After months of fevered anticipation, the US Supreme Court yesterday upheld the core of the ambitious healthcare overhaul driven through Congress by President Barack Obama in 2010, thus ensuring that provisions to extend health insurance to nearly every American can be implemented as planned.
The five-to-four ruling is momentous vindication for Mr Obama, who against the counsel even of some Democrats dedicated most of his energies in the first months of his term to win the reforms.
The Court found that the so-called individual mandate at the heart of the reform law, which will require nearly every American to buy health insurance, does not violate the US constitution and therefore can stand.
"Today's decision was a victory for people all over this country" Mr Obama said last night, offering a shopping list of new benefits he said the law, formally called the Affordable Care Act, will offer.
The main changes include expanding the existing Medicare programme to help provide coverage to the more than 30 million people who do not have it today, preventing insurance companies from turning away people with pre-existing conditions and allowing young Americans to remain on their parents' policies until they are 26-years old.
The anger of conservatives erupted within moments of the ruling coming out as hundreds of opponents – and supporters – of the act gathered in a noisy crush on the steps of the Supreme Court.
Mr Obama's Republican challenger in the presidential election this November, Mitt Romney, instantly appropriated the issue casting himself as the last hope for conservatives who want to see the reforms killed. "This is a time of choice for the American people. If we're going to get rid of Obamacare, we're going to have to replace President Obama," he said in Washington. "My mission is to make sure we do exactly that."