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Only about 5 percent of the city’s population is uninsured because of aggressive efforts to cover residents under Medicaid or the D.C. Healthcare Alliance, which enrolls many immigrants who are not eligible for the federal program, officials said.

“While the ruling will require in-depth study over the coming weeks and months, the court’s decision will allow the District to continue its remarkable progress to ensuring access to high quality care for its residents,” said council member David Catania, at-large independent and chairman of the Committee on Health.

In Maryland, leaders have wholeheartedly embraced the health care law since its passage and the heavily Democratic state is one of 14 that have already established health exchanges through the legislature or by an executive order.

The General Assembly passed bills in 2011 and this year that set the framework for a health benefits exchange, which state officials say could provide health care access to as many as half of the state’s 700,000 uninsured residents.

By diving into health care reform, the state has already received $34.4 million in federal grants toward getting the exchange up and running and has allotted $26.5 million in the upcoming fiscal 2013 budget to support its implementation.

Gov. Martin O’Malley, a Democrat, has said often that the state would plan to go ahead with its exchange and other health reforms regardless of the Supreme Court’s ruling, although officials acknowledged it would have been a difficult task without federal funding and the $500 million in first-year federal subsidies that the law is expected to provide for Maryland health care recipients.

Delegate Tom Hucker said Maryland’s aggressive approach will allow residents to reap the benefits of health care reform sooner, and will also make Maryland a model for other states as they try to catch up.

“This means other states are going to look to Maryland for some of the lessons on how to implement their exchange,” said Mr. Hucker, Montgomery Democrat. “It’s a terrific victory for the country. We’re going to see greater health care coverage, more competition and greater savings.”

Political fallout from the decision also resounded among the region’s leaders on Capitol Hill, where the law was born.

House Delegate Eleanor Holmes Norton, the District’s non-voting member of Congress, applauded the court for employing “the sleeper tool in the case.”

“The court today ignored the talking points on both sides and looked to the law and to the reality of the virtually unlimited taxing power of Congress that has long been used to encourage behavior, whether it is raising taxes on cigarettes to discourage smoking, or taxing individuals who choose not to obtain health insurance,” Mrs. Norton, a Democrat, said.

Her view contrasted with that of Rep. Trey Gowdy, South Carolina Republican with oversight of D.C. affairs, who deemed it “a sad day for those who believe in personal responsibility and a limited federal government.”

“The question every American should now be asking themselves is what’s next? … Can congress ‘tax’ you because you only walk on the treadmill and don’t run?” he said. “Are there any limits to the power of the federal government?”

During a forum last Thursday among business leaders, Mr. Gray took a jab at the political mixed bag that permeated the health care “firestorm.” At that time, he had no way of knowing Chief Justice John Roberts — appointed by Republican president George W. Bush — would provide the deciding vote that Democrats cheered and Republicans jeered.

“The Supreme Court would be subject to politics?” Mr. Gray quipped. “I thought it was a pure environment that they operated in.”

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