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The United States Supreme Court voted to uphold the Affordable Care Act June 28, a decision that DeKalb legislators and experts said will serve as a milestone for many Americans.

“After decades of choosing between buying medications and putting food on the table, after decades of living in fear of bankruptcy caused by an unexpected illness, Americans are entering a new era of reliable access to quality, affordable health care,” Rep. Hank Johnson (D-GA) said.

The act, which was upheld with a 5-4 vote, was signed into law by President Barack Obama in 2012. Seen by some as controversial legislation, more than 20 states, including Georgia, filed actions in federal court challenging its constitutionality.

“President Obama and Congress took the lead and did what no other administration has been able to do—put health insurance in reach for the more than 50 million uninsured Americans and make it more affordable for everyone,” Johnson said.

State Rep. Dar’shun Kendrick (D-94) said she is delighted by the court’s ruling. Kendrick said the court could have bent to corporate and Republican pressure but didn’t. Kendrick said the vote is a “clear and final” ruling of law, which would provide security to middle class Americans.

“Insurance companies will no longer be able to arbitrarily deny coverage to sick patients when they need it most and charge women more than men,” Kendrick said. “Instead of focusing on repealing what the Supreme Court has clearly and definitely stated is constitutional, Congress should instead focus on creating jobs and on the economy. Georgia has one of the highest unemployment rates and highest foreclosure rates.”

One of the more highly debated aspects of the law was whether the federal government, under the commerce clause, could require individuals to purchase health insurance or face a penalty.

Additionally, the law calls for an expansion of the Medicaid program but the court found that the federal government cannot threaten states with the loss of all Medicaid funding if they choose not to participate.

Emory University law professor William Buzbee is director of the Emory Environmental and Natural Resources Law Program and a director of Emory’s Center on Federalism and Intersystemic Governance. Buzbee said the court voted ultimately to uphold the law but also opened the door for new constitutional arguments.

“Probably the most novel part of the decision was that four justices on the losing side came up with a new view of the commerce power of the United States,” Buzbee said.

Additionally, Buzbee said Chief Justice John Roberts, who wrote the majority opinion and was also the critical fifth “swing vote,” did something unusual and weighed in on the individual mandate as it related to the Commerce Clause.

“He drafted parts of an opinion on the losing side, saying that the individual mandate could not be justified under the commerce clause, and the four justices on the losing side agreed with him,” Buzbee said. “That opinion will influence further cases but since the law was upheld it wasn’t needed.”

David Howard, an associate professor of health policy and management at Emory’s Rollins School of Public Health, said the Affordable Care Act will allow millions of people who are uninsured to gain health insurance, but said the Medicare expansion would be costly.

“Some states, perhaps Georgia, might decide not to expand Medicaid in accordance with the affordable care act,” Howard said. “It will expand coverage but it’s not cheap.”

Howard said the two main components of the act are the expansion of the Medicare program and offering subsidies for people who are within income levels of 100-400 percent of the poverty level to purchase health insurance. He said the recent Supreme Court ruling, which ruled that the federal government couldn’t force states to expand their Medicare programs, may put some of the perceived benefits in doubt.

However, Howard said even if Georgia decides not to expand Medicare, the Affordable Care Act will still make a number of changes. The act calls for employers to provide health insurance or face a penalty and he said the individual mandate will bring healthier people into the insurance market, which will lower insurance premiums.

“Yeah it’s a huge act,” Howard said. “Health reform is going to be unfolding over a long time.”