Although the Supreme Court decided Thursday to uphold key parts of President Barack Obama’s Affordable Care Act, including extended coverage for child dependents until age 26, many around the state are questioning how Texas will go forward with a Medicaid expansion.

The Patient Protection and Affordable Care Act, a comprehensive health reform act signed into law March 2010 by President Obama, includes an individual mandate requiring individuals to purchase insurance if they are not insured by an employer or public insurance plan such as Medicare or Medicaid. The Supreme Court initially ruled the mandate to be unconstitutional under the Commerce Clause, as proposed by the Obama Administration, but voted to uphold the mandate as a tax in a 5-4 ruling last week rather than a penalty fee.

Danny Zeng, government and finance senior and communications director for UT’s College Republicans chapter, said the provision of the bill that allows child dependents to stay on their parents’ insurance until age 26 seems like a positive change but may have detrimental long term effects on younger generations.

According to the National Center for Health Statistics, approximately 2.5 million dependents nationwide gained private coverage between September 2010, when the provision was enacted, and June 2011.

“It sounds good from the surface, and as young people, it’s hard to say that we don’t like the provision,” Zeng said. “But I think we believe in the long term that the provision doesn’t really encourage us to go proactively and find a job and go out there and look for health care on our own.”

Zeng said the split vote between justices made the ruling very interesting since Chief Justice Roberts, a conservative, sided with the court’s four more liberal justices.

“I personally was really surprised with the decision because I thought Chief Justice Roberts would side more with the conservative block,” Zeng said. “I think he did that to protect his own legacy. It’s controversial and probably one of the biggest decisions he’ll get to make.”

The ruling also upheld the federal expansion of Medicaid requiring states to increase the number of eligible citizens covered with the help of additional federal funding. The states are granted the choice to implement the expansion or to instead exempt themselves from the additional funding.

Josh Havens, spokesman for the governor’s office, said Gov. Rick Perry will be working with Attorney General Greg Abbott as well as other state agencies in the coming months to determine the appropriate course of action for the expansion of Medicaid. He said Texas is continuing to find a way to stop the health care bill entirely.

“Gov. Perry will stand up and do what is right for Texas, based on the priorities of fiscal responsibility and the best interests of Texas taxpayers,” Havens said. “As the governor has previously made clear, he has no interest in fast tracking any portion of this bankrupting and overreaching legislation. We will continue to call for the full repeal of the bill.”

Another provision of the bill includes the 80/20 rule, or Medical Loss Ratio standard, which requires insurance companies to spend at least 80 percent of consumers’ insurance premium payments on medical care, leaving only 20 percent for administrative costs such as company salaries and advertising. In a statement, U.S. Health and Human Services Secretary Kathleen Sebelius said this rule will result in $1.1 billion rebates nationwide. Rebates in Texas will amount to $167 million, averaging $187 per family, according to healthcare.gov, a website managed by the U.S. Department of Health and Human Services.

Huey Fischer, government junior and president of UT’s University Democrats chapter, said adapting to the Medicaid expansion is the most fiscally responsible course of action for Texas.

“We’ve got to do what’s affordable and sustainable for the state,” Fischer said. “Right now with the legislature having cut so much the last session, those are funds we desperately need and something that Texas should definitely take advantage of. It’s the responsible thing to do.”

The Supreme Court handled the case in a respectable way, Fischer said, and their decision should be respected regardless of a person’s individual views.

“I’m grateful that the court’s outcome was the way it is,” Fischer said. “It was a very politically-charged case. It was brought forth with very politically-charged intentions by those who opposed it. I honestly feel like the justices were able to keep their politics out of it at the end, even though it was a 5-4 split.”

Gary Freeman, government professor and department chair, said despite the finality of the ruling, the end of the political battle over the Affordable Care Act is nowhere in sight.

“You could say the court upheld the constitutionality of the mandate, but they have not settled the disagreement over it at all,” Freeman said. “In a way, they have made it kind of worse. We’re in for a long and nasty fight.”

Freeman said the Affordable Care Act will have far-reaching effects for years to come and potentially be used as a gauge for the positions of future Supreme Court justices.

“I expect the issue to be heated for a long time,” Freeman said. “The next time a justice dies or resigns from office and there’s an appointment, the big issue will be whether the candidate does or does not believe Obamacare is constitutional. Similar to how abortion was a few years ago, Obamacare will be a sort of litmus test.”