By ROBBYN BROOKS

BNI News Service

Alabama Republican leaders are not happy.

A Supreme Court decision announced Thursday upheld President Barack Obama’s health care law that mandates everyone must have health coverage and guarantees it will be available to all Americans, even if they are already ill or need expensive care.

Alabama’s Lt. Governor Kay Ivey compared the decision to others that caused former great powers to “collapse.”

“The Supreme Court’s ruling [Thursday], upholding major portions of Obamacare, perpetuates the illusion that taxpayers can and should provide healthcare for every citizen, in spite of the fact that the country is broke! If our elected leadership in Washington does not overturn this law, it will bring America down,” Ivey said.

The court’s decision means the 2010 health care law will keep taking effect. It’s expected to bring coverage to about 30 million uninsured people. The law is designed to help the poor and many middle-class people afford coverage.

The downside, Republican leaders note, is that the mandate requires virtually all Americans to have health insurance or pay a fine. The court realizes the fine as a tax and agrees with the government’s ability to impose it. There will be subsidies planned to help people who can’t afford coverage all on their own.

Most employers will face fines if they don’t offer coverage for their workers and newly created insurance markets will make it easier for individual and small businesses to buy affordable coverage.

Insurers will be prohibited from denying coverage to people with medical problems or charging those people more. And they won’t be able to charge women more, either.

Although the law will expand Medicaid to make it more available to low-income people, Thursday’s ruling did limit the law’s plan. The U.S. government won’t be able to withhold a state’s entire Medicaid allotment if it doesn’t participate in the expansion.

“If there is a silver lining to this ruling, it is that the federal government may not penalize Alabama if we cannot afford to participate in this expansion of government,” said Alabama’s Speaker of the House Mike Hubbard. “That’s important because, with our budgets already strapped for funds, the last thing we need is a mass increase in Medicaid healthcare costs.”

Obama said Thursday that the decision upholds the fundamental principle that in the wealthiest nation on Earth, no one should be ruined financially by an illness or accident. He called it “a victory for people all over this country whose lives will be more secure because of this law.”

Alabama Attorney General Luther Strange disagrees.

“Make no mistake, the consequences of today’s decision are dire,” Strange said.  “The law forces the states, private employers and individuals to be used as instruments in carrying out the federal government’s increasingly burdensome policies, including forcing religious based employers, even self-insured ones, to start providing coverage for sterilization and contraception in 2013, without regard to their religious beliefs or conscientious objections.”

Aside from the ethical and moral implications of the law, Alabama Sen. Jeff Sessions said the plan is “2,700-page Rube Goldberg contraption that will never work.”

“Independent of the constitutional issues, the healthcare law is utterly unaffordable—costing $2.6 trillion over the first full 10-year window,” Sessions said. “It is unthinkable our nation would add this new, colossal debt burden at a time when we are already borrowing forty cents out of every dollar we spend.”

Tax increases, health industry fees and Medicare cuts are expected to help pay for the changes implemented by the law.

Even with the law fully implemented by 2016, an estimated 26 million people will remain without coverage. That number includes illegal immigrants, people who don’t sign up and choose to instead face fines, and those who can’t even afford insurance with subsidies. The Congressional Budget Offices estimated about 4 million people will pay the penalty for being uninsured to the Internal Revenue Service.

The IRS won’t be able to prosecute violators, or place liens against them, according to the law. Its only enforcement option may be withholding money from refunds.

On the political front, the Supreme Court’s decision only increases controversy around the most polarizing issue of Obama’s re-election campaign. Republican Mitt Romney has promised to repeal the law if Republicans are in power after the November election.

“Obamacare was a bad law yesterday. It’s bad law today,” Romney said after the ruling.

Some parts of the law are already in place. Young adults can stay on their parents’ insurance until they are 26. Insurers can’t deny coverage to children with health problems and co-payments for preventive care for all ages have been eliminated.

On Thursday, Sessions called for the law to be repealed. Even if that were to happen before the November elections, Hubbard said he hoped Alabamians will still voice their opinions by ballot.