Chief Justice of the United States Supreme Court John Roberts sided with the court's more liberal justices in a 5-4 decision Thursday that upholds the hotly debated and still controversial federal health care overhaul bill.

The law requires most Americans to buy health insurance or pay a penalty. Opponents argued that if Congress could mandate this, it could mandate that Americans buy anything. While being careful to not call it a tax while the bill was in progress, once passed, the Obama administration defended the law in federal court, saying the "penalty" was a "tax" and was within the scope of Congressional authority.

The court rejected two of the three arguments the administration made in support of the law, but agreed that the "penalty" is a "tax." Chief Justice Roberts said, "Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."

In the final decision of the court's term, President Obama won an important victory as he faces re-election in just over four months. The health care law has been seen as the major achievement of Obama's first term.

Analysis off the potential political fallout has been all over the board. Some have argued that a loss at the Supreme Court would only reinvigorate opponents of the law. Others argue that a win at the court will provide an incentive for supporters of the health care law to work even harder for President Obama's re-election.

For his part, Republican Presidential Candidate Mitt Romney has made it clear in the last few days of campaigning that if elected, he will work to repeal the law and replace it with other reforms.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Local reaction to the decision was mixed. Nebraska Sen. Ben Nelson applauded the ruling. “Today’s decision by the Supreme Court preserves new health benefits that tens of thousands of children, young adults, seniors and families in Nebraska have already received under the Affordable Care Act. Maybe this decisive action by the high court will mark a turning point in America, where people start working together because we need to fix our economy, create jobs and bring down the deficit. For the tea party types who waged a political campaign against the health reform law, the court’s decision that it is constitutional means they should stop discussing the issue and start offering their ideas and solutions. What the Supreme Court has done today is allow the nation to move forward, so let’s move forward together.”

“I respect the Supreme Court, but strongly disagree with this decision,” said Iowa Sen. Chuck Grassley. “The court has upheld the law saying that the president’s health care law is a tax on every American regardless of income, unless that American takes an action the government demands. The only way the law is constitutional is by doing what the president denied, that the penalty was a tax. The legislation was sold in Congress and to the country under false pretenses.”

The Supreme Court took up the case as the law was challenged by 26 states, including Nebraska, and could have struck down the law in its entirety or in part. Nebraska health care consumers will undergo minimal changes between now and 2014.

“We’ll continue the work that we started in 2011, preparing to help Nebraskans every way we can to navigate a new health insurance market,” said Steven S. Martin, president and chief executive officer of Blue Cross and Blue Shield of Nebraska. “We’re pleased that the Court left the door open for every person to get coverage regardless of pre-existing conditions.”

Martin said the ruling will send a strong message to state governments and federal agencies that the clock is ticking. “There are massive government systems that have to be put in place and ready to go in a little over a year. The state of Nebraska and other states have at least undergone analysis of how they will handle the coming exchange. Some states haven’t even started.”

“As a health care provider, our organization has continued to prepare for the future, working on how to effectively manage the health of our populations while the law was being reviewed,” said Richard A. Hachten II, president and CEO of Omaha-based Alegent Health.

“And while there may continue to be discussions around this topic, the Supreme Court’s ruling helps the people we serve who have not had access to insurance coverage. Alegent Health will continue our mission to make health care easier to access as we work to improve the overall health and well being of our communities."

Iowa Rep. Steve King released a statement, which said in part: “The fate of ObamaCare is not yet set. The House has voted to pass my language to repeal 100 percent of ObamaCare. Every Republican senator has voted to do the same. On the other hand, President Obama and Democrats in Congress remain as committed as ever to forcing the unconstitutional law that bears the president’s name upon an unwilling and disapproving public. The choice could not be clearer. The American people should be reminded that there is no force more powerful than their voice. After the passage of ObamaCare, the American people made their disapproval known in a powerful way. Today’s decision should renew that call and spirit. The Constitution lays out a government of limited, enumerated powers, and the size and scope of our current government, and specifically ObamaCare, are well beyond what our founding fathers ever intended. The American people will decide the fate of ObamaCare.”

Nebraska Sen. Mike Johanns agreed. "The Court today ruled the health care law is the law of the land and that's something we have to live with unless and until we repeal it, which I continue to fully support. Now we have a multi-trillion dollar bill which threatens the budgets of our federal and state governments as well as families nationwide. Even health care experts within the administration project health insurance premiums will increase at more than double the rate under the law than they otherwise would have without it. A ruling that the law is constitutional doesn't mean it is wise or that we have to keep it on the books and I will continue to press for full repeal."