— Now that the U.S. Supreme Court has upheld the health care reform law’s central tenets, Indiana officials are setting about determining what it means for the state’s government.

One major decision the state will have to make: Whether to participate in the expansion of Medicaid from those at 100 percent of the poverty line to 133 percent – a move that would mean 500,000 more Hoosiers qualify for the health insurance program for the poor.

The Supreme Court’s decision gave the green light to that expansion, but said states would not face losing all of the rest of their Medicaid funding if they did not participate.

It’s a significant new amount of wiggle room for states such as Indiana, where an actuary said the Medicaid expansion could cost as much as $3.6 billion over the next decade.

Indiana Attorney General Greg Zoeller, who decided to make Indiana one of the more than two dozen states that challenged the constitutionality of the “individual mandate” requiring all Americans to purchase health insurance, said his office is now unwrapping today’s decision.

“My office’s legal advice will be provided to state agencies and federal and state policymakers so they may decide how best to address specific circumstances families face,” Zoeller said.

“Congress imposed an unprecedented mandate on individuals to buy a commercial health insurance product or face a penalty. Bringing a legal challenge was therefore the only appropriate way for the states to raise this constitutional question to the Supreme Court to decide with finality, and it was important and worthwhile for Indiana to join in this challenge.”

The decision means Indiana will also have to go ahead with setting up its own state exchange – something Gov. Mitch Daniels has been slow to do.

It also means health care reform will be a prominent issue in political races this fall – especially the U.S. Senate campaign between Democratic U.S. Rep. Joe Donnelly, who voted for the law, and Republican state Treasurer Richard Mourdock, who wants to repeal it.

“Hoosiers will be pleased to learn that many positive aspects of this law, such as lower prescription drug costs for seniors, making sure people cannot be dropped by insurance companies if they get sick, and making healthcare more affordable and accessible, remain law. Yet this law is far from perfect, and I will work with both parties to improve it and protect Medicare,” Donnelly said in a statement issued after the decision.

The Supreme Court upheld the individual mandate, but Chief Justice John Roberts wrote that it voted 5-4 to do so under Congress’ powers to tax and spend. That point is one conservatives criticizing Donnelly were quick to make.

“Joe Donnelly likes to pretend he’s not a liberal, but the fact is that Joe Donnelly voted for ObamaCare, which the Supreme Court just recognized as a massive tax increase,” said Club for Growth President Chris Chocola.

“Joe Donnelly and Obama are two peas in a pod: they both believe that big government is the answer to every problem and they want the government mandating what you purchase in the private economy. Hoosiers will reject Donnelly and Obama this November.”

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