HispanicBusiness

In a stunning, historic ruling expected to create the largest overhaul of American health care in decades, the U.S. Supreme Court today ruled constitutional President Barack Obama's landmark health reform law that requires most Americans to have health insurance beginning in 2014 or pay a penalty.

The 5-4 ruling gave Obama an election-year victory but surprised even many proponents of the two-year-old Affordable Care Act. It sets up a blazing duel in the fall presidential elections between the president and Republican contender Mitt Romney over health care changes.

In reaching the decision, the court ruled that the controversial insurance requirement is constitutional under Congress' power to tax. It also let stand a major expansion of the Medicaid program, though the court said the federal government could not penalize states that chose not to expand by withhold existing Medicaid funds from those states. The extension could add a half-million uninsured people in Michigan who might meet expanded eligibility criteria.

Chief Justice John Roberts, considered a conservative member of the court, sided with the court's more liberal justices, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan. Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito dissented -- as did conservative groups across the nation.

"The values that should have determined our course today are caution, minimalism, and the understanding that the federal government is one of limited powers," the dissenting justices wrote. "But the court's ruling undermines those values at every turn. In the name of restraint, it overreaches. In the name of constitutional avoidance, it creates new constitutional questions. In the name of cooperative federalism, it undermines state sovereignty."

From the White House, Obama said with the court's decision in hand, "it's time for us to move forward -- to implement and, where necessary, improve on this law."

Michigan, which challenged the law and declined to accept $10 million in federal funds to implement a key piece of the legislation while waiting for the decision, now has to scramble to meet the law's deadlines. The biggest comes January 1, 2013, when states must have set up the initial framework for health insurance exchanges where consumers and small businesses could purchase insurance, beginning in 2014.

In a statement, Michigan Gov. Rick Snyder said the law "misses the point on the most important reforms needed in our health care system." Without more cost controls, the nation's and the state's economic recovery is in jeopardy, he said.

Snyder's statement did not precisely address whether Michigan may need to ask the federal government to help Michigan run the exchange, but he has indicated he prefers to have Michigan run one.

"While I may not agree with everything in the law, now that the Supreme Court has essentially upheld the act, we must act quickly to avoid an undue burden on Michigan residents and job providers," he said.

"Implementing this law will require an immense amount of coordination between the public and private sectors," Snyder's statement said. "We plan on working closely with Michigan consumers, businesses and health providers to ensure that the decisions we make have as much of a positive impact on Michigan as possible."

Michigan has received $999,772 to start the exchange but the Legislature last year decided not to accept nearly $10 million in federal funds awarded to the state for further work. Legislators said they preferred to wait for the Supreme Court ruling.