By CHAD ABSHIRE

Staff Writer

WASHINGTON, D.C. — With yesterday’s landmark decision from the Supreme Court to uphold President Barack Obama’s health care reform law, which will affect nearly every American, many West Virginia and Kentucky state officials offered comments.

The law tells almost everyone they must have health coverage and guarantees it will be available to them even if they are already ill or need hugely expensive care. It helps the poor and many middle-class people afford coverage.

“Today, the Supreme Court confirmed what Congress knew to be true when we wrote the health reform law – that it is constitutional. Health care reform is the law of the land and, given the court’s decisive ruling, I am hopeful that we will move forward with its implementation in earnest,” Sen. Jay Rockefeller (D-W.Va.) said.

“The idea that the vast majority of Americans are satisfied with health care the way it is today simply doesn’t match what I have heard from West Virginia’s about health care over many, many years,” Rockefeller said. “West Virginians are tired of insurance companies drastically raising their premiums every single year – including a 55 percent jump in West Virginia in just seven years — without providing better care and in some cases kicking people off when they get sick and actually need medical services.

“West Virginians are tired of hearing that our state ranks among the top states for prevalence of chronic conditions like heart disease, diabetes, and cancer. And, West Virginia families who have health insurance are tired of paying thousands of dollars more in premiums each year to cover the costs of the uninsured. The status quo is not acceptable, which is why Congress passed this health reform law,” Rockefeller said.

The high court upheld almost all of the law, including the most disputed part: the mandate that virtually all Americans have health insurance or pay a fine. The court said that fine is essentially a tax, and that’s why the government has the power to impose it.

The ruling limited the law’s plan to expand the Medicaid insurance program for the poor, a joint effort of the federal government and states. It says the U.S. government cannot withhold a state’s entire Medicaid allotment if it doesn’t participate in the expansion.

Chief Justice John Roberts sided with the court’s four liberal justices — Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor — to form the 5-4 majority.

U.S. Senator and Senate Minority leader Mitch McConnell (R-Ky.), who delivered more than 110 floor speeches arguing the the constitutionality of the law, expressed displeasure in the Supreme Court’s decision.

“Today’s decision makes one thing clear: Congress must act to repeal this misguided law,” McConnel said. “Obamacare has not only limited choices and increased health care costs for American families, it has made it harder for American businesses to hire. 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. It is my hope that with new leadership in the White House and Senate, we can enact these step-by-step solutions and prevent further damage from this terrible law.”

Right now, the 2010 health care law will keep taking effect, which is expected to bring coverage to about 30 million uninsured people. Overall, more than 9 in 10 eligible Americans will be covered.

And some parts are already in effect: Young adults can stay on their parents’ insurance up to age 26. Insurers can’t deny coverage to children with health problems. Limits on how much policies will pay out to each person over a lifetime are eliminated. Hundreds of older people already are saving money through improved Medicare prescription benefits. And co-payments for preventive care for all ages have been eliminated.

“We should all recognize that the health care challenges that many West Virginians and Americans face are not going to go away unless Congress takes additional action to repair this bill,” U.S. Sen. Joe Manchin said. “Now that the Court has ruled, we can move forward with fixing what is wrong with this bill and saving what is right. I have always been determined to reduce the burden on states from the Medicaid expansion, and this ruling affirms my position – and makes clear that states must have the flexibility to live within their means by determining Medicaid eligibility as each state sees fit. I have always said one size doesn’t fit all.

“In addition, I believe there are several parts of this bill that are good for West Virginians: especially ending discrimination against people with pre-existing conditions, improving access to preventive care and eliminating the prescription drug donut hole for seniors,” Manchin said. “Looking ahead, we must work to find common ground on the individual mandate, which doesn’t make sense to West Virginians. I am determined to work with my colleagues on both sides of the aisle to move forward with a solution.”

Starting in 2014, almost everyone will be required to be insured or pay a fine. There are subsidies to help people who can’t afford coverage. Most employers will face fines if they don’t offer coverage for their workers. Newly created insurance markets will make it easier for individuals and small businesses to buy affordable coverage. And Medicaid will be expanded to cover more low-income people.

“We know what the law is but as I’ve said before, I will continue to do what is best for West Virginia,” West Virginia Gov. Earl Ray Tomblin said. “We all know health care costs continue to rise and our health care system must be more efficient. We’re going to review the Supreme Court’s ruling, and work with our federal delegation on how we move forward.”

Insurers will also be prohibited from denying coverage to people with medical problems or charging those people more. They won’t be able to charge women more, either. During the transition to 2014, a special program for people with pre-existing health problems helps these people get coverage.

An assortment of tax increases, health industry fees and Medicare cuts will help pay for the changes.

“The Supreme Court’s decision to uphold Obamacare is terrible news for working families and seniors in southern and eastern Kentucky,” U.S. Rep. Hal Rogers (R-Ky.) said. “Obamacare taxes hardworking Americans, cuts Medicare, increases health care costs, and discourages small businesses from hiring new workers. In fact, some parts of the legislation have already been abandoned as budget-busting and unaffordable. Congress has a responsibility to fully repeal Obamacare and pass common-sense legislation that actually reduces medical costs without adding to our gross national debt. I will continue to fight to repeal this misguided, job-killing law and work to ensure that families make their own decisions on health care, instead of Washington bureaucrats.”

Even with virtually every American being affected by the law, an estimated 26 million people will remain without coverage once the law is fully implemented, including illegal immigrants, people who don’t sign up and choose to face the fines instead, and those who can’t afford it even with the subsidies. That number could be higher, depending on whether any states refuse the Medicaid expansion.

“Today, the Supreme Court affirmed that, in America, patients have rights,” U.S. Rep. Nick Rahall (D-W.Va.) said. “As long as this law remains in place, no American will lose their health coverage when they need it most, or fall into bankruptcy because of a lifetime limit on their coverage, or be denied coverage because of a pre-existing condition.

“As a nation, we must address the fact that, without reform, those with insurance will continue to pay for those without it, and our seniors and working families will see their health costs skyrocket, while their benefits plummet,” Rahall said. “With this decision, it’s now time to move forward with the business of improving the law, recognizing that, in America, we value health care as a basic human right.”

When the law was before Congress, Obama and Democrats avoided calling its penalty for going uninsured a “tax.” But the administration argued before the Supreme Court that the law was constitutional as a federal tax. The court rejected two other Obama administration arguments for the law but accepted the tax one.

In 2016, after the law is fully in place, about 4 million people will pay the penalty to the Internal Revenue Service for being uninsured, the Congressional Budget Office has estimated. They would pay $695 per uninsured adult or 2.5 percent of family income, up to $12,500 per year.

The IRS can’t prosecute violators or place liens against them, however. Its only enforcement option may be withholding money from refunds.

Obama said 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.”

However, the Republican-led House already has voted for repeal but can’t push it forward so long as Obama’s in the White House and Democrats lead the Senate — making the November elections crucial.

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

“This law is not perfect – no law ever is. But, there simply is no moral justification for anyone sitting back when individuals and families throughout our state – often our own friends and neighbors – don’t have health insurance,” Rockefeller said.

“And there is no financial justification for a health care system that forces people to seek care in the emergency room because they can’t afford insurance. Uncompensated care for the uninsured adds $2,000 on average to family health insurance premiums and $760 on average to individual health premiums in West Virginia.”

The Associated Press contributed to this article.