Supreme Court saves centerpiece of health care reform law

The Supreme Court upheld the health care reform law on Thursday in a ruling in which conservative Chief Justice John Roberts sided with the liberal wing and spelled out ways to keep the highly controversial law within the bounds of the Constitution. The ruling vindicates President Obama’s signature domestic policy initiative, even if it doesn’t stop the political debate over the sweeping Affordable Care Act.

The 5-4 ruling lets stand the mandate -- the requirement that just about everyone carry health insurance or pay a fine. But the ruling calls the fine a tax, allowing the law to escape arguments that it violates the Commerce Clause of the Constitution.

And the ruling, written by Roberts himself, also addresses the law’s controversial requirement that states expand Medicaid coverage to millions more. It says the federal government may ask the state to do so and can even pony up the cash, but it cannot withhold its share of Medicaid funds to coerce them to do it.

"Nothing in our opinion precludes Congress from offering funds under the ACA  to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use,” the ruling said. “What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding."

Not all the justices were convinced. "In our view, the entire Act before us is invalid in its entirety,” conservative justice Anthony Kennedy -- who many court watchers thought would be the swing vote -- wrote in his dissent.

“Today’s Supreme Court ruling is a clear, unambiguous, and complete victory for long-overdue health care reform. It sends an unmistakable message that the building of a better, fairer health care system will continue to move forward,” Ron Pollack, executive director of the pro-health reform group Families USA, said in a statement.