A federal judge's ruling that the Affordable Care Act (ACA) violates the U.S. Constitution alarmed healthcare advocates Friday, but left most unconcerned that the judge would succeed in taking away health coverage from 20 million Americans—and only served to bolster the argument for a Medicare for All system that would provide every American with the kind of free healthcare that's available in other developed countries.

"This is an outrageous, disastrous decision that threatens the health care and lives of millions of people. It must be overturned. We must move forward to make health care a right for every American." —Sen. Bernie Sanders (I-Vt.)Handing down his ruling in a lawsuit filed this year by Republican governors and attorneys general, Federal District Court Judge Reed O'Connor said Friday night in Ft. Worth, Texas that the ACA's individual mandate requiring all Americans to buy insurance is unconstitutional and cannot be considered a tax, invalidating the rest of the law.

Healthcare advocates quickly addressed the concern that the attack on the ACA could harm 133 million Americans who rely on the law's rule banning insurance companies from refusing coverage based on pre-existing conditions, and the 20 million Americans who gained insurance because of the law. The ruling will likely be repealed, many wrote on social media, and Americans who need coverage through their states can still sign up through Saturday.

A Texas court just ruled that the #ACA is unconstitutional. But there are other cases pending and this ruling will be appealed. This battle is NOT over. You can still sign up for health coverage now. Saturday, December 15th is the deadline: https://t.co/UCT8iwuhw4 — Kristen Clarke 66-OUR-VOTE (@KristenClarkeJD) December 15, 2018

But the ongoing court battles over the law are likely to proceed eventually to the Supreme Court, where President Donald Trump's appointees, Justices Brett Kavanaugh and Neil Gorsuch, could rule against the law.

Sen. Bernie Sanders (I-Vt.), whose Medicare for All bill now has 15 co-sponsors in the Senate, demanded that O'Connor's ruling be overturned to protect the millions of people who rely on the ACA, and was among those who called for the country to "move forward" from battles over healthcare access—instead prioritizing the availability of government-sponsored healthcare for every American.

This is an outrageous, disastrous decision that threatens the health care and lives of millions of people. It must be overturned. We must move forward to make health care a right for every American. https://t.co/MVPVw9fQAF — Bernie Sanders (@SenSanders) December 15, 2018

This execrable ruling has been stayed pending appeal, but it's stupidity like this that makes the case for why the Democrats need to retake the Senate and the presidency in 2020 and get Single-payer Universal Medicare implemented ASAP. https://t.co/Asxw9Uglxs — David Mack (@DavidAlanMack) December 15, 2018

Republicans should be careful what they wish for. If the Supreme Court ultimately strikes down the Affordable Care Act, it will speed the day when America finally moves to Medicare for All. https://t.co/ZrcPobPB3U SCROLL TO CONTINUE WITH CONTENT Never Miss a Beat. Get our best delivered to your inbox.





— Public Citizen (@Public_Citizen) December 15, 2018

New York magazine journalist David Freedlander portrayed the attack on the ACA as a sign that Republican courts would also likely immediately try to dismantle the bolder, more progressive Medicare for All law should it be passed.

"In light of yesterday's ACA ruling, any 2020 candidate pushing Medicare for All needs to explain how they will get it past a Court willing to toss out a law passed ten years ago by large congressional majorities," Freedlander wrote Saturday.

Washington Post columnist Dave Weigel quickly responded, however, that the comparatively straightforward Medicare for All plan, in which the broadly popular Medicare program would be expanded, would involve far fewer provisions for Republicans to quibble over.

Short answer: Every legal attack on ACA has been focused on the market-based aspects. Mandate, subsidies. No court has suggested that expanding existing government programs would violate the Constitution. https://t.co/1HkpcQ1odp — Dave Weigel (@daveweigel) December 15, 2018

The Republicans' repeated attacks on the laws—including their repeal attempt which resulted in a nationwide outcry, with the disability rights group ADAPT leading hundreds of Americans in protests on Capitol Hill—may bring Democrats closer to an opportunity to push through a Medicare for All bill.

Most interesting political aspect of these ACA lawsuits IMO is the moral hazard it hands the Democrats. Their *compromise* health care bill gets calvinball'd through courts for a decade? Okay, next time they'll just use reconciliation to expand Medicare and Medicaid. — Dave Weigel (@daveweigel) December 15, 2018

At Vox.com, Ezra Klein also called the ruling a "boon" to Medicare for All, whose support among Americans has skyrocketed in the last several years, with 70 percent of those surveyed in a recent Reuters poll reporting that they approved of the proposal.

I don't think this kind of nonsense is going to kill the Affordable Care Act. But the continued assault on Obamacare is very much why Democrats are going to pass some version of Medicare-for-All next time they hold power. — Ezra Klein (@ezraklein) December 15, 2018

"Nearly a decade of constant and cynical assault on what was supposed to be a compromise bill has pushed the Democratic Party left on health care policy, and persuaded Democrats everywhere that trying to compromise or placate Republicans is foolish," wrote Klein. "The legacy of the GOP's Obamacare repeal strategy won't be the Affordable Care Act's destruction, but Medicare-for-all's construction.

"This is doubly true if Republicans somehow succeed in this case. Imagine a world where Judge O’Connor's ruling is upheld. In that world, a Republican judge cuts tens of millions of people off health insurance mere weeks after Republicans lost a midterm election for merely trying to cut those people off health insurance," he continued. "The aftermath of that would be a political massacre for the GOP, and a straightforward mandate for Democrats to rebuild the health system along the lines they prefer."