A US appeals court has dealt a new blow to the health care reform law which forms President Barack Obama's proudest domestic achievement, declaring its centrepiece provision unconstitutional.
The Eleventh Circuit appeals court, based in Atlanta, ruled overnight that the law's individual mandate, which requires everyone to own health insurance in America's mostly private system or pay a penalty, exceeded Congress's powers.
But the court ruled that the remainder of the health care law, which extended coverage to an extra 32 million people and was a long-held dream of Democrats, was within the bounds of the Constitution.
The ruling increased the likelihood that the US Supreme Court, will be called upon to rule on whether the health reform law is constitutional, possibly as soon as next year, in the heat of a presidential election campaign.
Republicans strongly oppose the law, which they dubbed "Obamacare" as an infringement on individual liberty, and have sworn to repeal it.
By a 2-1 margin, the Eleventh Circuit affirmed a ruling by a lower Florida court that the individual mandate was unconstitutional, in a case brought by 26 state governors and attorneys general, most of the Republican.
But the judges overturned another part of the Florida court's ruling that the entire health care law, passed in 2010, was unconstitutional.
"The individual mandate exceeds Congress's enumerated commerce power and is unconstitutional," wrote Chief Judge Joel Dubina.
"This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them repurchase that insurance product every month for their entire lives."
The White House said it strongly disagreed with the decision and was confident the law would ultimately be upheld as constitutional.
It also pointed out that four courts, including the Sixth Court of Appeals had endorsed the law.
"Those who claim this provision exceeds Congress's power to regulate interstate commerce are incorrect," said Stephanie Cutter, a special assistant to Mr Obama.
She argued that those who chose not to buy insurance in the US private medical system hurt everyone else, because taxpayers end up subsidising their care when they are taken to emergency rooms.
The White House also justifies the individual mandate by saying that without it, people would wait until they get sick to apply for coverage, which would cause insurance premiums for everyone to rise.
"By bringing everyone into the health insurance system, we can not only lower costs for everyone but also finally ban discrimination against individuals with pre-existing conditions," said Ms Cutter.
But the ruling cheered Republicans who see the health care law as an unacceptable intrusion by government into individual freedoms.
"Forcing Americans to buy health insurance approved by the Government was an unprecedented, unwelcome and unconstitutional expansion of federal power," said Mitch McConnell, the top Republican in the Senate.
"Today's decision only strengthens and adds more momentum to the efforts of those of us who are working to repeal it."
Rick Perry, the conservative Texas governor who is launching a presidential campaign this weekend, described the law as an "egregious violation of our constitutional rights".
"This court decision further confirms that Obamacare ignores both the Constitution's limits on the power of our federal government, and its protections of individual liberties."
Though the health care law is one of Mr Obama's most significant achievements, its controversial nature means he has reaped little gain from a victory that required a huge investment of political capital.
A CBS News poll taken in June found that 37 per cent of those asked approved of the health care law, while 48 per cent took an opposite view.
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