The Supreme Court today upheld all parts of the Patient Protection and Affordable Care Act.
The decision was written by Chief Justice John Roberts, who joined the court's four liberal justices in upholding the law.
The key was support for the provisions which require everyone to buy insurance or pay a tax.
"Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax," Justice Roberts said in the opinion. "This is sufficient to sustain it," Justice Roberts said.
The decision did allow states the option not to go along with the expansion of the Medicaid insurance program for low-income people.
George Patton, an appellate lawyer with Bose McKinney & Evans LLP, of Washington, D.C. and Indianapolis, said under the decision, states can choose to expand Medicaid to 133%, but they are not required to.
Congress cannot "penalize States that choose not to participate in that new program by taking away their existing Medicaid funding," Roberts said in the majority opinion.
The Medicaid provision is projected to add nearly 30 million more people to the insurance program for low-income Americans.
Ruling specifics aside, industry officials and analysts caution that the ultimate decision will be left to the voters. They also caution that even if President Obama wins re-election, implementation of the health exchanges, a key component of the law, could be delayed, perhaps by a year.
Beth Mantz-Steindecker and Ira Loss of Washington Analysis, said, "Despite the settlement of the constitutional question, the ultimate fate of the health care reform law remains to be seen, which will be determined in large part by the outcome of the November elections."
And, the states are caught in the middle.
Perhaps only half have begun to prepare to implement the exchanges.
And there is a conflict within the hierarchy of the National Association of Insurance Commissioners.
The NAIC weighed in with a pledge to "continue to work to give regulators the tools they need to ensure a stable health insurance marketplace in the states."
The statement added that, "Where the ACA provides states with latitude, regulators will continue to work with insurers, consumer groups and the public to provide the best regulatory framework going forward."
However, while signing on to the NAIC statement, NAIC president Kevin McCarty implied that he might have difficulty getting the Florida legislature to act to implement the exchanges and other provisions of the law.
The state was a hotbed of opposition to the decision, and a federal court in Pensacola was the only federal court to declare the law unconstitutional, a ruling which today's Supreme Court decision reversed.
McCarty said that, "With the affirmation of the Affordable Care Act, I remain concerned about the potential for increased health insurance premiums and continued disruption to the stability of the marketplace for many Floridians.
"Nevertheless, we will work with the Florida Legislature and Gov. Scott to implement the Supreme Court's decision and develop an implementation strategy that minimizes market disruption and allows Florida's health insurers and HMOs to continue to provide coverage in our state," McCarty said.
Ken Crerar, president of the Council of Insurance Agents and Brokers, said that, "In a victory for the Obama Administration, and despite initial media reports to the contrary, the Affordable Care Act has been upheld by the Supreme Court. The basic import here is that all litigation is done and that the law proceeds."
Crerar said the ruling was "mixed, in that Chief Justice Roberts joined the left-leaning four justices in determining that the individual mandate is in fact a tax and within the powers of Congress."
