The Supreme Court's health care decision gave a boost to President Barack Obama and Maryland Democrats on Thursday but left the political landscape unsettled as Republicans doubled down on threats to undo the landmark law, either in Congress or by way of the election in November.
The 5-4 decision to uphold most of the law was a resounding victory for Obama, who made the Affordable Care Act a centerpiece of his first term, but it also meant that a full-throated debate on the controversial law will likely continue in coming months, even as Obama and Republican Mitt Romney try to focus on the economy.
Initial reactions from both parties indicated that the justices had reset the contours of a major campaign issue — and that a more nuanced and complicated political dynamic may now be coming into play. Less clear, though, was whether the ruling would move many voters Obama's way.
"It should be pretty clear by now that I didn't do this because it was good politics," Obama said Thursday during a White House address after the ruling was handed down. "I did it because I believed it was good for the country. I did it because I believed it was good for the American people."
Romney, who adopted a similar law as governor of Massachusetts, cast the issue in terms of the economy and signaled he would stay on the attack despite the apparent setback. Republicans coalesced around a message that equated the law's implementation with a series of tax increases — and renewed calls to repeal it.
"What the court did today was say that Obamacare does not violate the Constitution," Romney said in the shadow of the Capitol on Thursday. "What they did not do was say that Obamacare is good law or that it's good policy."
The decision also gave a lift to Maryland Democrats, particularly Gov. Martin O'Malley, who has positioned the state as a leader in implementing the law. Yet political experts said the ruling would likely have little impact on state contests this year, including the high-profile House race in Western Maryland.
Rep. Andy Harris, the lone doctor in Maryland's congressional delegation, predicted that public opinion would be no more favorable for the law just because the Supreme Court upheld its legality.
"The court didn't rule on the policy issues; they just ruled on whether this passed constitutional muster," said Harris, a Baltimore County Republican who made opposition to the health care law a pillar of his 2010 election. "I wouldn't be surprised if public opinion actually became more negative."
The ruling pushed lawmakers from both parties back into the corners they occupied during the fight over the law's passage. House Majority Leader Eric Cantor said that his chamber would take another vote to repeal the law when Congress returns to Washington after next week's July 4 recess. But past repeal efforts by the Republican-led House have been blocked by the Democratic majority in the Senate.
Democrats, including Obama, said the ruling should put an end to attempts to relitigate the fight over health care. Others pushed back on Republican attacks, arguing the GOP had offered little in the way of alternatives to the health care law.
"They're sticking to their rhetoric," said Sen. Barbara A. Mikulski, the second-highest-ranking Democrat on the Senate health committee, who led a fight to require health insurers to provide free preventative care for women. "Let them go home for the Fourth of July recess and get in touch with reality."
Though Democrats had predicted that the health care law would become more popular with time, most polls show that has not happened. A Kaiser Family Foundation survey in May found that 44 percent of Americans had an unfavorable view of the law, compared with 37 percent of respondents who said they support it. That said, the bulk of the law's provisions don't take effect until 2014.
Most Americans have told pollsters that the health care issue will be very important in deciding who they'll vote for in November. But when asked in a recent Gallup poll what they considered the most important issue facing the country, only 6 percent mentioned health care, while more than half mentioned the economy and jobs.
Donald F. Kettl, dean of the School of Public Policy at the University of Maryland, said the decision opened some new lines of attack for Republicans, particularly on the issue of taxes. But the ruling also put Romney's campaign into a corner.
"The harder the Republicans push, the more that the dust is in the air on this issue, there's that much less time to talk about the economy," Kettl said.
Both parties, meanwhile, moved quickly to use the decision to solicit political donations. Romney's campaign announced it had raised over $1 million in the hours after the ruling. Obama campaign manager Jim Messina sent an email to supporters seeking donations before the court ruled Thursday.
The potential for courting donors on the issue alone is likely to keep the rhetoric at a high pitch in coming weeks. Rep. Roscoe G. Bartlett, the Republican seeking re-election in Maryland's competitive 6th District, compared the ruling to the 1857 Dred Scott decision that found that slaves and their descendants were not U.S. citizens.
"I doubt there is a single justice today that would believe the Dred Scott decision was either moral or constitutional," Bartlett said in a statement. "I believe that future analysts will view this Supreme Court decision in the same light."
Sen. Ben Cardin, a Maryland Democrat who supported the health care law, predicted that swing voters would reject GOP proposals to repeal popular provisions of the law, including the prohibition on denying individuals health insurance because of pre-existing conditions.
"It's a popular bill, and the American people know it's a popular bill," Cardin said. "What do the Republicans stand for? They don't have an answer on that."
Paul West in the Tribune Washington bureau contributed to this report.