Republicans are trying to make the best of it. They say the court's upholding the healthcare law will energize their conservative base and help them win back the White House in November.
"I know there will be a lot of discussion today about the politics of all this, who won and who lost," said President Barack Obama.
In his post-ruling statement, the president acknowledged that, with fewer than 19 weeks before the election, the court decision would have widespread political implications.
"Whatever the politics, today's decision was a victory for people all over this country," Obama said.
Republican presidential candidate Mitt Romney's campaign had hoped the court would overturn the Affordable Care Act.
"What the court did not do on its last day in session, I will do on my first day if elected president of the United States," said Romney.
In fact, Romney cannot change the court's decision without help from Capitol Hill. So Republicans already plan to make the repeal of what they call "Obamacare" a major campaign theme in every congressional and Senate seat race in the country.
"We're sick of being taxed, we're sick of big government, we're sick of inefficient government, particularly here in Illinois where we're the worst of the worst," said Illinois Republican Chairman Pat Brady.
"Obamacare is going to be the issue in this election," said Rep. Joe Walsh, (R) Northwest Suburbs. "No matter what the Supreme Court decided to do, we know what we have to do with Obamacare. We need to repeal it."
Chicago Mayor Rahm Emanuel -- the former White House chief of staff when the healthcare law was conceived -- said the focus should not be on the administration's victory.
"There's another set of winners in this: That's the people actually that need it," said Emanuel.
Emanuel admitted that three years ago he advised Obama that trying to reform healthcare was filled with political danger.
"I gave him my advice," Emanuel said. "I told him many times, I said, 'The political cost of doing this'...and thank God for the rest of the country he didn't listen to me."
Democrats are hoping the decision will help the president with independent voters in so-called battleground states.
One of the ironies of the day: Conservative Chief Justice John Roberts sided with the pro-healthcare law majority. Senator Barack Obama voted against Roberts' confirmation back in 2005.