The U.S. Supreme Court's landmark decision on Thursday to uphold President Obama's health care mandate as a tax prompted Democratic leaders in the District and Maryland, as early adopters of Mr. Obama's vision, to rejoice while Virginia's Republican governor denounced it as "a blow to freedom."
Presaged as its most significant ruling in years, the high court's opinion on the Affordable Care Act passed in 2010 will allow the District to continue its roll-out of a virtual marketplace that allows the small percentage of uninsured city residents — and those seeking a better deal — to shop for coverage.
While many states have challenged the legality of the law, the District joined Maryland, 10 other states and the Virgin Islands in urging the U.S. Supreme Court in January to uphold the law as constitutional.
"We are delighted that the Court has upheld the Affordable Care Act," said D.C. Mayor Vincent C. Gray, who is traveling in China. "While the District already leads in access to care, we will continue moving forward to ensure every District resident has access to quality, affordable health care."
Mr. Obama's marquee law has enjoyed widespread support from leaders in the city, which is dominated by Democrats.
Wayne Turnage, director of the D.C. Department of Healthcare Finance, said he is "ecstatic" because the ruling allows the city to carry on with its plans to provide healthcare without putting up a large amount of local dollars.
"I am pleasantly surprised," he said of the opinion. "That just shows the court is a lot smarter than I am."
In a joint statement, Maryland Gov. Martin O'Malley and Lt. Gov Anthony G. Brown said the high court with its ruling "chose to protect the lives of millions of Marylanders and millions of Americans."
"Today's decision gives considerable momentum to our health care reform efforts here in Maryland," the statement said.
Meanwhile, leaders south of the Potomac River had little to cheer about.
"Today's ruling is extremely disappointing for Virginia and America," Republican Gov. Bob McDonnell said, arguing it will harm small businesses during trying economic times. "America needs market-based solutions that give patients more choice, not less."
Attorney General Kenneth T. Cuccinelli, who filed his own federal court challenge to the health care law on behalf of Virginia, said the ruling marked "a dark day for American liberty."
While Virginia officials challenged the law, their counterparts in Maryland the District led the nation in its implementation.
Mr. Gray established the city's Health Reform Implementation Committee in early 2011 to ensure a "smooth and rapid" roll-out of the law. The city has been moving aggressively since then, so the District could begin enrollment in its healthcare exchange — a virtual marketplace of health insurance plans — by fall 2013.
On July 10, the D.C. Council is expected to confirm Mr. Gray's nominees for an executive board to guide the exchange.
Mr. Obama's reforms expanded the pool of Medicaid-eligible residents in the District, allowing adults without children and up to 200 percent of the poverty level to enroll under Medicaid. Before the ACA, childless adults could not be eligible for Medicaid without waiving provisions of the federal law.
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."
• David Hill and David Sherfinski contributed to this report
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