The court’s nine justices voted 5-4 to kill the law’s individual mandate.

By Dustin Hurst ǀ Watchdog.org

HELENA — The court has spoken.

The U.S. Supreme Court, in a long-awaited and highly anticipated ruling, voted 5-4 to uphold the entire 2010 Patient Protection and Affordable Care Act, otherwise known as Obamacare. Chief Justice John Roberts sided with the court’s liberal wing to form a majority.

The court ruled the law’s controversial individual mandate qualifies as a tax, and Congress has the authority to levy it. Conservatives and small government types argued that the mandate is unconstitutional, maintaining that Congress cannot force Americans to purchase specific products or services.

State Sen. Jason Priest, R-Red Lodge, told Watchdog.org the ruling is disappointing, but remains optimistic about its eventual repeal. Now that the mandate qualifies as a tax, Priest says, it will only take a simple majority in the two chambers of Congress, along with presidential approval, to repeal it.

“I couldn’t have been more surprised,” Priest said. “It’s a terrible decision but you have to do what you are going to do. I can’t cry over that. I have to figure out how to fix the damn mess.”

Priest was a key opponent of implementing health reform initiatives in Montana’s 2011 legislative session and unsuccessfully carried legislation prompting the state to join with the 26 other states in the lawsuit challenging Obamamcare. His bill passed the Montana House and Senate, but Democratic Gov. Brian Schweitzer vetoed it.

Carl Graham, president of the Montana Policy Institute, which joined the suit against the law, told Watchdog.org shortly after the ruling that the decision would mean worse health care nationwide.

“The bottom line is we are going to see a massive shift in government-subsidized health care,” Graham said, adding that the law means millions more Americans on Medicaid and Medicare.

The health reform law says state-based Medicaid programs should expand to cover single adults who make up to 133 percent of federal poverty level, up from the previous 100 percent standard. The law also threatened states with loss of federal funding if that requirement wasn’t implemented. The court has apparently ruled that provision invalid.

Still, Graham says, it will be tough for state lawmakers in Montana and nationwide not to increase Medicaid eligibility. Health reform rules state that the federal government will pay nearly all the costs imposed by the new enrollees until 2019. At the point, new enrollees will be covered 30 percent by the state, with the feds paying the rest.

In all, it could add at least 70,000 new Montanans to the government-run health insurance program and cost the state more than $100 million annually once the enhanced funding drops off in 2019.

“It will be a very difficult argument to make,” Graham said of the fight against expanding Medicaid. “In the short run, it’s free money.”

The health reform law also mandates creation of state-based health exchanges, but again gives states the decision to opt out. Exchanges are online health insurance markets designed to streamline coverage purchasing.

Graham says his organization will continue to fight against Montana exchanges, meaning the federal government would step in to build the program. “It’s their law, let them do it,” Graham said.

The decision partially vindicates Democratic Attorney General Steve Bullock.

When Priest and other Republicans pushed Bullock, now running for governor, to join the suit against the health reform law, he declined, saying their challenge lacked merit. Bullock has not yet commented on the Supreme Court’s ruling.

Priest said lawmakers will spend the next legislative session figuring out how to give Montanans tax relief to help them pay for the increased costs he believes are coming through health care’s implementation. He also says Republicans plan to shift costs back to the federal government “wherever possible.”