It was a surprise finish with a Hollywood-like twist.
Few could have predicted that in the climactic moment of this national debate, conservative Chief U.S. Supreme Court Justice John Roberts would be the one announcing a majority decision upholding the central tenets of the health care reform law. Meanwhile, Justice Anthony Kennedy, who was expected to be the swing vote, would be announcing a dissenting opinion that essentially accused the majority of judicial activism.
But that's how history unfolded Thursday in a landmark decision upholding the central provisions of the Affordable Care Act, thus ensuring access to health care for about 30 million uninsured Americans.
Here's the crux of this 5-4 ruling: The so-called individual mandate passed constitutional muster not because it is a command but because, in the eyes of the court, it is a tax.
Roberts wrote for the majority that the requirement that Americans buy health insurance would not survive constitutional scrutiny if it were evaluated solely on government's specified authority to regulate commerce.
"The federal government does not have the power to order people to buy health insurance," Roberts wrote.
But given that the penalty for noncompliance is a fine, the court found it can be evaluated under Congress' authority to invoke a tax.
"The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax," Roberts wrote. "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."
Meanwhile, the court frowned upon part of the law that expanded Medicaid but ultimately ruled the expansion could move forward so long as the federal government did not threaten to withhold a state's entire Medicaid allotment if it chooses not to participate in the law.
Roberts was joined by Justices Sonia Sotomayor, Stephen Breyer, Ruth Bader Ginsburg and Elena Kagan in the decision.