WASHINGTON — America’s historic health care overhaul, derided by Republicans as the intrusive, costly “Obamacare,” narrowly survived an election-year battle at the Supreme Court Thursday with the improbable help of conservative Chief Justice John Roberts.
The 5-4 ruling now makes it certain that major health care changes will move ahead, touching virtually every American’s life. And Democrats, who have learned to accept if not love the GOP label for the law, heartily praised the decision.
But the ruling also gave Republicans unexpected ammunition to energize supporters for the fall campaign against President Barack Obama, the bill’s champion — and for next year’s vigorous efforts to repeal the law as a new federal tax
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 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.
Breaking with the other conservative justices, Rob-erts wrote 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.
Roberts, appointed by Republican President George W. Bush, opposed by a young Sen. Barack Obama of Illinois and much-criticized by Democrats in recent years, sided with his court’s liberals on a major case for the second time this week as the justices concluded their 2011-12 term.
In the health care case, Congress had referred to a penalty, not a tax, on people who don’t obtain insurance. 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.
Stocks of hospital companies rose and some insurance companies fell after the ruling.
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.
The court found problems with the law’s expansion of Medicaid, but 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.
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.
Kennedy summarized the dissent in the courtroom. “In our view, the act before us is invalid in its entirety,” he said.
The dissenters said in a joint statement that the law “exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding.”
The justices rejected two of the administration’s three arguments in support of the insurance requirement. Rob-erts agreed with his conservative colleagues that Congress lacks the power under the Constitution’s commerce clause to put the mandate in place.
“The federal government does not have the power to order people to buy health insurance,” he said in a part of his opinion that the liberal justices did not join. But his crucial bottom line was: “The federal government does have the power to impose a tax on those without health insurance.”
In all, the justices spelled out their views in six opinions totaling 187 pages. Roberts, Kennedy and Ginsburg spent 51 minutes summarizing their views in the courtroom.
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 other service providers may struggle once the Medicare cuts used to finance the law really start to bite.