The U.S. Supreme Court’s decision Thursday to uphold the Patient Protection and Affordable Care Act immediately elicited strong emotions both for and against President Barack Obama’s signature health care reform.

The court, in a 5-4 ruling, held that the law’s individual mandate provision that would require nearly all citizens to have health insurance, is constitutional.

“It’s a disappointment,” said Mary Burke-Russell, chairwoman of the St. Mary’s County Republican Central Committee. “However, we need to respect the decision of the Supreme Court no matter what it is.”

Burke-Russell said that the local committee does not make policy and tries only to support those Republicans who do, so she withheld any further comment on the court’s decision.

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

Republicans in Congress have said they will work to repeal the act, but, if they did, Obama would be expected to veto it. Mitt Romney, the GOP’s presumptive presidential nominee, has called for the law’s repeal.

Marek said that the individual mandate is a necessity for other parts of medical reform to work, and that people need to buy insurance to become part of the pool to lower costs for those who cannot afford insurance now.

Of younger people who think they do not need health insurance, Marek said, “I think they still have an obligation to contribute to the rest of the people who can’t.”

“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.

Leigh Stevenson Cobb, health policy director for the Maryland nonprofit Advocates for Children and Youth, said in a prepared statement, “This victory for health reform is a victory for all Maryland’s children and families. ... All children need access to health services in order to grow and thrive.”

The act bans denying coverage for pre-existing conditions of children currently and for adults starting in 2014. It also provides for free preventive services such as vaccinations for children.

“I just think it’s great. I think it’s wonderful and been a long time coming,” said Eugenia Santos, who was born and currently lives in Spain but is visiting family in the Washington, D.C., area, where she was raised.

Santos, who said, “I still consider myself a Yankee,” believes health care reform is one issue where the United States has lagged behind Europe.

“I and a lot of Europe think America is very forward-thinking, but this is one thing where we have to catch up with them,” she said.

In the court’s majority opinion, Chief Justice John Roberts wrote that the law was consitutional not under the Constitution’s Commerce Clause, as Obama had argued, but rather under Congress’ taxing authority.

“I’m all for it. We need and needed some type of reform,” said Jeff Thames of Waldorf, who is retired from the Prince George’s County Department of Corrections. “I think if Congress has some problem with it, they should fine-tune it through amendments.”

The court’s decision, Cobb said, “allows Maryland to continue its work in setting up the Maryland Health Benefit Exchange, a transparent health care marketplace that will allow individuals and small businesses to compare apples to apples and receive tax credits to help pay for good value health insurance coverage.”

Dr. Carol Paris had signed an amicus brief against the individual mandate portion of the act, preferring another alternative.

“I was one of the 50 doctors ... calling for the mandate to be declared unconstitutional,” she said.

The St. Mary’s County psychiatrist said that there is already 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,’” Paris said.

Paris for years has advocated for a single-payer health care plan.

She said that the individual mandate, as outlined in the Affordable Care Act, “is a complete sellout to the insurance industry.”

She said that doctors and hospitals struggle now with paying for medical care for uninsured patients, but that the way to fix that is through universal Medicare.

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

Paris was arrested in May 2009 during a protest in front of the Senate Committee on Finance during a hearing on health care legislation.

Paris said she had no quarrel with some of the other parts of the act, including allowing a person’s children to continue to be covered by his health insurance until they were 26.

“I guess you could say, ‘It’s better than nothing,’” she said.

Still, she said she now plans to close her practice in Leonardtown and move to New Zealand for six months out of the year while spending the rest of her time advocating in this country for continued health care reform.

“The practice of medicine is so compromised by our health care system,” Paris said.

St. Mary’s County Commissioner Larry Jarboe (R) said that he did not like the idea of raising taxes to cover the uninsured. The Affordable Care Act requires a penalty, which the court found to be a tax, for people who choose not to buy insurance. “The cost to small businesses will be very difficult,” he said.

He said he did not know if the region’s Amish community would be exempt from the mandatory insurance. He said the Amish currently contribute to a medical fund at their churches to cover needed medical expenses.

“They basically cover themselves through their community,” he said.

The act also expanded Medicaid, providing additional federal funds for states. The court ruled that the federal government could not withhold existing funding if a state doesn’t comply with the Medicaid expansion.

U.S. Rep. Andrew Harris (R- Md., 1st) predicted that individuals who qualify for Medicaid coverage under its expansion through the law will have the same difficulty finding doctors to treat them that persons on Medicaid do now because the Medicaid reimbursements to physicians are low. He has vowed to repeal the law.

U.S. Rep. Steny H. Hoyer (D-Md., 5th) praised the court’s decision, and said in a statement that the act “made it illegal for insurance companies to discriminate against patients on the basis of pre-existing conditions, which has already benefitted nearly 1,000 Marylanders. The Medicare Part D ‘donut hole’ is closing, saving Maryland residents over $53 million on their prescription drugs, and over 550,000 seniors on Medicare benefitted from free preventive services, like mammograms and colonoscopies last year alone.”

Maryland already has received more than $34.4 million in federal grants to help establish its health benefit exchange, which is part of about $13.7 billion in federal funds that have gone to state and local governments, according to an analysis by the Kaiser Family Foundation.

The exchanges are to create a virtual marketplace, including private insurers, where individuals and small businesses can compare and buy insurance plans.

The federal law calls for states to establish the health benefit exchanges by 2014 or participate in a federal exchange.

The Affordable Care Act already is benefiting some Marylanders, including seniors who are getting prescription drugs because of federal aid tied to the law, young adults who can continue to be insured under their parents’ health plans, and high-risk patients who otherwise would not be able to get insurance, Maryland Health Secretary Joshua Sharfstein has noted.

“I think everybody needs affordable health care, so I think it was a good decision,” said Sabrina Rose of Waldorf.

Legislation signed into Maryland law this year requires the Maryland Health Care Reform Coordinating Council to select the state’s benchmark for plans in the exchange, which must comply with state and federal laws by Sept. 30.

The new Maryland law also establishes requirements for health insurance carriers that want to participate in the exchange, and requires the establishment of “navigator” programs for small group and individual markets. The navigator programs are aimed at reaching people without health insurance and making it easy for them to determine whether they qualify for plans, and to move from one plan to another as needed.

Maryland is among 14 states and the District of Columbia that have established or are in the process of establishing exchanges.

Staff writers Margie Hyslop and Jeff Newman contributed to this report.

jyeatman@somdnews.com