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The Affordable Care Act on Thursday survived a third major challenge as the Supreme Court,on a 7-to-2 vote. turned aside the latest effort by Republicans to kill the health care law.The legislation has been the subject of relentless Republican hostility.

But attempts in Congress to repeal it failed. as did two earlier Supreme Court challenges, in 2012 and 2015.

The challengers in the casc sought to take advantage of the 2012 ruling, in which Chief Justice Roberts upheld a central provision of the law.its individual_mandate requiring most Americans to obtain health insurance or pay a penalty, saying it was authorized by Congress power to levy taxes. They argued that the mandate became unconstitutional after Congress in 2017 eliminated the penalty because it could no longer be justified as a tax. They went on to say that this neant the rest of the law must fall.

In the majority opinion, Justice Breyer did not address those arguments, focusing instead on whether the plaintiffs were entitled to sue at all. "The state plaintiffs have failed to show that the challenged minimum essentialcoverage (MEC)I provision,without any prospect of penalty, will harm them by leading more individuals to enroll in thesestate-sponsored programs. "“Neither logie nor intuition suggests that the presenee of the MEC requirement would lead an individual to enroll in one

of those programs.”

In a vigorous dissent, Justice Alito wrote that the court has routinely found that states have standing to challenge federal initiatives."The states have standing for reasons that are straightforward and meritorious. The courts contrary holding is based on a fundamental distortion of our standing jurisprudence. Unlike the majority, he went on to address the larger issues in the case, saying the mandate was now unconstitutional and could not be broken off from much of the rest of the law.

Had Justice Alito's view prevailed, the nation's health care system would have experienced an carthquake. Striking down the Affordable Care Act would have expanded the ranks of the uninsured in the United States by about 21 million people. The biggest loss of coverage would have been among low-income adults who became cligible for Medicaid under the law.

But millions of Americans would also have lost private insurance, including young adults whom the law allowed to stay on their parents plans until they turned 26 and families whose income was modest enough to qualify for subsidies that help pay their monthly premiums.

Republicans suggested on Thursday that their focus would now be less on secking to repeal the law than on the debate in Congress and on the campaign trail for 2022 over how to address issues like the affordability of hcalth insurance. "While the Supreme Court ruled today that states do not have standing to challenge the mandate, the ruling does not change the fact that Obamacare is hurting hard-working American families,"three top Republicans said in a statement. “Now Congress must work together to improve American hcalth care.”