In a narrow decision, on June 28 the U.S. Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act — delighting disability activists concerned that the court might overturn President Obama’s landmark piece of health-care reform legislation.

“To say that the Supreme Court’s decision is monumental for the disability community would be an enormous understatement,” said Paul Tobin, president and CEO of United Spinal Association. “It brings peace of mind to 22 million families who have loved ones living with significant disabilities and millions with chronic diseases.”

Mark Perriello, head of the American Association of People with Disabilities, also praised the court’s ruling. “Today’s decision means that millions of Americans will have access to insurance regardless of whether they have a disability. … It means more people with disabilities will be able to live full lives in our communities rather than nursing homes.”

The act was upheld in a 5-4 decision by the court, with Chief Justice John Roberts siding with the majority.

Signed into law in March 2010 over strong Republican opposition, the ACA includes a number of measures that improve access to health care for millions of Americans both with and without disabilities. Of particular interest to the disability community, by 2014 insurance providers will no longer be allowed to deny coverage or otherwise discriminate against people with pre-existing medical conditions. The act also closes the so-called “donut hole” in Medicare prescription drug benefits.

The ruling, however, does leave open questions about the ACA’s requirement that states expand Medicaid services or lose funding. The majority held that, although the federal government could penalize states by withholding new Medicaid funds provided under the act, it could not take away all existing funding under the program.

Spokespeople for ADAPT, which lobbied hard for provisions in the act that extend access to home- and community-based long-term care services, praised the ruling, but also stressed the need to make sure such services are implemented at the state level.

“This decision means that people with disabilities will have new community living options to live in their own homes,” said Chicago ADAPT activist Amber Smock. “In short, for people with disabilities, we feel the Court’s decision is historic.”

In addition to expanding the federal “Money Follows the Person” program for helping people with disabilities to move out of institutions, the ACA also creates the “Community First Choice Option,” which offers a 6 percent increase in Medicaid matching funds for states that provide community-based services as an alternate to institutionalization. Said New York ADAPT activist Bruce Darling, “We now have the tools to provide health care and eliminate the institutional bias, but it’s up to states to make that happen.”