When he served as the president's first chief of staff, Emanuel warned Obama that trying to expand health care coverage had eluded presidents of both parties for decades and would detract from achieving other goals early in his term.
"I gave him my advice. I told him many times (about) the political cost of doing this," Emanuel said after a jobs announcement. "And thank God for the rest of the country, he didn't listen to me."
Emanuel made it clear that after the president made up his mind, he worked to secure sufficient votes in the House, where Emanuel served before going to work for Obama.
"Because of the president's courage and not listening about politics," young adults who return home, people with pre-existing conditions and others who have chronic illnesses that have racked up major bills will still have insurance, the mayor said.
"That is the political leadership, that is the political courage that the president showed. And this is, in my view, an historic day, and the president took the leadership and the courage that is necessary to bend the needle of history," Emanuel said.
After saying he wanted to discuss the policy, not the politics, Emanuel went ahead and took a shot at the Republican presidential nominee.
"If Mitt Romney — I don't know which Mitt Romney would have showed up, the Massachusetts governor or the new one — but if Mitt Romney would have been in the Oval Office a different set of decisions would have been made, and they have bottom-line consequences in people's lives."
Emanuel also was asked about the fact that Republican appointee Chief Justice John Roberts tipped the balance on the narrow decision, which upheld the constitutionality of a federal mandate requiring everyone to have insurance or pay a penalty.
"It's rich with irony," Emanuel said.
Political historians would note another bit of irony: As a new U.S. senator, Obama voted against Roberts' confirmation to the high court. At the time, Obama praised Roberts' qualifications but questioned his philosophy.
Also Thursday, Cook County Board President Toni Preckwinkle applauded the Supreme Court decision, calling it "historic" and saying it could help ensure tens of millions of dollars in new funding for the county's financially struggling public health care system.
The county is seeking federal permission for early Medicaid enrollment of about 100,000 current nonpaying Cook County Health and Hospitals System patients. If the court had struck down the law, that effort would have been thwarted.