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In a 5-4 vote, the U.S. Supreme Court has upheld the Affordable Care Act and its mandate that individuals must buy health insurance or face penalties.

In its ruling, the court said that Congress has the power to impose the mandate as a tax, according to C-SPAN and SCOTUSblog, a blog on the Supreme Court that covered the announcement live. The ruling also said the expansion of eligibility requirements for Medicaid is constitutional, but that it would be unconstitutional for the federal government to withhold Medicaid funds for non-compliance with the provision. Chief Justice John Roberts Jr. sided with the majority to uphold the law, the Washington Post reported.

The court considered four parts: whether the individual mandate was constitutional; if not, could just that mandate be struck down; if the expansion of Medicaid was constitutional; and if a tax law prevented the court from addressing the act before it goes into effect in 2014.

The state of Maine in January 2011 joined 25 other states in a lawsuit challenging the constitutionality of the act.

Reactions:

In a statement, Steven Michaud, president of the Maine Hospital Association, said the act "presents both challenges and opportunities" for health care in Maine. Among the challenges are "significant reductions in Medicare reimbursements," which he said will reduce hospital revenues by $900 million over 10 years. The opportunities include increasing health insurance coverage and improving the health care system through payment reform. Michaud said: "MHA hopes that state leaders will work to ensure that the law is implemented in ways that fully benefit Maine citizens. The challenges posed by the ACA, such as payment reductions to Maine hospitals and the taxes on insurance products will take effect, so we must work together to make sure that the corresponding benefits to Maine citizens are fully realized."

U.S. Rep. Chellie Pingree said the court "made the right decision in preserving the basic consumer protections...like letting young people stay on their parents' policies or preventing insurance companies from cancelling your coverage when you get sick."

In a press release, the Maine Republican Party said the law needs to be repealed because it "is still hurting the economy" by increasing government spending and limiting Americans' health care choice.

The National Federation of Independent Business said the decision will result in "an onslaught of taxes and mandates" for small businesses. David Clough, director of the Maine chapter of NFIB, said, "The tragedy in this ruling is that Maine residents are now at the mercy of politicians from other states and bureaucrats in Washington whose decisions won't be based on what is best for Maine. Small businesses here will be overwhelmed by mandates, taxes and burdens imposed on them by people whom we cannot as easily hold accountable."

Maine Attorney General William Schneider said his office is reviewing the decision to determine its effect on Maine.

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