The U.S. Supreme Court decision upholding most of the federal health care reform law was being turned into a rallying cry later Thursday by most Republican lawmakers from the region.

Federal GOP lawmakers pledged to continue efforts to repeal and replace the law, which most said would be too costly for the nation and for those the law aims to help. Other descriptions ranged from “health care takeover” to “dangerous socialist engineering.”

Reactions from state officials were based more on where the states are in implementing the federal requirements and their potential costs. Legislatures in Missouri, Kansas and Oklahoma have not taken steps to establish the law’s state insurance exchanges where people can shop for and buy health insurance.

Despite praise of the ruling from the White House, the responses of Missouri Gov. Jay Nixon and U.S. Sen. Claire McCaskill, both Democrats, were measured.

Nixon, in a statement, cited “significant complexities” in the ruling and said he is committed to working with all interests “to move forward in a way that works best for families in our state.”

A statement from McCaskill’s office did not refer directly to the ruling, saying, “There’s only ever been one goal for Claire — affordable, accessible health care for Missouri.”

From the other side of the aisle, Republican U.S. Sen. Roy Blunt noted that Missourians in a 2010 election “overwhelmingly rejected the individual mandate” requiring people to have health insurance.

This November, Missouri voters will decide another provision of the federal law: whether the governor should be allowed to set up an online marketplace for patients to shop for health insurance. The ballot measure, if approved, would allow a state-created insurance exchange only if it is specifically authorized by a state law or a subsequent vote of the people.

“Elections matter, and this decision underscores the fact that we need new leadership in the White House and the Senate,” Blunt said.

State Rep. Tom Flanigan, R-Carthage, said the reform plan would add about 250,000 people to the state Medicaid rolls, where costs are shared by the state and federal governments.

“We have about 900,000 residents on Medicaid right now, so that would be a huge increase, with huge costs that would have to be paid for by taking money away from other things,” said Flanigan, who is a member of the House Budget Committee and chairman of the House Appropriations Committee on Health, Mental Health and Social Services.

The high court struck down a provision that threatened states with the loss of existing federal Medicaid dollars if they refuse to expand coverage, and Missouri House Majority Leader Tim Jones, R-Eureka, said the Republican-led Legislature will not consider the expansion.

Jones, who is in line to be House speaker next year, said that if Republican Mitt Romney defeats Democratic President Barack Obama in November, he believes Romney will suspend the requirement to have health insurance exchanges in each state.

U.S. Sen. Pat Roberts, R-Kan., said the result of the high court’s decision will be to increase health care costs and reduce the access to quality care.

He said Kansas residents already have had to deal with the “problems and pitfalls of the law,” and that the court has affirmed that the program “is a new additional tax.”

“It’s now up to Congress to repeal and replace this law with common-sense, cost-cutting solutions that work for Kansas and all Americans,” he said.

U.S. Rep. Todd Akin, of Missouri, one of the Republicans seeking to challenge McCaskill in November, called the law a “dangerous piece of socialist engineering.”

“Today’s ruling does not end the need for continued opposition for this offensive overreach into the most private aspect of American’ lives,” he said. “We will redouble our campaign to de-fund and repeal all of Obamacare.”

The House will “immediately get back to work addressing the major issues that face the health care system,” predicted U.S. Rep. Lynn Jenkins, R-Kan.

“First and foremost, we must repeal Obamacare, then as a member of the House Ways and Means Committee, I am anxious to get to work on passing sound, common-sense legislative reforms that will put patients in charge,” she said.

U.S. Rep. Billy Long, R-Mo., also pledged “to fight in Congress to repeal this harmful law and replace it with patient-centered health care that addresses the rising cost of health care in this country.”

Long also pointed out that the Obama administration had said the mandate “was not a tax, yet the Supreme Court chose to ignore that fact and uphold the mandate under the taxing provision granted to Congress. The decision is not only a blow to Americans who must deal with the consequences of government takeover of health care, but also a blow to democracy and individual liberties this country was founded on.”

U.S. Sen. Jim Inhofe, R-Okla., said he expects the individual mandate — as a tax matter — will be an issue in 2015 when that portion of the law goes into effect.

“Even though President Obama said in 2009 that this is ‘absolutely not a tax increase,’ it turns out that Obama and the Democrats have levied an enormous tax increase on the middle and lower classes,” he said.

“Obamacare costs too much in the form of lost rights, lost jobs, higher taxes and increased debt. I will join with my colleagues to repeal this law and pursue sensible health care reform.”



THE ASSOCIATED PRESS contributed to this report.