The Supreme Court on Thursday upheld all parts of the PatientProtection and Affordable Care Act.

The decision was written by Chief Justice John Roberts, whojoined the court's four liberal justices in upholding the law.

The key was support for the provisions which requires everyoneto buy insurance or pay a tax.

• 7 Things Credit Unions Need to Know About Obamacare andCompliance

“Our precedent demonstrates that Congress had the power toimpose the exaction in Section 5000A under the taxing power, andthat Section 5000A need not be read to do more than impose a tax,”Justice Roberts said in the opinion. “This is sufficient to sustainit,” Justice Roberts said.

However, industry officials and analysts caution that theultimate decision will be left to the voters.

They also caution that even if President Obama wins re-election,implementation of the health exchanges, a key component of the law,could be delayed, perhaps a year.

Beth Mantz-Steindecker and Ira Loss of Washington Analysis,said, “Despite the settlement of the constitutional question, theultimate fate of the healthcare reform law remains to be seen,which will be determined in large part by the outcome of theNovember elections.”

The decision did allow states the option to not to go along withthe expansion of the Medicaid insurance program for low-incomepeople.

George Patton, an appellate lawyer with Bose McKinney &Evans LLP, of Washington, D.C. and Indianapolis, said under thedecision, states can choose to expand Medicaid to 133%, but theyare not required to.

Congress cannot “penalizesstates that choose not to participatein that new program by taking away their existing Medicaidfunding,” Roberts said in the majority opinion.

The Medicaid provision is projected to add nearly 30 millionmore people to the insurance program for low-income Americans.

Elizabeth Festa contributed to this report.