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The United States Supreme Court in Washington has rejected a challenge to the Obama-era health care law, preserving insurance coverage for millions of Americans.

The judges, by a 7-2 vote, left the entire law intact Thursday by ruling that Texas, other Republican-led states and two individuals were barred from bringing their lawsuits before a federal court.

The Biden administration claims that 31 million people have health insurance because of the law popularly known as “Obamacare.”

Key provisions of the law include protections for people with pre-existing health conditions, a range of free preventive services, and the extension of the Medicaid program that insures people with low incomes, including those in low-paying jobs or provide health insurance.

There also remains in place the now toothless requirement in the law that people have health insurance or pay a penalty. Congress made this provision moot in 2017 when it reduced the penalty to zero.

Eliminating the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the law as a whole. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should also fall.

Former President Barack Obama was responsible for the laws that made healthcare affordable for millions of Americans (Danny Lawson / PA)

But the third major attack on the law at the Supreme Court ended in the same way as the first two, with a majority of the court pushing back efforts to either gut the law or get rid of it altogether.

The three people appointed by Trump to the Supreme Court: Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh, have divided their voices. Kavanaugh and Barrett joined the majority. Gorsuch disagreed, agreeing with Judge Samuel Alito’s opinion.

Judge Stephen Breyer wrote for the court that states and those who brought federal complaints “have failed to show standing to challenge the law’s minimum essential cover provision as unconstitutional.”

Disagreeing, Alito wrote, “Today’s ruling is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, as the Affordable Care Act faces a serious threat, the court managed an unlikely rescue. “

Alito was also a dissenter in the two previous cases.

Like Alito, Judge Clarence Thomas was dissenting in the previous two cases, but joined the majority on Thursday, writing: “Although this court has been wrong twice in cases involving the Affordable Care Act, it does make no mistake today.

Because it dismissed the case for the plaintiff’s lack of legal capacity – the ability to prosecute – the court did not actually rule on whether the individual warrant is unconstitutional now that there is no penalty for waiving insurance.

The lower courts had quashed the warrant, in rulings that were overturned by the Supreme Court ruling.

With the latest decision, the ACA is “here to stay for the foreseeable future,” said Larry Levitt, executive vice president of the nonprofit Kaiser Family Foundation, which studies healthcare.

“Democrats are in the driver’s seat and they have made revitalizing and strengthening the ACA a key priority,” Levitt said. “Republicans don’t seem to have much enthusiasm to keep trying to overturn the law.”

Republicans have made their case to strike down the entire law even though Congress’ efforts to wrest the entire “root and branch” law, in the words of Republican Senate Leader Mitch McConnell, have failed.

They came closest in July 2017, when Arizona Senator John McCain, who died the following year, voted in favor against a repeal effort by fellow Republicans.

Chief Justice John Roberts said in oral argument in November that it seemed enemies of the law were asking the court to do the job best left to the political branches of government.

The court ruling preserves the benefits that are now part of the fabric of the country’s health system.

Polls show the 2010 healthcare law gained popularity as it came under the most violent onslaught. In December 2016, just before Obama left office and Trump called the ACA a “disaster,” 46% of Americans had an unfavorable opinion of the law, while 43% approved of it, according to the tracking poll. of the Kaiser Family Foundation.

Those ratings rocked and by February of this year 54% had a favorable opinion, while disapproval had fallen to 39% in the same ongoing poll.

The health care law is currently being expanded under President Joe Biden, who sees it as the basis for moving the United States to universal coverage.

Its giant Covid-19 relief bill dramatically increased subsidies for private health plans offered by ACA insurance markets, while dangling higher federal payments ahead of the dozen states that have refused the Medicaid expansion of the law.