By MARK SHERMAN
WASHINGTON (AP) - The Supreme Court on Thursday upheld the individual insurance requirement at the heart of President Barack Obama's historic health care overhaul.
The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans.
The justices rejected two of the administration's three arguments in support of the insurance requirement. But the court said the mandate can be construed as a tax. "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.
The court found problems with the law's expansion of Medicaid, but even there 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 in the law's extension.
The court's four liberal 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.
"The act before us here exceeds federal power both in mandating the purchase of health insurance and in denying non-consenting states all Medicaid funding," the dissenters said in a joint statement.
Republican campaign strategists said presidential candidate Mitt Romney will use the court's ruling to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.
"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."
By The Associated Press
Here is a look at where each of the 50 states stand on implementing President Barack Obama's federal health care overhaul, which the Supreme Court ruled Thursday can go forward with its aim of covering more than 30 million uninsured Americans.
NUMBER OF UNINSURED: 720,000 state residents are uninsured, or about 15.4 percent.
WHERE THE STATE STANDS: Republican Gov. Robert Bentley, a physician, created a commission in 2011 to recommend a plan for a health insurance exchange, but he successfully opposed efforts by some legislators to enact one in May. Critics said the bill would have limited the exchange to companies operating statewide, which is one at this point. Bentley said it was premature to act before the Supreme Court ruled.
NUMBER OF UNINSURED: 125,000 state residents are uninsured, or about 18 percent.
WHERE THE STATE STANDS: Alaska, which is among the states that sued over the constitutionality of the federal health care law, has yet to implement a health care exchange. The health department has hired a consultant to help design one, and that report is expected soon.
NUMBER OF UNINSURED: 1.28 million state residents not covered, or about 19 percent
WHERE THE STATE STANDS: Arizona is among the states challenging the constitutionality of the health care overhaul. The lawsuit covers about 22,000 people statewide, including some 14,000 people in the Phoenix area. Republican Gov. Jan Brewer's administration is moving to implement part of the contested law by reviewing health insurance rates to see if they should be labeled unjustifiably high. The state also has accepted a federal grant to create a state health insurance exchange.
NUMBER OF UNINSURED: 539,000 state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: Arkansas decided on a federal-state partnership for its health insurance marketplace. Legislators blocked a bill by which the state would have created its own insurance exchange but have since accepted a grant that will allow it to at least have a role in the federally created exchange.
NUMBER OF UNINSURED: NUMBER OF UNINSURED: 7,209,000 state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: California has worked to be a model for the health care law and has begun implementing parts of it already, including creating the beginnings of health care exchanges to provide consumers a marketplace to purchase insurance policies starting in 2014. The state has also already banned insurers from refusing coverage for children with pre-existing illnesses and young adults are allowed to stay on their parents' plans through age 26 in California.
NUMBER OF UNINSURED: 656,000 state residents are uninsured, or about 13 percent.
WHERE THE STATE STANDS: Colorado lawmakers passed legislation in 2011 to set up health insurance exchanges, and a commission is in the process of implementing them. The exchanges are set to start October 2013.
NUMBER OF UNINSURED: About 377,000 state residents are uninsured, or about 11 percent.
WHERE THE STATE STANDS: Connecticut has hired staff and a board of directors to begin implementing health care exchanges and have them in place by the 2014 deadline set by the federal law. The state already is allowing people under 26 years old to stay on their parents' health insurance policies, which is part of the federal law.
NUMBER OF UNINSURED: Between 100,000 and 110,000 Delaware residents are uninsured, about 11 percent of the state's population.
WHERE THE STATE STANDS: Delaware officials are working on a health care exchange. State officials also are accepting public input as they come up with minimum coverage requirements that must be included in health care plans for individuals and small businesses.
NUMBER OF UNINSURED: 3.85 million Floridians are uninsured, or about 21 percent.
WHERE THE STATE STANDS: Republican Gov. Rick Scott ordered the state not to accept federal money for implementing the health care law after he took office last year. Florida has rejected or declined to pursue more than $106 million and has returned $4.5 million. The state has its own health insurance exchanges, mainly for small businesses but without an individual mandate. The state has not implemented an exchange that would meet the requirements of the federal law.
NUMBER OF UNINSURED: 111,000 state residents are uninsured, or 19 percent.
WHERE THE STATE STANDS: Georgia has done nothing to implement a health care exchange. Lawmakers have introduced bills that would either allow or hinder implementation of the law, though none have passed.
NUMBER OF UNINSURED: 97,000 state residents are uninsured, or 7.7 percent.
WHERE THE STATE STANDS: Hawaii has been moving at full speed in anticipation the overhaul will be upheld. It joined several states last year in filing a friend-of-the-court brief in support of the law. Gov. Neil Abercrombie, a Democrat, said at the time the law preserved the best elements of Hawaii's long-standing health care statutes. The state also used a $300,000 private grant to create a state job for a coordinator to implement the overhaul. Hawaii plans to develop its own insurance exchange, a key component of the federal overhaul.
NUMBER OF UNINSURED: 294,000 state residents are uninsured, or about 19 percent.
WHERE THE STATE STANDS: Idaho has not implemented health insurance exchanges, over objections from insurers including Blue Cross of Idaho. The GOP-controlled Idaho Legislature declined to accept federal grants for the project and also balked at putting together a scaled-down state-funded version while awaiting the Supreme Court's decision.
NUMBER OF UNINSURED: 1,914,000 state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: Illinois has received three federal grants to study and start building its health insurance exchange, but the Legislature has failed to pass a law establishing it. Gov. Pat Quinn, a Democrat, has considered an executive order to do that, but now may pursue a federal-state partnership instead.
NUMBER OF UNINSURED: 850,000 state residents are uninsured, or about 13.4 percent.
WHERE THE STATE STANDS: Republican Gov. Mitch Daniels ordered state agencies to build a framework for a possible exchange, but he has not implemented one pending the Supreme Court ruling. Indiana also has pushed to use its health savings account to help cover an estimated 500,000 who will become eligible for Medicaid in 2014 under the federal health care overhaul, but federal officials denied the request in September, saying it was premature.
NUMBER OF UNINSURED: 366,000 Iowa residents are uninsured, about 12 percent of the population.
WHERE THE STATE STANDS: The state does not have a law establishing a health insurance exchange, and Republican Gov. Terry Branstad has said Iowa will create a state-based exchange only if the law is upheld. The Republican House Majority leader says the state has already enacted several pieces of the law, including a website that helps residents find insurance, but the state has yet to comply with other requirements.
NUMBER OF UNINSURED: 350,000 state residents are uninsured, or almost 13 percent.
WHERE THE STATE STANDS: The Republican-dominated state government has been hostile to the 2010 federal law and hasn't moved to set up a health care exchange. Last year, GOP Gov. Sam Brownback's administration returned a $31.5 million federal grant.
NUMBER OF UNINSURED: 640,000 state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: Kentucky has laid the groundwork for a statewide health insurance exchange, but Democratic Gov. Steve Beshear opted to wait for the Supreme Court ruling before moving doing anything more.
NUMBER OF UNINSURED: 886,000 state residents are uninsured, or about 20 percent.
WHERE THE STATE STANDS: Louisiana has not implemented health care exchanges, instead choosing to have the federal government create and operate them. Republican Gov. Bobby Jindal and Attorney General Buddy Caldwell oppose the health care law, and Louisiana is one of the states challenging it in court.
NUMBER OF UNINSURED: 121,000 state residents uninsured, or about 9.4 percent. The number may rise due to Medicaid cutbacks authorized by the latest state budget.
WHERE THE STATE STANDS: Maine had a task force to create a health care exchange, but legislation implementing one was set aside until after the Supreme Court's decision. Maine has passed laws implementing components of the law, such allowing parents to add coverage of children up to age 26 and outlawing denial of insurance coverage due to pre-existing conditions. Maine has also passed a law that will allow consumers to shop out-of-state for coverage.
NUMBER OF UNINSURED: 747,000 state residents are uninsured, or about 13 percent.
WHERE THE STATE STANDS: Maryland has passed legislation to create a health care exchange, setting up standards and regulations to run the program and creating the framework for a marketplace where individuals and small businesses can purchase coverage.
NUMBER OF UNINSURED: Massachusetts says 120,000 people, or about 2 percent of the population, remained uninsured in 2010. The U.S. Census Bureau had a somewhat higher estimate of about 370,000 people, or more than 5 percent of the population.
WHERE THE STATE STANDS: Massachusetts passed a sweeping health care law in 2006 that became the blueprint for the federal overhaul. Many of the key elements of the federal law, including the "individual mandate" requiring nearly everyone have insurance, remain the law in Massachusetts.
NUMBER OF UNINSURED: 1.27 million Michigan residents are uninsured, about 13 percent of the population.
WHERE THE STATE STANDS: The Department of Licensing and Regulatory Affairs has been working to set up a health insurance exchange but has had limited success because House Republicans refuse to let it use $9.8 million in federal planning dollars. Because of looming federal deadlines to have an exchange in place, state officials are planning for a state-run exchange while also talking to federal officials about a possible partnership on a federal exchange where the state handles just some responsibilities, such as customer service.
NUMBER OF UNINSURED: 509,000 state residents are uninsured, or about 9.8 percent.
WHERE THE STATE STANDS: Minnesota has embraced the health care overhaul more than many states. Democratic Gov. Mark Dayton used a provision in the federal law to extend Medicaid coverage to more than 80,000 vulnerable adults as soon as he took office in 2011. His administration has focused on developing an online health insurance exchange envisioned as a key part of the law, securing $28.4 million from the federal government for Minnesota's planning efforts.
NUMBER OF UNINSURED: 618,000 state residents are uninsured, or about 21 percent.
WHERE THE STATE STANDS: Mississippi Insurance Commissioner Mike Chaney, a Republican, has been working on a health care exchange and has accepted federal money for the project. The exchange originally was proposed by Republican Haley Barbour when he was governor.
NUMBER OF UNINSURED: 835,000 state residents are uninsured, or about 14 percent.
WHERE THE STATE STANDS: Missouri received an initial planning grant but has not implemented a health insurance exchange because of opposition to it by some Republican state senators.
NUMBER OF UNINSURED: 176,000 state residents are uninsured, or about 18.1 percent.
WHERE THE STATE STANDS: Republican lawmakers in Montana who controlled the Legislature rejected any efforts to establish a health insurance exchange.
NUMBER OF UNINSURED: 237,000 Nebraska residents are uninsured, about 13 percent of the population.
WHERE THE STATE STANDS: The state does not have a law establishing a health insurance exchange. However, Republican Gov. Dave Heineman has instructed the state Department of Insurance to plan for one in case the law is upheld.
NUMBER OF UNINSURED: 563,000, or about 21 percent.
WHERE THE STATE STANDS NOW: The Nevada Legislature in 2011 passed a bill implementing the Silver State Health Insurance Exchange and creating a seven-member board to oversee it. Republican Gov. Brian Sandoval opposed the federal health care law as a candidate. He also allowed a private attorney appointed by former Gov. Jim Gibbons to continue representing Nevada in the lawsuit filed by more than two dozen states challenging the law. State officials estimate the Affordable Care Act would cost Nevada $575 million in the first five years as more people become eligible for Medicaid.
NUMBER OF UNINSURED: 134,000 state residents are uninsured, or just more than 10 percent.
WHERE THE STATE STANDS: New Hampshire currently has laws that echo portions of the Affordable Care Act, such as allowing dependent unmarried residents to remain on their parent's health care insurance until age 26. Last year, state legislators passed laws that said residents cannot be required to obtain health insurance or be fined for not being covered. They also established a state oversight committee that must give its OK before the federal law is implemented. Democratic Gov. John Lynch's office said it has done some work on implementing aspects of the Affordable Care Act, but has put plans on hold until the U.S. Supreme Court makes its ruling.
NUMBER OF UNINSURED: 1.3 million, or about 15 percent.
WHERE THE STATE STANDS: The Legislature passed a law to set up a state health insurance exchange, but Republican Gov. Chris Christie vetoed the measure in May, saying he did not want to spend money on something that could be ruled unconstitutional.
NUMBER OF UNINSURED: 433,000, or about 21 percent.
WHERE THE STATE STANDS: New Mexico this week announced formation of a task force to develop a proposal for creating a state health insurance exchange. Republican Gov. Susana Martinez's administration is also working on an overhaul of Medicaid to try to slow the growth of the program without cutting enrollment or changing who's eligible to receive medical services. The state wants to have the revamped Medicaid program implemented in the fall of 2013.
NUMBER OF UNINSURED: 2,886,000 state residents are uninsured, or about 15 percent.
WHERE THE STATE STANDS: Democratic Gov. Andrew Cuomo issued an executive order April 12 to establish a statewide health insurance exchange, where individuals and small businesses could tap up to $2.6 billion in federal tax credits and subsidies, planning to show by January that the state is ready to participate, start taking applications the following October and start operating Jan. 1, 2014.
NUMBER OF UNINSURED: 1.57 million state residents are uninsured, or about 17 percent.
WHERE THE STATE STANDS: Legislation aimed at prohibiting the mandate for individuals to buy health insurance was the first item introduced after Republicans took over control of by North Carolina's General Assembly last year. Lawmakers haven't been able to overcome Democratic Gov. Beverly Perdue's veto of their bill. But work to design health care exchanges has stalled since last summer.
NUMBER OF UNINSURED: 83,000 North Dakota residents, or about 13 percent, had no health insurance in 2010.
WHERE THE STATE STANDS: Legislators rejected a state-run health insurance exchange last year. Majority Republicans said it was too complex and too expensive and to do so would be tantamount to accepting the federal health care overhaul.
NUMBER OF UNINSURED: More than 1.5 million state residents are uninsured, or about 14 percent.
WHERE THE STATE STANDS: Ohio has not moved to create a health care exchange but is evaluating its options. It received a $1 million federal exchange planning grant in 2010. Republican Gov. John Kasich's administration has taken advantage of some parts of the new law to expand coordinated care and propose changes to Medicaid eligibility. Democrats have unsuccessfully pushed bills in the Legislature to set up a state-run exchange. But Lt. Gov. Mary Taylor, who is also Ohio's insurance director, frequently criticizes the overhaul and says it's premature to plan for an exchange without further clarification from the federal government.
NUMBER OF UNINSURED: About 624,480 Oklahomans are uninsured, or about 17 percent of the state's population.
WHERE THE STATE STANDS NOW: Oklahoma lawmakers first rejected $54 million in federal funding to create a health care exchange and then decided to take no action on developing an exchange, deciding instead to wait and see whether the law is upheld by the U.S. Supreme Court.
NUMBER OF UNINSURED: 612,000 state residents are uninsured, or about 16 percent.
WHERE THE STATE STANDS: Oregon is working aggressively to implement the health care law and is farther along than most other states. The federal government has committed more than $60 million in grants to develop a health insurance exchange that could be duplicated in other states.
NUMBER OF UNINSURED: 1.37 million state residents are uninsured, or about 11 percent.
WHERE THE STATE STANDS: Republican Gov. Tom Corbett, as state attorney general in 2010, joined a group of state officials in challenging the law. Still, Pennsylvania is working to set up a health insurance exchange required by the law, although the state Insurance Department says it is waiting for the Supreme Court's decision before it touches a $33 million grant it won in January to build out the exchange.
NUMBER OF UNINSURED: 119,000 state residents are uninsured or about 11.4 percent.
WHERE THE STATE STANDS: Rhode Island has received $58 million in federal funds to assist in the creation of its health benefits exchange. Gov. Lincoln Chafee, an independent, last week picked a former state health official to direct the exchange.
NUMBER OF UNINSURED: 930,000 state residents are uninsured, or more than 20 percent.
WHERE THE STATE STANDS: South Carolina, which is among the states that sued over the constitutionality of the federal health care law, opted not to implement health care exchanges after a panel concluded there were too many unanswered questions.
NUMBER OF UNINSURED: Federal officials estimate 105,000 state residents are uninsured, or about 13 percent; South Dakota officials say state survey data is lower, about 9 percent.
WHERE THE STATE STANDS: Republican Gov. Dennis Daugaard has delayed work on setting up a health insurance exchange until the Supreme Court's decision.
NUMBER OF UNINSURED: About 930,000 people, or 15 percent.
WHERE THE STATE STANDS: Tennessee has laid the groundwork for a health insurance exchange but would have to wait until the Legislature returns in January to complete it.
NUMBER OF UNINSURED: About 6.2 million, or about 25 percent.
WHERE THE STATE STANDS: Texas has not implemented a health care exchange. Texas has joined with other states in challenging the law in court. Gov. Rick Perry, who is vocally opposed to the law, says the state can "deliver health care more efficiently, more effectively and cheaper than the federal government can."
NUMBER OF UNINSURED: 386,000 state residents are uninsured, or nearly 14 percent.
WHERE THE STATE STANDS: Utah implemented a health insurance exchange before the federal Affordable Care Act was passed to help small businesses obtain insurance coverage for their employees. Utah is among 26 states that sued the federal government over the law. Republican Gov. Gary Herbert has criticized the individual mandate and the expansion of Medicaid rolls that administration officials say would cost the state hundreds of millions of dollars.
NUMBER OF UNINSURED: 59,000 state residents are uninsured, or about 9.5 percent.
WHERE THE STATE STANDS: Vermont in 2011 passed legislation to use the insurance exchange called for under the federal health care law as a springboard to launch a statewide, universal, publicly funded health care system by 2017.
NUMBER OF UNINSURED: Nearly 1.1 million state residents are uninsured, or about 14 percent.
WHERE THE STATE STANDS: Virginia has expressed its intent to create a health care exchange, but Republican Gov. Bob McDonnell has not acted on recommendations made by a gubernatorial advisory council. Virginia filed its own lawsuit challenging the health care law, but lost in federal appeals court.
NUMBER OF UNINSURED: 927,000 state residents are uninsured, or about 13.8 percent
WHERE THE STATE STANDS: Republican Attorney General Rob McKenna signed on to the health care lawsuit against the wishes of the state's Democratic governor and majority Democrats, but Washington state moved ahead this past legislative session with implementing its own health insurance exchange.
NUMBER OF UNINSURED: 244,000 West Virginians are uninsured, or about 13.5 percent.
WHERE THE STATE STANDS: West Virginia has enacted legislation allowing for a state-run health care exchange, but the state has slowed the pace of setting it up to see how the Supreme Court rules.
NUMBER OF UNINSURED: 526,000 state residents are uninsured, or about 9 percent.
WHERE THE STATE STANDS: Wisconsin has not begun setting up its health insurance exchange. Work on that was put on hold in January by Republican Gov. Scott Walker, who wanted to await the Supreme Court's decision.
NUMBER OF UNINSURED: 93,000 state residents are uninsured, or about 17 percent.
WHERE THE STATE STANDS: Wyoming has not implemented health care exchanges, but a steering committee is studying an exchange for Wyoming and will present a report to the Legislature this fall.
Hospital stocks jump after health care ruling
By The Associated Press
Stocks of hospital companies are moving sharply higher after initial reports said the Supreme Court upheld the individual insurance requirement in President Barack Obama's health care overhaul.
HCA Holdings stock is up 10 percent. Community Health Systems is also up 10 percent.
Stocks of drug companies and medical device makers are slightly lower for the day as analysts sort through the Supreme Court's ruling. Stocks of the biggest insurance companies are also lower.