Early Thursday morning, the U.S. Supreme Court, on a narrow 5-4 ruling, upheld most of the Affordable Care Act, with the exception of a part regarding Medicaid expansion. Read the entire decision here. President Obama addressed the nation just after noon Eastern Time:

Whatever the politics, today’s decision was a victory for people all over this country,” Mr. Obama said as he listed the law’s major provisions. “Thanks to today’s decicison (sic), all of these benefits and protections will continue.

Single payer advocates vow to fight on for Medicare for all. National Nurses United released a statement:

“Nurses experience the crisis our patients continue to endure every day. That’s the reason we will continue to work for reform that is universal, that doesn’t bankrupt families or leave patients in the often cruel hands of merciless insurance companies,” said NNU Co-president Karen Higgins, RN.

“Medicare is far more effective than the broken private system in controlling costs and the waste that goes to insurance paperwork and profits, and it is universally popular, even among those who bitterly opposed the Obama law,” said Higgins. “Let’s open it up to everyone, no one should have to wait to be 65 to be guaranteed healthcare.”

The Affordable Care Act still leaves some 27 million people without health coverage, does little to constrain rising out of pocket health care costs, or to stop the all too routine denials of needed medical care by insurance companies because they don’t want to pay for it.

The healthcare crisis is greater than ever, say nurses who see patients in distress every day. After all the attention on the court ruling fades, the problems will remain, said Higgins.

“We will continue to see a steady stream of employers dropping health coverage or shift more and more costs to their employees.”

Even after this decision, said Higgins, who was at the Supreme Court when the ruling was announced,

“We will continue to see patients who postpone filling prescription medications, or delay doctor-recommended diagnostic procedures or even life saving medical treatment because of the high out of pocket costs, or families faced with the terrible choice of paying for medical care or food or clothing, or who delay payment on medical bills at the risk of bankruptcy or a destroyed credit rating.”

“We will continue to see hospitals, insurance companies and drug companies engage in price gouging and insurance companies refusing to authorize treatment recommended by a doctor under the pretext it was “experimental” or “not medically necessary,” euphemisms for care that doesn’t meet the real test of a profit driven bottom line. “