It is the defining legislation of Barack Obama's presidency, a law that, once fully implemented, will provide health insurance for 30 million more Americans. But it has also been among the most divisive issues of Obama's first term in the White House.
It sparked vitriolic protests and helped mobilise what is now known as the anti-big government Tea Party movement.
"Tens of millions of other Americans will remain woefully under-insured with only partial coverage within so many gaps…that when they face a prolonged illness they can be bankrupted despite having private insurance."
- Stephanie Woolhandler, the co-founder of Physicians for a National Health Program
The health care law was challenged in the Supreme Court by 26 US states.
Opponents from the right accused the US president of trying to push through a government takeover of the health care system. Opponents on the left said the law did not go far enough to insure that all Americans have affordable access to health care.
The question for the Supreme Court was whether Congress had the right to require all Americans to obtain health insurance. The law was upheld on Thursday.
But despite the court ruling the political rancour remains. In a speech after the decision was announced, he said it was time to move beyond that and focus on implementing and improving the law.
"It should be pretty clear by now that I didn't do this because it was good politics. I did it because I believed it was good for the country. I did it because it was good for the American people… The highest court in the land has now spoken. We will continue to implement this law and we'll work together to improve on it where we can.
"Jobs created in the last couple of quarters have been in health care, so health care is jobs. It's a real opportunity for the president to link those two messages, to link the economy, jobs, health care, all in one."
- Igor Volsky, the deputy editor of ThinkProgress.org
"But what we won't do, what the country can't afford to do, is re-fight the political battles of two years ago, or go back to the way things were. With today's announcement it's time for us to move forward to implement and where necessary to improve on this law."
Many Americans are just one health care crisis away from bankruptcy. It is an issue that impacts millions.
As of 2010 the number uninsured in the US was nearly 50 million people. The health care law promises to bring coverage to 30 million people.
Inside Story US 2012 asks: So how will the Supreme Court's decision impact Americans? Will it hurt or harm Obama's chances in the upcoming election?
Joining presenter Anand Naidoo for the discussion are guests: Anne Kornblut, the deputy national political editor for the Washington Post; Stephanie Woolhandler, the co-founder of Physicians for a National Health Program; and Igor Volsky, the deputy editor of ThinkProgress.org.
"In the ruling the court was careful to say 'we're not passing judgement on whether this is good policy we're simply saying that it's constitutional'…this is a very good day for the Obama administration, there is no question about that."
Anne Kornblut, the deputy political editor at the Washington Post
KEY ASPECTS OF THE AFFORDABLE CARE ACT:
- Once it goes into effect, the Obama administration says some tens of millions of Americans currently without insurance will be covered. This will be partially due to an expansion of Medicaid, the US health programme for those with low incomes, to cover an additional 16 million uninsured Americans.
- People who do not have insurance will be required to purchase it, but most will get tax credits to help them pay for it. Larger businesses will now have to provide coverage for employees, in return for tax credits too.
- Insurers will not be able to reject people with pre-existing conditions, drop those who get sick, or impose lifetime limits on coverage. Insurers also will not be able to charge higher premiums based on gender, health or other characteristics.
- Young Americans can stay on their parents plan until the age of 26.