WASHINGTON — The U.S. Supreme Court on Thursday upheld the bulk of the federal health care law, including its controversial mandate that most Americans have insurance, a sweeping victory for President Barack Obama and Democrats who had struggled for decades to enact reform.
The landmark 5-4 ruling — the most anticipated since Bush vs. Gore — provided new grist for the 2012 presidential campaign, with Republicans seizing the court's characterization of the mandate as a new tax.
It rested surprisingly on Chief Justice John Roberts, an appointee of President George W. Bush whose confirmation Obama voted against as a U.S. senator.
"The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax," Roberts wrote in the majority opinion. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."
Joining him were the court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor.
Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented. "In our view, the act before us is invalid in its entirety," Kennedy, who had been widely expected to be the swing vote, said from the bench.
The ruling means the law, commonly called Obamacare, will continue to go into effect over the next several years and could bring coverage to 30 million people. In Florida about 3.8 million people, or 21 percent, are uninsured.
The mandate begins in 2014. Employers face fines if they do not offer coverage to employees. Those who cannot afford coverage will receive subsidies. Those who refuse to carry insurance will pay a penalty, or tax as the court defined it. That penalty grows as the law takes effect: $95 in 2014; $325 in 2015; and $695 or 2.5 percent of income in 2016.
Republicans once championed the mandate but hammered away at it as a broad government invasion. Polls for the Associated Press have consistently shown that more than 8 in 10 Americans think the government should not have the right to require everyone to buy insurance.
Obama himself resisted the mandate as a candidate in 2008, but architects of the policy that became law saw the mandate as critical to spread the cost of health care more broadly.
"It should be pretty clear by now that I didn't do this because it was good politics; I did it because I believed it was good for the country," Obama said from the White House East Room. "The highest court in the land has now spoken. We will continue to implement this law, and we will 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. With today's announcement it's time to move forward."
Obama, who highlighted popular provisions of the law, such as one blocking insurers from discriminating against people with pre-existing conditions, now has a chance to reframe his signature legislative achievement as he heads toward an uncertain November re-election vote with the cloud of a struggling economy.
Disappointed and somewhat stunned Republicans — not one of whom voted for the legislation when it passed Congress in early 2010 — pounced on the tax issue, circulating a 2009 ABC News interview in which the president declares penalties under the mandate are "absolutely not a tax."
"This bill was sold to the American people on a deception," Senate Republican leader Mitch McConnell of Kentucky said in a fiery speech from the Senate floor.
House Majority Leader Eric Cantor, R-Va., said the House will vote on a repeal the week of July 9, though it's a symbolic measure because Democrats control the Senate.
Republican Sen. Marco Rubio said, "This is a big deal. People across this country and across Florida have every right and every reason to be worried about the impact that this is going to have on them."
Republican presidential nominee Mitt Romney traveled to Washington and declared, "Obamacare was bad policy yesterday; it's bad policy today." He said he would repeal and replace the law if elected, but he would need Republican majorities in both chambers of Congress. Republicans hold the House and would have to win a net four seats to take over the Senate.
Romney's campaign said it raised more than $3.2 million Thursday after the decision was announced. Conservative groups said they would spend millions on TV ads attacking the law and those who voted for it. Democrats, whose enthusiasm for the decision did not match the outrage from Republicans, were quickly circulating their own fundraising appeals.
In Florida, Attorney General Pam Bondi, who days ago predicted the court would throw out the mandate, said she was "shocked" but found comfort that the court did not uphold the law under the commerce clause.
"This is a tax on the American people, and that's how it was upheld," Bondi told reporters in Tallahassee.
The court's decision affirmed a decades-long struggle by Democrats to achieve health care reform, and the conditions were ideal when Obama was elected in 2008 because his party controlled the House and Senate.
Over months of debate, however, the issue grew more divisive, and some Democrats wondered if Obama had squandered an opportunity to enact other initiatives or better tackle the economy. Health care was a defining issue of the 2010 midterm elections, and Democrats lost the House.
The road to the Supreme Court began seven minutes after Obama signed the bill into law on March 23, 2010, when then-Florida Attorney General Bill McCollum filed a lawsuit in federal court in Pensacola. Eventually 25 other states would join the challenge.
The heart of the case was the claim that Congress could not force people to buy a product: health insurance. That individual mandate was borne out of conservative circles more than two decades ago and was once embraced by many Republicans, including Romney, who oversaw a health care plan as governor of Massachusetts that was a template for Obama.
Despite that history, Republicans successfully turned the mandate into a potent symbol of government intrusion and freedom itself.
"Everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market; therefore, you can make people buy broccoli," Justice Scalia said during oral arguments in March. "If the government can do this, what else can it not do?"
The Obama administration argued Congress had power to regulate interstate commerce and pointed to established case law. Obama's legal team, in briefings submitted to the court, used Scalia's words in a 2005 decision that upheld the federal government's right to prevent Californians from growing marijuana for personal medical use even though state law allowed it.
Roberts rejected that. "People, for reasons of their own, often fail to do things that would be good for them or good for society," he wrote. "Those failures — joined with the similar failures of others — can readily have a substantial effect on interstate commerce. Under the government's logic, that authorizes Congress to use its commerce power to compel citizens to act as the government would have them act. That is not the country the Framers of our Constitution envisioned."
What saved Obamacare was something Democrats strategically tried to avoid — a tax.
"Had the bill originally been introduced as a tax, the constitutional issue of the mandate would never have come to court, because Congress has the ability to tax," said Jay Wolfson, associate vice president for health law, policy and safety at the University of South Florida. "But it would have never gotten past Congress as a tax.
"But the Supreme Court, in its distinct wisdom, read the law, the operation of the law and the words of the Constitution and said they can call it what they want, it is operating as a tax and we are deeming it as a tax."
Times staff writer Richard Martin contributed to this report. Alex Leary can be reached at email@example.com.