FRANKFORT — FRANKFORT  —  Reaction to the ruling by the U.S. Supreme Court upholding the Affordable Healthcare Act was predictably along party lines in the state capitol, but the ruling will impact the state and its residents in very specific ways.

Chief Justice John Roberts joined the court’s four more liberal justices in voting to uphold the signature policy achievement of President Barack Obama and also wrote the majority opinion. The ruling did leave room for states to opt out of one provision in the law — an expansion of Medicaid eligibility for lower income citizens but it upheld the individual mandate, a key provision tied to some of the more popular elements of the bill such as prohibiting denial of coverage for pre-existing conditions.

Republicans in Frankfort Thursday decried the ruling, saying it will drive up taxes and medical costs while Kentucky’s Republican congressman called for repeal of the law.

“The Democrat health care law has made things worse,” said U.S. Sen. Mitch McConnell, the Republican Leader in the Senate. “Americans want it repealed and that’s precisely what we intend to do.”

U.S. Rep. Hal Rogers, R-Somerset, agreed.

“Obamacare taxes hardworking Americans, cuts Medicare, increases health care costs, and discourages small businesses from hiring new workers,” Rogers said in a prepared statement. “Congress has a responsibility to fully repeal Obamacare and pass common sense legislation.”

Kentucky’s other U.S. Senator, Rand Paul, said he will fight “every hour, every day” to elect a new president and repeal the law and questioned the validity of the court ruling.

“Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so,” Paul said in a statement issued by his press office.

Meanwhile, Democrats generally praised the ruling.

State Sen. Walter Blevins, D-Morehead, who is a dentist, agreed with the ruling.

“I didn’t think it was unconstitutional,” said Blevins who said he isn’t certain the law is sufficient to deal with the rising costs of health care and the inability of many to buy insurance.

“We need to do something on health care but at least President Obama had the guts to do something,” Blevins said.

House Speaker Greg Stumbo, D-Prestonsburg, said he disagrees with Obama on some policies, especially on coal issues, but “there are certain issues where I agree with the President, and affordable and accessible healthcare is highest on that list.”

Republican Rep. Robert DeWeese, a Louisville physician, said the law will ultimately raise taxes and hurt consumers.

“Terrible,” was DeWeese’s first reaction to news of the court ruling. “It will be the highest tax increase this country’s ever seen. I think it’s going to be bad for the practice of medicine and bad for the consumers of medicine.”

While the law has been generally unpopular, the public supports many of its component parts such as banning health insurance companies from denying coverage to those with pre-existing conditions and allowing dependents to remain on their parents’ policies until age 26.

It also establishes federally subsidized high-risk pools and requires states to establish health care exchanges where consumers can compare plans and prices.

Gov. Steve Beshear and Audrey Haynes, Secretary of the Cabinet for Health and Family Services, said Kentucky has already begun looking at how to establish the health care exchange and will now move ahead on that issue.

Beshear and Senate President David Williams, R-Burkesville, expressed concern about the Medicaid provisions. Kentucky is already struggling with Medicaid costs and has more than 700,000 enrolled in the federal-state program to cover health care for the indigent and disabled.

“We continue to review the Supreme Court’s opinion, particularly on the Medicaid portion of the Affordable Care Act to determine what our options may be,” Beshear said.

Roberts’ opinion said states may – but cannot be forced – to expand Medicaid coverage.

“Obviously, we are very concerned about resolving the Medicaid aspect of the law,” said Williams, who went on to make a political point about the law and its costs. “The Supreme Court ruling is a victory for President Obama and his cheerleader in Kentucky, Gov. Steve Beshear. By upholding the individual mandate, our employers, especially the small and medium size ones, face a huge tax increase.”

A feature which isn’t so popular and has drawn criticism from business groups requires small businesses with more than 50 fulltime workers to provide coverage to employees or face expensive fines.

But the most unpopular component is the “individual mandate,” requiring individuals who can afford insurance to buy coverage or pay a penalty tax which would be used to help pay costs of medical care. A federal income formula would determine who falls into that category. But those who cannot afford insurance will receive government subsidies to pay for insurance or qualify for Medicaid. Insurance companies demanded the mandate in exchange for dropping pre-existing conditions as a barrier to coverage.

Health advocates hailed the ruling.

“Today’s ruling is a major win for kids,” said Terry Brooks, executive director of Kentucky Youth Advocates. Because the ACA will advance the well-being and health of Kentucky’s children, it will also advance the Commonwealth’s shared prosperity today and tomorrow.”

AARP CEO Barry Rand said the organization that represents retired seniors is pleased with the ruling and said the law is already improving the health and financial security of its members.

Ronnie Ellis writes for CNHI News Service and is based in Frankfort. Reach him at rellis@cnhi.com. Follow CNHI News Service stories on Twitter at www.twitter.com/cnhifrankfort.