Supreme Court Stuns Wall Street by Upholding Core Healthcare Reform Mandate. Contrary to widespread expectation, the justices ruled in a 5-4 decision that the reform measure’s “individual mandate” that forces all Americans to buy health insurance or pay a penalty fee is constitutional. Surprisingly, conservative Chief Justice John Roberts sided in favor of the liberal-oriented decision and said in his majority written opinion that the law was “a valid exercise of Congress’s power to tax.” In essence, the Supreme Court labels the mandate penalty fee as a tax. The highest court however, limited the law’s extension of the Medicaid program for the poor by ruling the federal government cannot threaten to withhold money from the states that do not fully comply. Hospital stocks are sharply higher on the news.