The Supreme Court's ruling upholding the heart of the health care law left Republicans vowing to redouble their efforts at a repeal but also cleared the way for Democrats who said they can now try to correct some of the errors they acknowledge they made when they wrote the bill.
The court said the bulk of the law was constitutional and that Congress was able to require Americans to buy health insurance under its taxing powers -- but the decision did little to settle the matter for lawmakers who have been battling over the issue for three years.
House Majority Leader Eric Cantor, Virginia Republican, said he'll schedule yet another repeal vote for July 11, marking the 31st time the House will have voted for full or partial repeal, as Republicans said they're more determined than ever to do away with the law.
"The real outcome of this decision is to strengthen our resolve that this law is repealed," House Speaker John A. Boehner said.
But Democrats said that now that the court has settled the legal standoff, the White House can continue to implement the law, even as Democrats on Capitol Hill revisit it and try to correct flaws that have been in the legislation since the beginning.
"No one thinks this law is perfect," said Senate Majority Leader Harry Reid, Nevada Democrat. "But Democrats have proven we're willing to work with Republicans to improve the problems that exist in this law or any other law."
One target could be the CLASS Act, a long-term care program pushed by Sen. Edward M. Kennedy, who died in 2009, which all sides now say would be financially unsustainable.
The administration already put the provisions on hold but had rejected Republican efforts to repeal it altogether.
Overall, only a few changes to the health care law have succeeded. One repealed an onerous business tax reporting requirement, and on two other occasions Congress agreed to claw back some of the health-exchange subsidy overpayments that were built into the law.
President Obama said he's willing to adjust the law if needed as his administration keeps working to meet the key deadlines for putting it in place.
"We'll work together to improve on it where we can, but what we won't do — what the country can't afford to do — is re-fight the political battles of two years ago or go back to the way things were," he said. "With today's announcement, it's time for us to move forward, to implement and, where necessary, improve on this law."
The only part of the law that the court altered Thursday was the vast expansion of Medicaid, which is the federal-state partnership program that provides health care for the poor.
Seven justices agreed that states should be allowed to opt out of the new expansion and forgo new federal money without losing their existing Medicaid funds.
Justices Sonia Sotomayor and Ruth Bader Ginsburg were the only justices to say the federal government could cut off a state if it doesn't cooperate.
Republican attorneys general in several states that have been resistant to the Medicaid expansion applauded the ruling, pleased that they now have license to turn it down if they deem it too expensive.
Virginia Attorney General Kenneth T. Cuccinelli II, who was the first to file a lawsuit against the Affordable Care Act shortly after lawmakers passed it, said he will meet with Gov. Bob McDonnell over the next few weeks to decide whether Virginia will participate. He said opting out of the expansion of the federal-state program could save Virginia $200 million a year.
"Now we must squarely face questions like ... if we should enter this new program," Mr. Cuccinelli said. "Given the extraordinary expense to Virginia, there might be reasons for why Virginia might not go down this road."
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