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The Supreme Court on Thursday largely upheld the constitutionality of the Obama Administration’s health care law. The mandate was upheld as a tax, according to The Wall Street Journal. Congress acted within its powers under the Constitution when it required most Americans to have health insurance or pay a penalty.

The justices made some changes to the Medicaid portion of the law, the article notes.

The decision avoids disruptions for hospitals, physicians and employers, who have spent more than two years preparing for changes in the law. Twenty-six states filed suit against the law, and lower courts have issued conflicting rulings since then.

The Obama Administration has been moving ahead with implementing the law as it waited for the Supreme Court’s ruling. It has been negotiating with states to set up exchanges where consumers can purchase subsidized insurance plans, and to sign up lower-income Americans for Medicaid. Texas and Florida were among the states that refused to cooperate, because they expected the law to be overturned by the court.

The exchanges are scheduled to open in 2014, when insurers must accept all customers, regardless of their medical histories, the newspaper states. People will have to show when they file tax returns for 2014 that they had coverage during that year, or else they will have to pay a tax penalty. The penalty will increase over time, and will reach a maximum of several thousand dollars annually.

Companies with more than 50 workers will have to pay penalties starting at $2,000 per employee if they don’t offer a set level of health benefits, starting in 2014.

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