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By MARK SHERMAN
WASHINGTON (AP) - America's historic health care overhaul, certain now to touch virtually every citizen's life, narrowly survived an election-year battle at the Supreme Court Thursday with the improbable help of conservative Chief Justice John Roberts.
But the ruling, by a 5-4 vote, also gave Republicans unexpected ammunition to energize supporters for the fall campaign against President Barack Obama, the bill's champion _ and for next year's vigorous efforts to repeal the law as a new federal tax
Roberts' vote, along with those of the court's four liberal justices, preserved the largest expansion of the nation's social safety net in more than 45 years, including the hotly debated core requirement that nearly everyone have health insurance or pay a penalty. The aim is to extend coverage to more than 30 million people who now are uninsured
The decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, with an impact on the way that countless Americans receive and pay for their personal medical care.
The ruling handed Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they would try to use the decision against him.
At the White House, Obama declared, "Whatever the politics, today's decision was a victory for people all over this country." Blocks away, GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it "bad law" and promising to work to repeal it if elected in November.
Demonstrators for and against the law crowded the grounds outside the Supreme Court Building on Capitol Hill as Roberts, sitting at the center of the nine black-robed justices inside, announced the decision to a packed courtroom.
Breaking with the other conservative justices, Roberts wrote the judgment that allows the law to go forward. He explained at length the court's view of the insurance mandate as a valid exercise of Congress' authority to "lay and collect taxes." The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.
Roberts, appointed by Republican President George W. Bush, opposed by young Sen. Barack Obama of Illinois and much-criticized by Democrats in recent years, sided with his court's liberals on a major case for the second time this week as the justices concluded their 2011-12 term.
On Monday, he had voted to invalidate parts of Arizona's tough crackdown on illegal immigrants.
In the health care case, Congress had referred to a penalty, not a tax, on people who don't obtain insurance. But Roberts said the court would not get hung up on labels. Among other indications it is a tax, Roberts said, "the payment is collected solely by the IRS through the normal means of taxation."
"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.
Many Republicans oppose the law, arguing that it marks a government takeover of health care at the same time it curtails Medicare spending and raises taxes. They also point to studies that predict private employers will be forced to reduce or eliminate coverage and that the legislation will wind up costing far more than estimated, raising federal deficits as a result.
Stocks of hospital companies rose and some insurance companies fell after the ruling.
The decision should help hospitals by adding millions of people to the rolls of the insured, expanding the pool of health care consumers. But by the same reasoning, insurance companies will also gain millions of premium-paying customers.
The court found problems with the law's expansion of Medicaid, but even there it 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.
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.
Kennedy summarized the dissent in the courtroom. "In our view, the act before us is invalid in its entirety," he said.
The dissenters said in a joint statement that the law "exceeds federal power both in mandating the purchase of health insurance and in denying non- consenting states all Medicaid funding."
The justices rejected two of the administration's three arguments in support of the insurance requirement. Roberts agreed with his conservative colleagues that Congress lacks the power under the Constitution's commerce clause to put the mandate in place.