The United States Supreme Court handed President Barack Obama a crucial election-year victory on Thursday when, in a narrow ruling, it upheld the Patient Protection and Affordable Care Act with the unlikely help of conservative Chief Justice John Roberts.

The decision marked a pivotal point in the presidential race and gave Republicans unexpected ammunition to energize supporters in the battle for the White House and to fight health care reform as a new tax on people who don’t obtain health insurance.

Roberts’ vote, along with those of the court’s four liberal justices, preserved the largest expansion of the nation’s social safety net in more than 45 years, including the hotly debated core requirement that nearly everyone have health insurance or pay a penalty.

The aim is to extend coverage to more than 30 million people who now are uninsured.

The 5-4 decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, with an impact on the way that countless Americans receive and pay for their personal medical care.

It also vindicated the president’s most significant legislative accomplishment.

Obama said the Supreme Court’s decision to uphold his health care overhaul was a “victory for people all over the country” and would make their lives more secure.

He said the decision upholds the fundamental principle that in America — the wealthiest nation on earth — no one should fall into financial ruin because of an illness.

“The highest Court in the land has now spoken.  We will continue to implement this law.  And we’ll work together to improve on it where we can.  But what we won’t do — what the country can’t afford to do — is refight the political battles of two years ago, or go back to the way things were,” he said.

The president said that people with pre-existing medical conditions would not be discriminated against and people would be able to afford quality health care.

Breaking with the other conservative justices, Roberts read the judgment that allows the law to go forward.

He explained at length the court’s view of the insurance mandate as a valid exercise of Congress’ authority to “lay and collect taxes.”

The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.

Congress called the payment a penalty, not a tax, but Roberts said the court would not get hung up on labels.

Among other indications it is a tax, Roberts said, “the payment is collected solely by the IRS through the normal means of taxation.”

“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.

Many Republicans oppose the law, arguing that it marks a government takeover of health care at the same time it curtails Medicare spending and raises taxes.

They also point to studies that predict private employers will be forced to reduce or eliminate coverage and that the legislation will wind up costing far more than estimated, raising federal deficits as a result.

The decision should help hospitals by adding millions of people to the rolls of the insured, expanding the pool of health care consumers.

But by the same reasoning, insurance companies will also gain millions of premium-paying customers.

Even though she was in the majority in the ruling, Justice Ruth Bader Ginsburg took issue with the court’s reasoning that the individual mandate, which would require most Americans to purchase health insurance, was an invalid use of the Constitution’s clause giving Congress the power to regulate interstate commerce; Ginsburg said the mandate should have been supported under the commerce clause.

She also said the entire law should have been upheld as written and without forcing any changes to the Medicaid provision.

The majority found problems with the expansion of Medicaid but said it could proceed as long as the government didn’t threaten to withhold a state’s entire Medicaid allotment if it didn’t take part in the extension.

Ginsburg, in a statement from the bench, said that even though the health care law survives, the court’s position on the commerce clause “has been set awry.”

Meantime, Mitt Romney, the president’s Republican challenger, opposed the health care overhaul and was expected to double-down on his campaign pledge to repeal the law if he is elected.

He called the decision incorrect and said on Thursday that it was “bad law” and would raise taxes and cut Medicare.

“This is the time of choice for the American people. Our mission is clear: If we want to get rid of Obamacare, we’re going to have to replace President Obama. My mission is to make sure we do exactly that. That we return to the American people the privilege they’ve always had to live their lives in the way they feel most appropriate. Where we don’t pass on to coming generations massive deficits and debt, where we don’t have a setting where jobs are lost,” he said.

“If we want good jobs and a bright economic future, for ourselves and for our kids, we must replace Obamacare. That is my mission.”

FLORIDA REACTION

In Florida, the lead state in the challange to health care reform, Governor Rick Scott was unsure how the state would comply with the decision.

Scott would not say whether the state would opt out of an expansion of the Medicaid program that was ordered under the overhaul.

The Supreme Court decision made it clear that states would not forfeit federal Medicaid money if they refused to authorize the expansion.

“If you look at every government program in the world, they over-promise, they run out of money, they underpay providers and then that rations care,” Scott said. “On top of that, as bad as it’s going to be for patients, it’s going to be just as bad for taxpayers. We’re not going to be able to afford this.”

Scott, who has been a sharp opponent of the health care overhaul, also could not say whether the state would set up its own health care market as required under the law.

Earlier, U.S. Senator Marco Rubio echoed calls for the law to be repealed.

“What’s important to remember is that what the Court rules on is whether something is constitutional or not, not whether it’s a good idea,” he said.

“While the Court has said that the law is constitutional, it remains a bad idea for our economy, and I hope that in the fall we will have a majority here that will not just repeal this law, but replace it with real solutions that will insure more people and cost a lot less money.”

REPEAL EFFORT

On Capitol Hill, House Speaker John Boehner agreed and said the law needed to be repealed.

The Ohio Republican said in a statement that the law would hurt the economy by increasing health care costs and making it difficult for small businesses to hire.

A vote to repeal the law was scheduled for the week of July 9th.

Read reaction to the ruling and share your comments here: http://scrbliv.me/51229.

– Alex Sanz and the Associated Press contributed to this report.

Tags | Affordable Care Act, Alex Sanz, Barack Obama, health care reform, marco rubio, Mitt Romney, Obamacare, rick scott