(ABC7, AP) - The Supreme Court on Thursday upheld the vast majority of President Barack Obama's historic health care overhaul, including the hotly debated core requirement that virtually all Americans have health insurance.
The 5-4 decision means the huge overhaul, still taking 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 hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call "Obamacare."
Obama declared after the ruling, "Whatever the politics, today's decision was a victory for people all over this country."
But he also commented on the political aspects of the ruling.
"I know there will be a lot of discussion today about the politics of all this, about who won and who lost," he says. "That is how things tend to be viewed here in Washington."
Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.
Breaking with the court's other conservative justices, Chief Justice John Roberts announced the 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.
Presumptive GOP nominee Mitt Romney is promising that he will repeal the federal health care law if elected. He called the decision incorrect and said Thursday that it is "bad law."
He says it raises taxes and cuts Medicare. Romney says that, if elected in November, he will work to repeal and replace the law.
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. Kennedy summarized the dissent in court.
"In our view, the act before us is invalid in its entirety," he said.
The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Republicans announced in advance of the ruling they would vote to wipe out whatever was left standing by the justices, and Romney has joined in calls for its complete repeal.
Justice Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision.
She said Congress' constitutional authority to regulate interstate commerce supports the individual mandate.
She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.
"So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions," Ginsburg said in a statement she, too, read from the bench.
Attorney General Kenneth Cuccinelli had argued to the contrary in a separate lawsuit that was tossed out by a federal appeals court.
"This is a dark day for American liberty," Cuccinelli said in a written statement minutes after the Supreme Court issued its ruling. "This decision goes against the very principle that America has a federal government of limited powers; a principle that the Founding Fathers clearly wrote into the Constitution, the supreme law of the land."
Gov. Bob McDonnell had a similar reaction, calling the decision "a blow to freedom."
He said the health care law will impair economic recovery, hurt small businesses and impose "dramatic unfunded mandates" on states.
But former governor and current Democratic U.S. Senate candidate Tim Kaine called the law "an important first step in curbing discriminatory insurance company practices and increasing access to health care."
Cheryl Jernigan is a cancer survivor whose husband battles cancer. For her - the ruling alleviates one reason she wakes up at night.
"Worrying about whether my husband cannot have treatment because we couldn't afford it, we couldn't afford the health insurance and to have to watch him die because he wasn't getting the comprehensive cancer treatment that he needed," she says.
But many small business owners worry the ruling could make the cost of doing business prohibitive.
"A small business person doesn't need one more thing that they have to follow," says Barbara Lang of the D.C. Chamber of Commerce. "So it is a concern."
The scene outside the court
From the belly dancers to a grim reaper, the partisans battled for attention and occasionally confronted each other with their dissenting views at the Supreme Court.
"I think health care is a social justice issue and it's a right," says Nina McHugh, who was countered by Brian Rhodes, who said, "whatever they say it is unconstitutional."
And then came the confusing moment of truth. As the court issued its opinion two cable news networks incorrectly reported the health care bill had been ruled unconstitutional. On the steps of the supreme court it was pandemonium as both sides claimed victory
As the truth spread that the act had been upheld the crowd slowly drifted away. Half left happy, half left vowing to fight on. Most feeling like they'd witnessed something important.
"It's very America and it's a very historic moment and I think people wanted to be in Washington at a moment of history," says Tim Massie.