The U.S. Supreme Court, in an opinion by Chief Justice Roberts, upheld the constitutionality of the Affordable Care Act ["ACA"] (a/k/a/ “Obamacare”) by a 5 to 4 vote. The importance of this holding can be gauged by the fact that the opinions issued by the different Justices totaled 193 pages. While the majority of the Justices did not find the ACA valid under the commerce clause or the necessary and proper clause of the U.S. Constitution, a majority of the Justices did hold that the individual mandate provision and the entirety of the ACA was constitutional under the taxing authority of Congress. The only portion of the ACA found unconstitutional was the provision that would punish individual states which did not adopt the expanded coverage of Medicaid that is also provided in the ACA. This landmark decision will obviously have significant impact on this year’s elections. It will also have a substantial impact on the delivery of healthcare in the United States, especially for those individuals who are uninsured or under-insured, as well as individuals with pre-existing conditions or with catastrophic illnesses. Many of the key provisions of the ACA take effect in 2014.