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People wait on line for passes to enter the Supreme Court in Washington, Thursday, June 28, 2012.
Obama might have his law, but the GOP has a cause. —Terry Holt

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The U.S. Supreme Court has upheld the individual mandate of the Patient Protection and Affordable Care Act, often referred to as ACA or Obamacare, with a 5-4 decision. That means that individuals will be required to buy health insurance or face financial penalties. The court struck down part of the expansion of Medicaid.

The court said the individual mandate was the equivalent of a tax and it was not its role to strike down imposition of a tax. The expansion extended Medicaid coverage to more low-income parents and adults without children. The majority held that the Medicaid expansion is constitutional, but said only the expansion money could be withheld from states that did not want to participate; the federal government could not withhold other Medicaid funding.

That leaves the Medicaid expansion on "shaky ground," according to Judi Hilman of the Utah Health Policy Project.

ACA was passed by Congress along party lines in 2010. Not long after, 26 states challenged the law. This March, the Supreme Court justices listened to three days of oral arguments.

Among other things, the act contains the now-affirmed individual mandate to buy insurance or face fines. It eliminates lifetime caps on insurance coverage, discrimination in pricing and denial of coverage based on pre-existing conditions. Adult children are allowed to stay on a parent's insurance policy until age 26. It also says some preventive health services must be provided at no cost to the insured. And it expanded Medicaid to cover more low-income people.

In the moments following release of the decision, Twitter was buzzing with contrary reports of what happened, some major outlets reporting incorrectly that the individual mandate was overturned.

Reaction to announcement of the decision was swift.

The ruling surprised some watchers, who'd predicted that Chief Justice John Roberts and Associate Justice Anthony Kennedy would side together on the issue. Instead, Roberts, who wrote the majority opinion, sided with the more liberal view of the law, "although it was pretty clear Roberts didn't much like the law," said Robert Bennett, former U.S. Senator from Utah and now a fellow at George Washington University's School of Media and Public Affairs.

In voting that way, said Bennett, Roberts countered critics of the Supreme Court who have said the justices are too political and would not set aside personal beliefs and decide cases on the basis of the law. His position on health care reform "drove a major stake in that argument," Bennett told the Deseret News.

But Bennett believes the decision, while upholding the individual mandate, also weakens it. It is possible people will choose to ignore the mandate and pay the tax penalty instead, he noted. That would change the depth of the risk pool, which has to be big enough to afford the costs associated with all that the ACA provides. And the ruling on the Medicaid expansion "takes away the stick with which to beat the states" for not complying, but leaves the carrot.

Presumptive GOP presidential candidate Mitt Romney said the act takes consumer choice away and vowed to fix that. He said that if he's elected, he will get rid of Obamacare and make sure those who want to keep their existing insurance can do so, while protecting the ability of people with pre-existing conditions to get insurance. There are better ways than the act, he said, that provide care and insurance at lower cost. While the court upheld most of the law, he said, it did not say it's good law or good policy.

"Whatever the politics, today's decision was a victory for people all over the country," said President Obama. He said the law means the quarter-billion Americans who already have insurance will be able to keep it, while reaching others who don't have care. He called the provisions "common sense protections for families."

"I did it because I believed it was good for the country. I did it because I believe it was good for the American people," he said.

Utah's senior senator, Orrin Hatch, issued this statement: "The American people know that this law violates our deepest constitutional principles of limited government, despite the Supreme Court's ruling today. President Obama's $2.6 trillion health spending law is an unprecedented power grab by this White House that will increase health care costs, add to our skyrocketing national debt and put Washington bureaucrats in between patients and their doctors. This ruling doesn't change the fact that a majority of the people of Utah and across America want this law repealed. The American people will have the last word in the ballot box this November. But let me be absolutely clear, I will continue to fight to repeal this assault on individual liberty and limited government."

"The court's decision illustrates one of the most egregious aspects of Obamacare, that it is a massive tax on the American people during one of the most challenging economic times in our nation's history," said Rep. Rob Bishop, R-Utah. "One of the primary concerns of families and small businesses is the cost of health care. Republicans in Congress have proposed hundreds of reforms that among other things will also lower costs. These reforms ensure that the American people, not Washington, make their own healthcare decisions.

"A one-size-fits-all approach works when you need one solution for one problem. With regards to healthcare, Americans want choices and options to address their unique and diverse needs. The (act) tramples on the rights of Americans to tailor their healthcare coverage. States and the American people, not Washington bureaucrats, are best suited to address our country's healthcare needs."

Retailers from the National Retail Federation expressed "dismay" with the ruling and said the court "missed an opportunity to redress the many shortcomings of the law. As it stands, the law wrongly focuses more on penalizing employers and the private sector than reducing health costs," it said in a prepared statement circulated to media. "For these reasons, NRF has been a consistent skeptic of the Affordable Care Act."

Consumers Union hailed it as a victory for consumers. "Health reform is alive and well and will benefit all of us," said its president, Jim Guest. "But today we are especially thinking of the seriously ill children who will continue to be able to get critical care, the young adults who can stay on their parent's insurance and the seniors who can better afford the prescription drugs they need. For these people and the millions of Americans with pre-existing conditions, the uncertainty is over."

The American Academy of Pediatrics also hailed the court's ruling. Its president, Dr. Robert W. Block, said the act "invests in children's health from the ground up."

The Tax Foundation released a statement calling the ruling flawed and said it was wrong in its definition of what a tax is.

A crowd started gathering near the steps to the Supreme Court on Wednesday, a day before the ruling was expected, to be in place to hear the landmark decision. And media outlets in Washington, D.C., were reporting crowds "crammed in" to hear the decision.

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Meanwhile, House Republicans were promising before the decision that if the Court did not strike down the act, they would act to replace pieces of the legislations a bit at a time to get rid of it.

"Obama might have his law, but the GOP has a cause," veteran campaign adviser Terry Holt told The Associated Press. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Supreme Court opinion in the Patient Protection and Affordable Care Act, often referred to as ACA or Obamac...