U.S. President Barack Obama (R) and Vice President Joe Biden walk back to the Oval Office after speaking about the Supreme Court ruling to uphold the nationwide availability of tax subsidies that are crucial to the implementation of the Affordable Care Act, at the White House in Washington June 25, 2015.Jonathan Ernst/Reuters
Obamacare, the biggest achievement of Barack Obama's presidency so far, survived a potentially fatal attack when the Supreme Court decisively upheld its legitimacy on Thursday.
An exultant President Obama cheered the ruling. "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all."
Undeterred, Republican presidential hopefuls vowed to kill the controversial health-care scheme but Thursday's long-awaited ruling – the second time the Supreme Court has upheld the Affordable Care Act – likely ends legal challenges.
Obamacare, as the law is known to backers and detractors alike, now seems firmly established, having survived a presidential election, two major Supreme Court challenges and dozens of failed efforts by Republicans in Congress to gut it.
Once again, it was Chief Justice John Roberts, the conservative jurist named to the court by president George W. Bush, who wrote for the majority in a landmark decision saving the program that extends – for the first time in U.S. history –health-care insurance to almost all Americans.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Justice Roberts wrote, rejecting the legal challenge that subsidies applied only to those who purchased coverage on state-run exchanges and not the dozens of states where the federal government runs the marketplace.
But Justice Roberts, referring to the cumbersome and ambiguous language in the 900-page law, added that the act "contains more than a few examples of inartful drafting."
Still the 6-3 ruling was a huge victory for the President.
"The Affordable Care Act is here to stay," Mr. Obama said.
As the number of people covered grows and companies increasingly offer employees funds to pick their own health-care plans from state and federally-run exchanges, Obamacare may join Social Security and Medicare as part of the widely accepted net of social-entitlement programs in the United States.
But at least for the moment, it remains a political target. Republican presidential candidates vowed to attack it despite the growing political risks of targeting a scheme increasingly valuable to key constituencies.
Jeb Bush, the former Florida governor and son of and brother to former presidents, denounced the Supreme Court ruling and promised it "does not end the fight against Obamacare." "As president of the United States," he added, "I would make fixing our broken health-care system one of my top priorities."
Senator Ted Cruz of Texas, another presidential candidate, also railed against the decision. "For the second time in just a few years, a handful of unelected judges have rewritten the text of Obamacare in order to impose this failed law on millions of Americans." The Canadian-born Tea Party favourite said every "candidate for the Republican nomination should know that this decision makes the 2016 election a referendum on the full repeal of Obamacare."
More than any previous social safety-net program, Obamacare has riven the nation.
Not a single Republican voted for it in either the House of Representatives or the Senate, and Mr. Obama's reference to "bipartisan debate" overlooks the political reality that Democrats forced passage with their majorities at the time in both chambers.
On Thursday, in a celebratory appearance in the Rose Garden, Mr. Obama claimed the law is working "better than we expected," adding: "For all the misinformation campaigns, all the doomsday predictions, all the talk of death panels and job destruction, for all the repeal attempts – this law is now helping tens of millions of Americans."
Not quite.
According to the government's own figures 16.4 million Americans have gained health insurance since the Affordable Care Act became law five years ago. But crucially, in terms of political clout and the outcome of the next election, Obamacare has delivered the biggest percentage gains in coverage to Hispanics, now the largest minority in the United States. An additional 4.2 million Hispanics have coverage, although more than one-third remain without health insurance.
Another crucial voting bloc, millennials, have also benefited disproportionally, because Obamacare allows them to remain covered by their parents' health insurance until they are 26.
Those two groups will be crucial to the outcome of the 2016 presidential election with Democrats needing to hold substantial majorities among them and Republicans needing to make significant inroads – especially among Hispanics – to win.