One vote in June, 2012, decided the fate of President Barack Obama's crowning first-term achievement: universal health insurance. Chief Justice John Roberts of the U.S. Supreme Court cast the deciding vote to uphold the keystone of the reform: the mandate to purchase insurance. That mandate had a convoluted history. Though born in a conservative think-tank and originally adopted by Republican leaders as a necessary component of reform, it was rejected by Republicans when taken on board by the President and Democrats. Roberts' decision rested on an interpretation of the mandate as a tax.