The Supreme Court upheld Barack Obama's health care reforms to insure another 32 million Americans on June 28 in a major victory for the president in the heat of a tight re-election contest.
Limitations were placed on the expansion of coverage to 16 million more poor Americans, but the key payment provision on Obama's signature domestic achievement, the individual mandate, was upheld in a tight 5-4 vote.
Two years after Obama signed into law an act to insure most of the 50 million uninsured Americans and prevent coverage from being refused on the basis of patients' medical histories, its fate lay in the hands of six men and three women.
Chief Justice John Roberts, the conservative-leaning leader of the court who is often a bete noire for Democrats, was this time the key swing vote who teamed up with the more liberal members of the bench to uphold the law.
Hundreds of protesters waving American flags or toting signs in support of the law had gathered from the small hours along with banks of TV cameras outside the court's neo-classical building opposite the Congress.
Obama, who was due to speak imminently after his crowning achievement was upheld, had issued a staunch defense of his signature domestic policy achievement at a fundraiser in Miami on June 26. "I believe health reform was the right thing to do," he said. "I believe it was right to make sure that over three million young people can stay on their parent's health insurance plan.
"I believe it was right to provide more discounts for seniors on their prescription drugs. I believe it was right to make sure that everybody in this country gets decent health care and is not bankrupt when they get sick.
"That's what I believe. But it's up to you. You decide."
Justices ruled that extending health insurance to some 32 million Americans was constitutional, but imposed some limitations on extending aid to the nation's poorest.
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