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WASHINGTON (AP/WUSA) - The individual mandate survives.

The Supreme Court has upheld the heart of President Barack Obama's health care overhaul -- ruling in favor of the requirement that most Americans can be required to have health insurance, or else pay a penalty.

READ:Health Care Ruling Opinions (PDF)

The decision means the historic overhaul will continue to take effect over the next several years, affecting the way countless Americans receive and pay for their personal medical care.

The ruling also hands President Barack Obama a campaign-season victory.

The court found problems with the law's expansion of Medicaid. But even there, it said the expansion could proceed as long as the federal government does not threaten to withhold the entire Medicaid allotment to states if they don't take part in the extension.

Ron Pollack of Families USA was overjoyed. He says thefederal governmentprovides 100% of the funding for Medicaid expansion for the first three years and that the feds contribution to the states never goes below 90% after that. He doubts many states will turn down that kind of money.

Twenty-six states sued the Department of Health and Human Services to overturn the act. Many of them have failed to set up the insurance exchanges designed to make it easier for people to get affordable health insurance. They may now have to scramble to set them up by 2014, or the feds will do it for them.

The court's four liberal justices, Stephen Bryer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome. Most legal observers had pinned Justice Anthony Kennedy as the swing vote, but he offered a blistering dissent instead and said the whole law should have been thrown out.

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