The Supreme Court upheld the health care law today in a splintered, complex opinion that appears to give President Obama a major victory.
Basically. the justices said that while Congress may have overreached in part with the individual mandate -- the requirement that most Americans buy health insurance or pay a fine -- the provision is held constitutional as a tax.
Chief Justice John Roberts -- a conservative appointed by President George W. Bush -- provided the key vote to preserve the landmark health care law, which figures to be a major issue in Obama's re-election bid against Republican opponent Mitt Romney.
The announcement will have a major impact on the nation's health care system, the actions of both federal and state governments, and the course of the November presidential and congressional elections.
A key question for the high court: The law's individual mandate, the requirement that nearly all Americans buy health insurance, or pay a penalty.
Critics call the requirement an unconstitutional overreach by Congress and the Obama administration; supporters say it is necessary to finance the health care plan, and well within the government's powers under the Commerce Clause of the U.S. Constitution.
While the individual mandate remained 18 months away from implementation, many other provisions already have gone into effect, such as free wellness exams for seniors and allowing children up to age 26 to remain on their parents' health insurance policies. Some of those provisions are likely to be retained by some insurance companies.
Other impacts will sort themselves out, once the court rules:
-- Health care millions of Americans will be affected – coverage for some, premiums for others. Doctors, hospitals, drug makers, insurers, and employers large and small all will feel the impact.
-- States -- some of which have moved ahead with the health care overhaul while others have held back -- now have decisions to make. A deeply divided Congress could decide to re-enter the debate with legislation.
-- The presidential race between Obama and Republican challenger Mitt Romney is sure to feel the repercussions. Obama's health care law has proven to be slightly more unpopular than popular among Americans.
Not since the court confirmed George W. Bush's election in December 2000 -- before 9/11, Afghanistan and Iraq, Wall Street's dive and Obama's rise -- has one case carried such sweeping implications for nearly every American.
Passed by Democrats along strictly partisan lines and still 18 months short of full implementation, the law is designed to extend health coverage to some 32 million uninsured people, ban insurers from discriminating against those with expensive ailments, and require nearly all Americans to buy insurance or pay penalties.
Its passage on March 23, 2010, marked the culmination of an effort by Democrats to overhaul the nation's health care system that dates back to Harry Truman's presidency. The most recent effort by President Bill Clinton in 1994 fell victim to Republican opposition. Since then, lesser changes have been enacted, including creation of a separate Children's Health Insurance Program in the states.