The U.S. Supreme Courtupheld the constitutionality of President Obama's health care law Thursday, ruling that the government may impose tax penalties on people who do not have health insurance.
The court's long-awaited ruling rejected a broad legal attack on the Patient Protection and Affordable Care Act brought by Republican state officials and the National Federation of Independent Business.
The legal challenge focused on the law's so-called mandate that all must have insurance by 2014 or pay a tax penalty.
The administration defended this requirement under Congress' power to regulate interstate commerce. The challengers insisted the mandate was unprecedented and unconstitutional because the federal government would be forcing Americans to buy a private product.
"The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax," Chief Justice John Roberts wrote for the court's majority.
"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," he concluded. The conservative Roberts joined the four most liberal justices to uphold the law's key provision.
The ruling was not a total victory for the Obama administration.
Roberts said the required expansion of Medicaid violates states' rights and may be unconstitutional.
"The states are given no choice in this case. They must either accept a basic change in the nature of Medicaid or risk losing all Medicaid funding," he wrote.
He said the federal government cannot require the states to follow this part of the law.
Initial projections show about 84,000 Marylanders would have gained coverage through Medicaid's expansion in the first year, according to the Governor's Office of Health Reform.
Roberts' opinion was joined by Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan.
Justice Anthony Kennedy delivered a dissent for Justices Antonin Scalia, Clarence Thomas andSamuel A. Alito Jr.
Obama said the ruling was a victory for the American people, and promised to implement it and improve upon it going forward.
"The highest court in the land has now spoken. We will continue to implement this law and we'll work together to improve on it where we can," Obama said at the White House.
"What we won't do — what the country can't afford to do — is re-fight the political battles of two years ago or go back to the way things were. With today's announcement, it's time for us to move forward."
During an appearance in Washington Thursday, presidential candidate Mitt Romney said, "This is the time of choice for the American people. If you don't want the course that President Obama has put us on, if you want instead a course that the Founders envisioned, then join me in this effort. Help us. Help us defeat Obamacare."
In Maryland, which has an estimated 750,000 uninsured residents, state leaders aggressively worked to implement several aspects of the health care law.
Gov. Martin O'Malleyand Lt. Gov. Anthony G. Brownsaid, "Today's decision gives considerable momentum to our health care reform efforts here in Maryland.
"In upholding the Affordable Care Act, theU.S. Supreme Courtchose to protect the lives of millions of Marylanders and millions of Americans," they said in a joint statement. "American businesses will be more competitive in the global economy with lower health care costs and a healthier workforce. Parents will be able to keep their children on their health care plans until age 26. Seniors will avoid the Medicare Donut Hole. And by 2014, no American will be denied health care coverage because of a pre-existing condition."
Carmela Coyle, president and CEO of the Maryland Hospital Association, said that the health care decision will reinforce and allow the state to continue what it has already done to increase coverage for its residents.
"I think the Supreme Court decision replaces a lot of negative what ifs with a single positive and that is to change for the better the way we take care of people in the United States," said Coyle, whose organizaton represents 46 acute care hospitals. "That is what health care reform was all about."
"The Affordable Care Act can now move forward and provide new coverage and healthcare for hundreds of thousands of Maryland residents, which will give them security and peace of mind," said Dr. Peter Beilenson, the Howard County health officer.
House Republicans said the decision would prompt them to redouble their efforts to repeal the law.
"The president's health care law is hurting our economy by driving up health costs and making it harder for small businesses to hire," House Speaker John Boehner, an Ohio Republican, said in a statement. "Today's ruling underscores the urgency of repealing this harmful law in its entirety. What Americans want is a common-sense, step-by-step approach to health care reform."
Rep. Andy Harris, the only doctor in Maryland's congressional delegation and a Republican who made the law a centerpiece of his 2010 election, said he respected the opinion and would continue efforts to repeal the law.
"The Supreme Court's decision determined the law's constitutionality, not whether the law is good policy," Harris said. "Americans have already made up their mind on that issue. A majority favor repealing the law."
Supporters say the ruling should end the debate over the law.
Rep. Steny Hoyer, a Maryland Democrat who helped to shepherd the law through the House, described the decision as "a victory for all Americans who have ever worried about being able to access or afford the care they need."
Hoyer, the second-highest ranking Democrat in the House, said the ruling means Republicans now have a responsibility to work with Democrats to implement the new law.
"Republicans have been trying to repeal the Affordable Care Act since the day it was enacted, and they have been eagerly awaiting today's ruling," Hoyer said. "But they must now accept that the Affordable Care Act will remain in place and that the time for litigation and partisan posturing on this issue ought to come to an end."
John Gage, president of the American Federation of Government Employees, which represents thousands of federal workers in Maryland, agreed that the decision should end the debate over the law in Washington.
"Now that this historic legislation has been upheld by the highest court in the land, it's time for Republican leaders in Congress to stop their campaign to repeal the law and to focus instead on improving the economy and creating jobs," Gage said.
Sen.Barbara A. Mikulskicalled the ruling a victory for women. "Today, what we've been able to affirm is that insurance companies will no longer be able to discriminate on the basis of gender. No longer will women pay 30% more for their health care than men of the same health care status. Number two, simply being a woman will no longer be a pre-existing condition."
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Sen. Ben Cardin, a Maryland Democrat who supported the law said, "Before this law, every responsible American with health insurance was subsidizing the health care needs of the rest. That unfair arrangement will be coming to an end soon, as all Americans become part of a more efficient, more cost-effective health care system."
The National Federation of Independent Business, the group that initially filed part of the lawsuit, said in a statement it was disappointed by the ruling and immediately pivoted to the November presidential campaign, arguing in a statement that the law represented a broken campaign promise by Obama not to raise taxes.
The group's Maryland director, Ellen Valentino, said the decision will ultimately prove harmful to the state's small businesses.
"The tragedy in this ruling is that Maryland residents are now at the mercy of politicians from other states and bureaucrats in Washington whose decisions won't be based on what is best for Maryland," Valentino said in a statement. "Small businesses here will be overwhelmed by mandates, taxes and burdens imposed on them by people whom we cannot as easily hold accountable."
Meanwhile, NAACP Chairman Roslyn M. Brock said, "Access to quality, affordable health care is a civil and human right that should not be reserved for the wealthy or the few. The 32 million American men, women and children covered under this law can now breathe easier."
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David G. Savage and Maeve Reston of Tribune, Reuters and Baltimore Sun reporters Meredith Cohn, Andrea K. Walker and John Fritze contributed to this report.