The US Supreme Court has upheld the law which aims to provide affordable health insurance for all Americans, dismissing a legal challenge from Texas and 17 other Republican-governed states.
This is the third time since 2010 that the Affordable Care Act (ACA), the signature policy of former president Barack Obama, has survived a challenge.
It bans insurers from denying coverage due to pre-existing conditions.
The law gave millions of low-income Americans access to medical insurance.
The justices ruled by a 7-2 majority that the challengers had no legal standing to file their case, and as such did not address the question of whether a key provision in the law was unconstitutional.
The legal challenge was backed by former president Donald Trump, who promised to have the act repealed when he was elected in 2016.
Republicans tried and failed to overturn the law in Congress, when they controlled both houses, and in the courts on numerous occasions.
Earlier this month, the White House said a record 31 million Americans were now covered by healthcare under the ACA, which is popularly known as Obamacare.
Conservative groups, led by the Republican-controlled state of Texas, were essentially trying to get the entirety of the Affordable Care Act killed on a technicality. By a comfortable 7-2 vote, the justices of the Supreme Court kicked their case to the curb.
The court didn’t even bother to rule on the merits of Texas’ arguments, instead holding that the litigants lacked the standing even to bring the case.
The ruling suggests that while this court is decidedly more conservative than the one that narrowly upheld Obamacare in a highly charged 2012 decision, there’s simply nowhere near a majority of justices interested in reversing that ruling, even if they disagreed with it at the time.
This was the third case seeking to dismantle Barack Obama’s signature healthcare reform to reach the Supreme Court – and the law has been sustained by a growing majority each time.
While the conservative bent of many lower federal courts means future challenges could still get a toehold in the judicial system, it’s increasingly clear that the Supreme Court – the nation’s ultimate legal arbiter – has no interest in striking down the law.
Given that attempts to roll back the legislation in Congress have failed as well, the future of Obamacare now appears secure.
Thursday’s ruling left in place an Obamacare requirement known as the “individual mandate” – a provision instructing people to buy health insurance or face a tax penalty. But it’s no longer much of a penalty: in 2017, a Republican-led Congress set the fine to $0.
The majority opinion was written by Stephen Breyer, the most senior liberal justice on the court.
He wrote: “The matter is not simply technical… It would threaten to grant unelected judges a general authority to conduct oversight of decisions of the elected branches of Government.”
Conservative Justice Samuel Alito dissented from the majority, along with one of Mr Trump’s appointees, Neil Gorsuch.
“No one can fail to be impressed by the lengths to which this Court has been willing to go to defend the ACA against all threats,” Mr Alito wrote.
To Republicans, the ACA represents a drastic – and costly – move towards socialist healthcare. They argue it increases expense but lowers the quality of care.
It has also been unpopular among the already-insured who saw coverage costs rise when sicker individuals were added to the pool.
But the law remains well-liked by many Americans – nearly 50% viewed it favourably last year, pollsters found – and it has become increasingly intertwined with the country’s healthcare system as a whole.