WASHINGTON (AP) — The Supreme Court on Thursday upheld the vast majority of President Barack Obama’s historic health care overhaul, including the hotly debated core requirement that virtually all Americans have health insurance.
The 5-4 decision means the huge overhaul, still taking effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care.
The ruling hands Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they will try to use the decision to rally their supporters against what they call “Obamacare.”
Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.
Breaking with the court’s other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.
The justices rejected two of the administration’s three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. “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.
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.
Kennedy summarized the dissent in court. “In our view, the act before us is invalid in its entirety,” he said.
The legislation passed Congress in early 2010 after a monumental struggle in which all Republicans voted against it. House Republicans announced in advance of the ruling they would vote to wipe out whatever was left standing by the justices, and GOP presidential candidate Mitt Romney has joined in calls for its complete repeal.
After the ruling, Republican campaign strategists said Romney will use it to continue campaigning against “Obamacare” and attacking the president’s signature health care program as a tax increase.
“Obama might have his law, but the GOP has a cause,” said veteran campaign adviser Terry Holt. “This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history.”
Democrats said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling.
“Mitt Romney is the intellectual godfather of Obamacare,” said Democratic consultant Jim Manley. “The bigger issue is the rising cost of health care, and this bill is designed to deal with it.”
Justice Ginsburg said the court should have upheld the entire law as written without forcing any changes in the Medicaid provision. She said Congress’ constitutional authority to regulate interstate commerce supports the individual mandate. She warned that the legal reasoning, even though the law was upheld, could cause trouble in future cases.
“So in the end, the Affordable Health Care Act survives largely unscathed. But the court’s commerce clause and spending clause jurisprudence has been set awry. My expectation is that the setbacks will be temporary blips, not permanent obstructions,” Ginsburg said in a statement she, too, read from the bench.

North Carolina’s position
Number of uninsured: 1.57 million state residents are uninsured, or about 17 percent.
Where the state stands: Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina’s General Assembly last year. Lawmakers haven’t been able to overcome Democratic Gov. Beverly Perdue’s veto of their bill. But work to design health care exchanges has stalled since last summer.

Previous health care initiatives
WASHINGTON (AP) — The Supreme Court’s ruling on President Barack Obama’s health care overhaul law follows a century of debate over what role the government should play in helping people in the United States afford medical care. A look at the issue through the years:
1912: Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House.
1929: Baylor Hospital in Texas originates group health insurance. Dallas teachers pay 50 cents a month to cover up to 21 days of hospital care per year.
1935: President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first.
1942: Roosevelt establishes wage and price controls during World War II. Businesses can’t attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk.
1945: President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as “socialized medicine” and it goes nowhere.
1960: John F. Kennedy makes health care a major campaign issue but as president can’t get a plan for the elderly through Congress.
1965: President Lyndon B. Johnson’s legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor.
1974: President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes.
1976: President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside.
1986: President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost.
1988: Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn’t last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.
1993: President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate.
1997: Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid.
2003: President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people.
2008: Hillary Rodham Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Obama, who has a less comprehensive plan.
2009: Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can’t afford insurance.
2010: With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as “Obamacare.”
2012: On a campaign tour in the Midwest, Obama himself embraces the term “Obamacare” and says the law shows “I do care.”