreme Court's position as an institution above politics."
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