Supreme Court upholds Affordable Care Act

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The US Supreme Court upheld the bulk of the Democratic health care reform plan with a 5-4 vote Thursday. 

The court's four liberal justices, Stephen Bryer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome.

The high court ruled in favor of the mandate that most Americans must have health insurance, or else pay a penalty.The decision means the historic overhaul will continue to take effect over the next several years, affecting the way people receive, and pay for, their personal medical care.

But the court also rejected a mandatory expansion of Medicaid, saying the federal government can ask states to provide new benefits, but cannot throw them out of the Medicaid system if they don't.

It was chaos at the court as the decision of the year was rushed to television cameras and the nation. The complicated ruling led to CNN and Fox News getting it wrong by reporting that the mandate had been struck down. They quickly issued corrections.

Chief Justice John Roberts broke with fellow conservatives, joining liberal justices to declare the so called "individual mandate" constitutional. He ruled the penalty in the law for not buying insurance amounts to a tax.

"Because the constitution permits such a tax, it is not our role to forbid it," Roberts wrote.

Chief Justice John Roberts argued that it can't be upheld under the commerce clause but that Congress can do it under its taxing authority, so the penalty for not having health insurance remains intact.

Conservatives were enraged.

"What is with this court today?" said Rep. Michele Bachmann (R-MN). "This is clearly a turning turning point day in American history."

It's a huge political win for President Obama. But he ticked off the benefits to citizens: guaranteed coverage, even with pre-existing conditions, no more dollar caps on coverage, and he praised the justices.

"They've reaffirmed fundamentally that here in America the wealthiest nation in earth. No illness or accident should lead to any family's financial ruin," the president said.

Democrats in Congress celebrated the victory.

"We now know that health care is legal, constitutional, undeniable and irreversible!" said Sen. Barbara Mikulski (D-MD).

Meanwhile, Republican presidential challenger Mitt Romney vowed he would see it repealed.

"This is time for choice for the American people. Our mission is clear. If we want to get rid of Obamacare we're gonna have to replace President Obama," said Romney.

Republicans in Congress won't wait.

"I've scheduled a vote for total repeal of Obamacare bill to occur on Wednesday, July 11th," said Rep. Eric Cantor (R-VA).

President Obama says Thursday's ruling ought to mean moving forward to implement his health care law. Republicans say the ruling marks a fresh start in their fight for repeal.

For 850,000 uninsured Hoosiers, the decision is a critical one. People who can afford to pay for insurance, but don't, will be required to starting in 2014, or they will face a penalty. But those with pre-existing conditions who currently cannot get coverage will no longer be denied, and for patients with serious conditions requiring costly treatment, there are no lifetime caps.

Health care interactive: Where states stand

Read details from The Associated Press.

What does the ruling mean for your family?

What's next

Now that the Supreme Court has settled the legal argument, Americans will find out if President Barack Obama's health care overhaul will work as advertised to give coverage to millions of uninsured people while keeping costs in check, too.

Republicans from presidential candidate Mitt Romney to lawmakers on Capitol Hill will keep pushing for repeal. But the focus will shift from Washington to the states.

Under the law, states play a key role in delivering new health insurance coverage to millions of lower-income and middle-class people.

Follow the live SCOTUS blog here.

But Republican-led states have resisted, and the National Association of Insurance Commissioners expects only about half the states to be ready to set up new health insurance markets, slated to open for business in 2014.

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