The wait for the Supreme Court decision on the Affordable Care Act — what some call "Obamacare" — is over.

On Thursday, the last day of the 2011-2012 Supreme Court session, Chief Justice John Roberts said the individual mandate may be upheld as a tax under a narrow reading of the Constitution.

The decision was 5-4 with Roberts siding with the more liberal members of the court.

"The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause," Roberts wrote. "That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress's power to tax."

A circus-like atmosphere outside the court, with media and protestors milling about, awaited the decision to be handed down this morning.

"The Supreme Court says it stands," a commentator on CNN reported Thursday morning.

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The Affordable Care Act became law March 23, 2010. Virginia, along with more than a dozen other states, sued the federal government based on the argument that the "commerce clause" of the U.S. Constitution cannot be used by Congress to mandate that individuals purchase health insurance as part of the Patient Protection and Affordable Care Act.

The Affordable Care Act was designed to:

• Expand access to Medicaid
• Require most individuals to carry health insurance
• Prohibit insurers from denying health insurance coverage based on pre-existing conditions
• Create exchanges so individuals and families not eligible for government or employer-sponsored health insurance plans may purchase coverage at more affordable rates.

For a more detailed summary of the act, see the document (PDF) at right.

Uninsured in Northern Virginia and Nationwide

There are about 30 million people in the United States without health insurance. In Virginia, there are 1,039,300 uninsured, according to figures from statehealthfacts.org. Of those in Virginia, more than 10 percent — 157,300 — are children.

As of April, Fairfax County — one of the largest and wealthiest counties in the country — had 66,947 individuals participating in the Medicaid program, according to county spokesman Jeremy Lasich. According to the U.S. Census, approximately 144,000 residents or about 13.5 percent of the county population is without health insurance, he noted.

In Arlington County, about 13 percent of those ages 18 to 64 are uninsured, according to 2009 data available on CountyHealthRankings.org, which cautions on its site that "more current estimates are likely to be higher." In Alexandria City, the uninsured adult population is about 15 percent (in the same age group).

In Loudoun County, the percent of uninsured adults ages 18 to 64 is about 9 percent, according to the same website, which based its data on the U.S. Census Bureau's Small Area Health Insurance Estimates (SAHIE) program. Prince William County's rate is about 15 percent, with much higher rates in the cities of Manassas and Manassas Park. 

Health care reform is "bringing better access to care for many state residents," Jill Hanken, a staff attorney with the Virginia Poverty Law Center, said last year. 

Political Implications of the Health Care Ruling

Today's ruling will likely become a political football, pundits say, in the run-up to the presidential election just four months away.

Former Massachusetts Gov. Mitt Romney, who will face President Obama in the presidential election on Nov. 6, has called for doing away with the law. Romney appeared Wednesday in Sterling, Va., and told supporters, "We already know it's bad policy that's got to go." (See video of Romney's campaign stop in Sterling here.)

Virginia Attorney General Ken Cuccinelli, who is running for governor, is one of several state attorneys general who challenged the health care law. On a statement on his Web site, before the ruling today, Cuccinelli wrote: "I am cautiously optimistic that the Supreme Court will strike down the law and its requirement that every citizen buy government-approved health insurance.

"Congress clearly has the power to regulate commerce, but using that power to force individuals into commerce goes too far. If the federal government crosses that line, it will have unlimited power to order citizens to buy virtually anything in the name of the 'public good.' That is why I have said that Virginia’s lawsuit against the federal health care law is about liberty, not health care."

Cuccinelli debated the issue in February at the National Press Club on C-SPAN with Massachusetts Attorney General Martha Coakley. (C-SPAN's website has video of the debate between Cuccinelli and Coakley.) 

The Supreme Court's website has audio from arguments in the Supreme Court Affordable Care Act case when it was heard by the court in March.

About 56 percent of Americans say they oppose the law, according to a Reuters/Ipsos poll released over the weekend.