June 28--The U.S. Supreme Court upheld the constitutionality of Obamacare, the controversial federal health care reform program, in a blockbuster decision related today.

Chief Justice John Roberts acted as the swing vote, joining the liberal justices on the court to save the signature achievement of the Obama Administration.

The court ruled 5-4 that Congress acted within its power when it required Americans to have health insurance, finding Congress could impose the mandate under its authority to levy taxes.

"This is sufficient to sustain it," ruled Roberts, one of the court's most conservative justices. "It is not our role to forbid it or to pass upon its wisdom or its fairness."

The court also ruled that Congress acted constitutionally in expanding Medicaid under the act, but warned that if states do not comply with the expansion provisions, the federal government could only withhold new funds, not existing funding.

"Nothing in our opinion precludes Congress from offering funds under the (Affordable Care Act) to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding," wrote Roberts in the majority opinion, according to early reports from the SCOTUSblog before the written decision was released.

The Affordable Care Act, passed in 2010, guarantees all Americans health care, but mandates that all American have health insurance. It was immediately the focus of legal battles after its contentious passage.

Today's ruling was quickly hailed by the medical community, which had largely backed the legislation.

"We are so pleased that the ACA was upheld," said Massachusetts Medical Society President Richard Aghababian, M.D. "Universal coverage is a state-federal partnership -- no state can do this on its own. We've accomplished a great deal since 2006 -- and there's still a lot of work to do. Affordability is still a big challenge. We promise to work with the governor, legislators, and the leaders of the health care community to ensure that the noble vision of our health reform law is fulfilled for many years to come."

The five justice who today ruled in favor of the legislation were Roberts, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan. Writing the dissent was the court's key swing-voter, Anthony Kennedy, joined by Antonin Scalia, Clarence Thomas and Samuel Alito.

The hotly anticipated ruling had the White House, lawmakers, business leaders and the nation anxiously waiting to see if the Affordable Care Act would survive. Now, the decision is sure to have sweeping consequences, as the nation enters the presidential election season amidst a shaky economic recovery.

christine.mcconville@bostonherald.com

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