WASHINGTON (AP): The Supreme Court has upheld President Barack Obama's health care overhaul, including the individual insurance requirement and requiring insurers to cover young adults until age 26.
More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.
There's also an added safety net for all Americans, insured and uninsured. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections, now standard in most big employer plans, will be available to all, including people who get laid off, or leave a corporate job to launch their own small business.
Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no copayments for preventive care. But hospitals, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.
The court on Thursday handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
Republican challenger Mitt Romney opposes the health care overhaul and is expected to double-down on his campaign pledge to repeal the law if he is elected.
Analysts on the Supreme Court blog said the justices determined that people without health insurance can be taxed differently, that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power.
"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Chief Justice John Roberts said.
The court found problems with the law's expansion of Medicaid, but even there 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 in the law's extension.
The court's four liberal 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.
"The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding," the dissenters said in a joint statement.
Illegal immigrants are not entitled to the new insurance coverage under the law, and will remain one of the biggest groups uninsured.
Obama's law is by no means the last word on health care. Experts expect costs to keep rising, meaning that lawmakers will have to revisit the issue perhaps as early as next year, when federal budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-income people.
The case began almost as soon as Obama signed the law on March 23, 2010. Even before the day was out, Florida and 12 states filed the lawsuit that ended up at the Supreme Court. Another 13 states later joined in later.
The heart of the challenge was the claim that Congress could not force people to buy a product -- health insurance.
The administration advanced several arguments in defense of Congress' authority to require health insurance, including that it falls under the power to regulate interstate commerce.
The government also argued that the insurance requirement was necessary to make effective two other undoubtedly constitutional provisions: the requirements that insurers accept people regardless of existing health problems and limit what they charge older, sicker people.
The administration also said that even if the court rejected the first two arguments, the insurance requirement and penalty are constitutional as an exercise of Congress' power to enact taxes. The penalty assessed for not buying insurance functions like a tax, the government said.