WASHINGTON (MCT) — The Supreme Court on Thursday upheld nearly all of the Obama administration’s health care law, including its controversial requirement that compels most U.S. residents either to buy insurance or pay a fee.

In a landmark ruling that reshapes the legal, political and medical landscapes, the court said in a 5-4 decision that Congress had acted within its taxing power when it imposed the so-called individual mandate. The rest of the health care law likewise survives, save for some changes to a provision that directs states to expand Medicaid coverage.