Hundreds of people gather Thursday outside the Supreme Court building in Washington, D.C., as the court issues its decision on the Affordable Health Care Act. (Photo by Carten Cordell)

ALEXANDRIA — It was a chaotic scene Thursday morning at the U.S. Supreme Court, where it took a few moments for the hundreds of spectators to sort out that the justices had indeed upheld President Barack Obama’s signature piece of legislation, the Patient Protection and Affordable Care Act.

Tea party members cheered at first, when it appeared that the individual mandate was struck down — as CNN and a few other news outlets originally headlined. But that enthusiasm quickly turned sour as opponents of what has been come to be called Obamacare realized the court allowed the mandate to be upheld as a tax.

“It is absolutely a historic day for the 1 million Virginians who are uninsured and the 30 million Americans who are uninsured,” Virginia Delegate Patrick Hope, D-Arlington, told Watchdog.org Virginia Bureau minutes after the ruling was released.

Now that the court has ruled, Hope said it’s time Virginia follows through with the law’s provisions. Hope said he’s calling on Gov. Bob McDonnell to call the General Assembly back into session this year to get Virginia the legal authority to put in place a health insurance exchange.

McDonnell didn’t mince words about the decision.

“Today’s Supreme Court ruling is extremely disappointing for Virginia and for America,” he said in a statement. “The PPACA will create a costly and cumbersome system that will impair our country’s ability to recover from these challenging economic times, infringes on our citizen’s liberties, will harm small businesses, and will impose dramatic unfunded mandates on Virginia and all states. Simply put, this is a blow to freedom.”

Also untouched by the justices is the Medicaid expansion rolled into the Affordable Care Act, which is what some analysts say is biggest burden.

The Heritage Foundation, a think tank that promotes limited government and free enterprise, estimated the Virginia tab for Medicaid expansion alone to be $754 million.

That equates to roughly $94.25 for every man, woman and child in the Commonwealth.

“This will have a significant and unavoidable impact on the bottom line of our state budget, and the general fiscal welfare of Virginia,” Gov. Bob McDonnell said at the passage of the Affordable Care Act. “We simply cannot afford this expansion.”

The federal government will bear the costs for “100 percent” of the enrollment increase, at least, for now, said Craig Markva, spokesman at the Virginia Department of Medical Services, which oversees the state-and-federally run program. But that burden increasingly will fall upon the state of Virginia. The fed’s share will decrease to 90 percent in 2020 and thereafter.

Virginia’s Medicaid eligibility under the law jumps from roughly 950,000 to roughly 1.4 million, according to Markva. The jump is so enormous because eligibility no longer rides on disabilities and resources, but on income alone. With the Affordable Care Act, those under 65 earning up to 133 percent of the federal poverty level — or more than $30,600 for a family of four in 2012 — are automatically eligible.

New taxes 

The worst — at least, as far as taxes go — is yet to come, said Pete Sepp, executive vice president at the National Taxpayers Union. The worst taxes won’t go into effect until 2013, a clever move on lawmakers’ part. That’s when the threshold for claiming medical expenses for tax deductions jumps from 7.5 to 10 percent of income, among other forms of tax increases.

“The whole phase-in period, regardless of the election, does amount to turning up the water to boil the frog,” Sepp said.

Cuccinelli’s challenge

Virginia was the first state to leap into action against the Affordable Care Act, filing a legal challenge the same day President Obama signed it into law on March 23, 2010.

Virginia Attorney General Cuccinelli argued the federal law’s individual mandate conflicted with the Virginia Health Care Freedom Act, passed through the General Assembly during the 2010 session. The VHCFA says, “[n]o resident of this Commonwealth . . . shall be required to obtain or maintain a policy of individual insurance coverage.”

But the Fourth Circuit Court of Appeals eventually dismissed the suit on Sept. 8, 2011, explaining in its opinion that Virginia “lacks standing to challenge the individual mandate.”

Carten Cordell and Kathryn Watson can be reached by email at, carten@olddominionwatchdog.org, and katie@olddominionwatchdog.org.