Washington: The law extending health care coverage to millions of Americans, the Affordable Care Act, is 2,400 pages long, but only a few points have been challenged before the US Supreme Court, including a monumental case decided Thursday.
The reforms that became known as "Obamacare" passed Congress in 2010, with many key provisions entering into force on January 1, 2014.
To date, it has been used by 16 million people to acquire coverage, with a long-term goal of 30 million insured.
Critics of the law have attacked two of its pillars, well aware that if one of them is pulled down, the entirety of Obamacare could collapse.Since 2014, every US citizen is obliged to acquire health insurance, either individually or through their employer, or be subject to fines -- set at $695 for 2016.
The only exceptions are members of certain faiths, prisoners, elderly or disabled Americans covered by Medicare, and those covered by Medicaid, the insurance program for the poor.
This most controversial element of the law was challenged by 28 states, which argued that Congress overstepped its constitutional prerogatives in requiring individuals to buy insurance.
In June 2012, the Supreme Court ruled otherwise, backing the administration that said the individual mandate was constitutional.Beginning in 2014, insurance companies were required to extend fair and affordable coverage to all applicants regardless of pre-existing health conditions.
Rate fluctuations based on medical history or gender are also now prohibited, as is the placement of dollar limits on medical benefits an insured person receives.
The pre-existing condition point has not been challenged in court, but its survival would have been in jeopardy if the individual mandate was deemed unconstitutional. Each state was expected to create a marketplace by 2014 where individuals and employers can compare insurance policies and rates and sign up for coverage.
Some part of the population, notably low-income workers and families, and small businesses could be eligible for government assistance.
Businesses with more than 50 employees who do not offer their employees coverage must pay a fine.
Sixteen states have set up the exchanges. The remaining 34 states, mostly governed by Republicans, refused.
The Department of Health and Human Services set up a federal exchange, accessible through the Web portal healthcare.gov, to accommodate people in those states.
So far, seven million Americans have signed on through the federal exchange.To help many Americans pay their premiums, Obamacare provides income-based assistance in the form of tax credits, known as subsidies.
Such assistance is available to those who sign an insurance contract through one of the exchanges that, according to the law, were "established by the state."
Those four words became the subject of the latest legal battle.
The Supreme Court ruled Thursday that everyone was entitled to the subsidies, regardless of their location or which exchange they used, and that failure to do so would have condemned the law to a "death spiral."
