The Supreme Court today upheld in its 5-4 decision on the Affordable Care Act, the largest tax increase in U.S. history.

In the ruling, the high court decided the most controversial provision — the individual mandate requiring people to have health insurance — is valid as a tax, even though it is impermissible under the Constitution’s commerce clause.

“In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance,” Chief Justice John Roberts wrote in the majority opinion. “Such legislation is within Congress’s power to tax.”

The majority decision says that the penalty for failing to comply with the individual mandate “may reasonably be characterized as a tax”. These penalties can be over $2,000 per household. It amounts to “one of the largest middle-class tax increases in the history of the country”. This extra expense will hurt low-income workers the most.

Over the next decade, the federal government will spend over $1 trillion expanding Medicaid to include millions of new and mostly middle class patrons, at least some of whom probably already had quality health insurance before this law came into existence.

That money will have to come from somewhere, and it comes from not only fines and penalties but also higher payroll and investment taxes.

Americans were hungry for reform when the President’s health care law passed, but it is clear that this is not the solution to our problems. We need real reform that preserves the relationship between patients and doctors and doesn’t raise taxes.