In a surprising 5-4 decision, the U.S. Supreme Court ruled that the President’s signature health care reform plan can go forward, deciding that the controversial individual mandate is constitutional if it is applied as a tax rather than as part of the commerce clause.

Various news sources and attorneys are busy parsing the language of the lengthy ruling, but as of now, ObamaCare appears to have been upheld. Chief Justice John Roberts proved to be the critical vote needed to allow the mandate to survive as a tax.

“The Affordable Care Act is constitutional in part and unconstitutional in part,” Roberts wrote. “The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress’s power to tax.”

On the Medicaid expansion issue, which would force states to expand their program or face penalties, the Court allowed this to stand, but imposed restrictions.

Chief Justice John Roberts wrote: “Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”

In opening his statement in dissent, Justice Kennedy said: “In our view, the entire Act before us is invalid in its entirety.”   

It is unclear what the political ramifications of the ruling will be. The law remains intensely unpopular with the citizenry, and the fact that the mandate will now be levied as a tax – which most will see as a middle-class tax increase – puts President Barack Obama in a precarious situation. Throughout the process of crafting the bill, the president vehemently denied that the individual mandate was a tax. For instance, in this 2009 interview with ABC News’ George Stephanopolous, the president said he “absolutely rejects” the notion that the mandate is a tax.

On the other hand, foes of the law are likely to become more galvanized than ever to see get  the law repealed in Congress. This could result in a boost to GOP presidential candidate Mitt Romney, who has already promised to repeal ObamaCare on his first day in office.

Senate Republican Leader Mitch McConnell has also vowed to repeal the law. “Today’s decision makes one thing clear: Congress must act to repeal this misguided law. … Today’s decision does nothing to diminish the fact that Obamacare’s mandates, tax hikes, and Medicare cuts should be repealed and replaced with common sense reforms that lower costs and that the American people actually want.”

Those who are concerned about another controversial mandate, the HHS mandate which will force religious employers to provide insurance coverage to employees for services that violate their religious beliefs, have already vowed to fight on.

According to Hannah Smith, senior counsel with The Becket Fund for Religious Liberty, the lawsuits will “all go forward” if any part of the health care overhaul is left standing.

Smith’s group is leading the legal fight against the contraception mandate and is currently engaged in four separate federal lawsuits on behalf of four religious institutions. Earlier this year, dozens of other Catholic universities and groups filed their own set of coordinated lawsuits against the regulation. As of right now, there are 23 lawsuits pending in 14 states and the District of Columbia involving more than 50 plaintiffs.

Her group’s clients say they will opt to disobey the Obama administration rule – in turn subjecting themselves to a $2,000-per-employee fine. She estimated this could cost those groups between $300,000 and $600,000 a year starting in 2013.

The fallout from today’s ruling will continue for weeks and it is yet to be known if the unpopular law will survive until its 2014 implementation date.

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