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This story was updated on June 29, 2012.

The U.S. Supreme Court decision Thursday preserving the Patient Protection and Affordable Care Act drew strong reaction — ranging from disappointment to elation — from Maryland politicians and people on the streets.

Writing for the 5-4 majority, Chief Justice John G. Roberts Jr. ruled the Affordable Care Act, also known as Obamacare, was constitutional because the mandate that individuals obtain insurance can be viewed as a tax.

“Such legislation is within Congress’s power to tax,” Roberts wrote.

The ruling was not based, as many had expected, on the Commerce Clause, which authorizes Congress to regulate interstate transactions.

Although he disagreed with the Commerce Clause component, Maryland Attorney General Douglas F. Gansler said the important point was the act was determined to be constitutional.

“If there was intellectual honesty, it would have been 9-0 [in favor] because of the Commerce Clause,” Gansler said.

In Maryland, uninsured patients have left hospitals with more than $1 billion in nonpayments, causing a drain on health care resources and the economy, Gansler said, adding that was why the Affordable Care Act fits under the Commerce Clause.

Maryland health officials applauded the court’s decision Thursday.

“The health care reform bill is not perfect — what legislation ever is? But the reform bill is already helping Marylanders and, taken to its full effect, promises better coverage and care for generations to come,” said Carmela Coyle, president and CEO of the Maryland Hospital Association, a professional organization that represents the state’s hospitals.

On Capitol Hill

U.S. Sen. Barbara Mikulski, (D) of Baltimore, praised the decision at a Capitol Hill news conference.

“The Congress voted on health care. The Supreme Court has ruled on health care. We now know that health care is legal, constitutional, undeniable and irreversible,” a jubilant Mikulski said. “We’ve broken the stranglehold of insurance companies, where guys in pinstripes sitting in their board rooms decided who got health care.”

U.S. Rep. Andrew Harris, (R-Dist. 1) of Cockeysville disagreed.

Speaking on WAMU radio, Harris said he would work to repeal Obamacare entirely.

“Already, Obamacare is driving up costs,” Harris said.

Republican U. S. Senate candidate Dan Bongino also blasted the ruling.

"Your liberty and freedom were sold out today to a now-boundless government, free to dictate your health care choices,” he said.

The man Bongino seeks to defeat in November, U.S. Sen. Benjamin L. Cardin, (D) of Baltimore, saw the ruling differently.

Cardin called it the “best possible decision for the American people” because it would make health insurance more accessible and protect them against insurance company abuses.

Word from the street

Others praised the act for making health insurance more affordable through provisions to let states set up health insurance exchanges and available to 32 million previously uninsured Americans, as well as its provisions to prohibit insurance companies from denying those with pre-existing conditions or lifetime limits for coverage. The act also gives tax credits to small businesses that provide insurance coverage to employees.

“It’s about time we became a civilized country,” said John Huey of Bethesda, who supports the health care law, as he walked into the Bethesda Metro Station on Thursday after the decision was announced.

Hugh Shepard, of Towson, was not surprised at the decision, but was disappointed.

“All I know is that I sure hope people wake up in November and vote [President Obama] out of office,” Shepard said.

Brian Foxworth, of Hyattsville, said no one should be denied life-saving health care, although he does not approve of the individual mandate to buy insurance. He said he voted for Obama, but he questions some of his actions.

“I support Obama fully and I will vote for him again, but a lot of the stuff he does, I don’t know,” Foxworth said.

Michele Hassanyeh, of Middletown, was walking along South Market Street in downtown Frederick on Thursday morning when she learned that the Supreme Court upheld the health care law.

Minutes later she used her smartphone to tell her Facebook friends how excited she was.

“I’m super happy with the decision,” she said. “I’m lucky that I’ve always had medical coverage, but there are too many [in this country] that do not.”

Some people in Frederick’s downtown, however, said they are not sure an individual mandate is fair.

“On one side, I think I’m not sure if it’s right to make people have health care, but I also know there are a lot of people that need it,” said Kevin Colye, of Frederick.

What the doctor ordered?

Dr. Carol Paris, a St. Mary’s County psychiatrist, opposed the individual mandate requirement because she supported a national single-payer system. Paris had filed an amicus brief with 50 other doctors who were against the individual mandate.

Paris said there already is a constitutional mechanism in place for establishing universal health care — expanding taxpayer-funded Medicare to everyone from birth to death.

“We can do that by dropping two words, ‘over 65’,” she said.

The individual mandate as outlined in the Affordable Care Act “is a complete sellout to the insurance industry,” Paris added.

Others disagreed and said the act was the correct beginning for reform efforts.

“I was very pleased with the outcome,” said Dr. William Marek, who led the St. Mary’s County Health Department for 24 years. “I think there’s still going to be a lot political fighting on the side against it.”

Marek said he has problems supporting a single-payer system like expanded Medicare, which would involve “too much bureaucracy and politics... I’d rather see it stay in the private sector.”

“We’re certainly pleased that the national health care is going to go forward,” said Ella May Russell, director of St. Mary’s County Social Services and a co-founder and president of Health Share of St. Mary’s.

From the State House

Reaction from legislative leaders and the governor showed how divisive the issue remains along partisan lines.

House Republican leaders called the Supreme Court’s decision disappointing.

“But, it is important to remember the Supreme Court upheld the individual mandate as a tax — something that President Obama has repeatedly denied,” said House Minority Leader Anthony O’Donnell (R-Dist. 29C), of Lusby.

Some observers say the Republicans can use the tax recognition on the campaign trail leading up to the presidential election.

“The one bright spot in this ruling is that states cannot be forced to expand their Medicaid programs,” said House Minority Whip Jeannie Haddaway-Riccio (R-Dist. 37B), of Newcomb. “Of course, with Governor [Martin] O’Malley’s rush to be one of the first states to enact Obamacare, Maryland’s budget may not benefit from this ruling.”

O’Malley (D) hailed the decision.

“Today’s decision gives considerable momentum to our health care reform efforts here in Maryland,” he said.

Staff writers Morgan Young, Kara Rose, Jessica Ablamsky, Nicholas Gallagher and Margie Hyslop contributed to this report.