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."
Obama's campaign for re-election this November used the issue to hit up donors for contributions, telling them "no matter what, today is an important day to have Barack Obama's back."
Republicans, who have vowed to repeal "Obamacare" no matter what the Supreme Court decided, say it will increase costs, cause insurance premiums to rise and hurt the quality of health care. "Whatever the Supreme Court does tomorrow, one thing we know: If I'm elected president, we're going to get rid of Obamacare and replace it with real reform," Obama's Republican presidential challenger Mitt Romney said at a campaign event in Virginia on June 27.
The non-partisan Congressional Budget Office says the legislation would reduce the ballooning U.S. deficit a little over the first decade and substantially more over the second.
At the heart of the Patient Protection and Affordable Care Act, dubbed "Obamacare" by its critics, lies the individual mandate that requires every US citizen from 2014 to take out health insurance or be subject to a fine. Opponents argue that Congress overstepped its constitutional prerogatives in requiring individuals to buy insurance, while the Obama administration contends that the move was vital and in line with existing trade and tax law.
There was also the question of the law's expansion of the Medicaid health program for low-income families, a move the CBO says will cover an estimated 16 million uninsured, poor Americans. Opponents had argued that the expansion was unconstitutional as it forces states to provide coverage to this new group with an implicit threat to withhold federal Medicaid funds. As it turned out, the court decided to let the expansion stand with some limitations.
Underlining the size and scope of the decision, the nine Supreme Court justices held almost six hours of oral arguments over three days in late March, the longest time allotted to a single issue in more than 45 years.
Although the United States is the world's richest nation, it is the only industrialized democracy that does not provide health care coverage to all its citizens.
Copyright Agence France-Presse, 2012