Mississippians might not want to celebrate this morning's U.S. Supreme Court ruling affirming President Barack Obama's health-care law just yet.

With Chief Justice John Roberts as the surprising swing vote, justices ruled 5-4 that the act is constitutional. However, the ruling still leaves the door open for states to opt out of expanding Medicaid coverage by not allowing the federal government to penalize states.

Warren Yoder, executive director of the Public Policy Center of Mississippi, said overall the ruling was "great but not perfect," but added the Medicaid provision could hurt the middle class—the people Obamacare was designed to take care of.

"We're not talking about poor families; they're covered. We're not talking about well-to-do families, even in a Mississippi context; they're covered. We're talking about the middle. ... It's the middle that we're worried about," Yoder said.

Still, Obama and his supporters are touting the ruling as a victory. Originally, Obama's administration had argued that the law would stand under the Constitution's commerce clause, which empowers Congress to regulate businesses.

Under the act, Obama argued, small businesses would benefit from a tax credit to help pay for insuring workers, by prohibiting insurance companies for charging more for businesses with sick workers and creating health exchanges to give small companies more bargaining power. However, the court didn't uphold the act under the commerce clause.

"It would not survive the commerce clause of the Constitution, but because the effect of not complying with the mandate is a 'tax,' then Congress does have that authority," the ruling states.

The Affordable Care Act requires people who don't have health coverage to purchase insurance on the open market or face penalties. It also prohibits insurance providers from denying coverage because a person has a preexisting condition and would cover approximately 30 million uninsured Americans.

Speaking from the White House, Obama said the law was necessary for the nation's future prosperity.

This morning's SCOTUS decision spurred an outpouring of reaction from supporters of Obama and the act as well from the law's opponents.

"The decision by the U.S. Supreme Court today does not change the fact that Obamacare raises taxes on Americans and expands the bureaucracy of our health-care system," Lt. Gov. Reeves said in an emailed statement. "Defeating Barack Obama in November is even more important to limit the intrusion of the federal government into our daily lives and fight for the full repeal of Obamacare."

Obama will face former Massachusetts Gov. Mitt Romney for the presidency in November. Under Romney's governorship, Massachusetts implemented a health-care law that served as the model for the federal Affordable Care Act. Romney used the occasion to make a case for his presidential candidacy.

"If we want to get rid of Obamacare, we're going to have to replace President Obama," said Romney, a Republican. 
Linda Darnell of Dekalb agreed with Romney, calling SCOTUS' ruling "upsetting."

"Contrary to what they said, it will cost more money. This could be what breaks the country," Darnell said, speaking at the University of Mississippi Medical Center.

Others were jubilant, heralding the decision as a win for Obama.

"If the Supreme Court upheld it, (and) they have more knowledge (about the health care), I would certainly stand with them and with my president," said Albert Stokes of Utica at the medical mall.

Twenty-six states challenged ACA on the grounds that forcing states to add millions more people to the Medicaid rolls was coercive. Those states represent approximately 8.5 million people who would benefit if those states expanded eligibility by 2019.

Mississippi has already received more than $71 million in federal grants under the act for community health centers, consumer-protection programs, public health infrastructure support, health-care training, research activities, public education and to set up health-care exchanges.

Without the Medicaid expansion, Yoder believes there's a serious question whether those middle-class families will be left uninsured in Mississippi and other southern states that have been hostile to the ACA.

"We're hopeful, but at this moment, nobody really knows how this is going to work out for these middle class families that we're so worried about," Yoder said. "It has the potential to hurt working families pretty hard--it could hit them hard.