The signature health care legislation signed by former President Barack Obama more than 10 years ago has been a veritable boogeyman of conservative politics. It has managed to survive despite dozens of lawsuits over its constitutionality and attempts at repeal, especially on a crucial element at the heart of this latest Supreme Court case, California v. Texas, or Texas v. U.S. in lower courts: the individual mandate. That’s the requirement for all Americans to have some kind of insurance coverage, which the law’s critics tried to use as a means to nix every part of the ACA, including protections for Americans with pre-existing medical conditions and Medicaid expansion for the nation’s poorest. That could have led to some 20 million people losing health coverage relative to current law.

Seven Supreme Court justices disagreed that the plaintiffs in the case had the legal right to claim harm from the individual mandate. The circumstance that brought American health law to this juncture are somewhat bizarre. An individual requirement to carry insurance is a historically conservative idea which was co-opted to enact the fundamental liberal principle of universal medical coverage. It was held up as constitutional in a stunning decision by Chief Justice John Roberts, a conservative-leaning Justice, as part and parcel of Congress’ taxation powers.

And then things got weirder. Former President Donald Trump set out to scuttle Obamacare while in office only to face a rebuke from a trio of Senators in his own party in dramatic fashion. Eventually, as part of the Trump administration’s 2017 tax cut law, the GOP effectively gutted the ACA’s tax penalty for not carrying insurance by reducing it to $0. That means the individual mandate essentially doesn’t matter.

But Obamacare foes went one step further in this case, asserting that the unconstitutionality of the individual mandate means the entirety of the health law should be tossed out the door. It’s a concept known as “severability,” whether or not one part of a law is so inextricably linked to others that the entire legislation collapses.

“If the Supreme Court finds that the individual mandate is unconstitutional and invalidates only that provision, the practical result will be essentially the same as the ACA exists today, without an enforceable mandate,” wrote the health care think tank Kaiser Family Foundation (KFF).

A coalition of conservative- and liberal-leaning Justices disagreed with the fundamental premise of the lawsuit given that the individual mandate has been moot for years now. “Neither the individual nor the state plaintiffs have shown that the injury they will suffer or have suffered is ‘fairly traceable’ to the ‘allegedly unlawful conduct’ of which they complain,” Breyer wrote in his majority opinion.

Were the opinion to go the other way, the consequences would have been massive, not only for the tens of millions of Americans who receive insurance in some form or another through the ACA, but those who have gained coverage under special enrollment periods during the pandemic. More than 1.2 million Americans who had lost their jobs or needed other forms of federal medical assistance signed up for coverage through Obamacare marketplaces by the end of May. The special enrollment period will continue through the middle of August.

“If the Supreme Court adopts the position that the federal government [under the Trump administration] took during the trial court proceedings and invalidates the individual mandate as well as the protections for people with pre-existing conditions, then federal funding for premium subsidies and the Medicaid expansion would stand, and it would be up to states whether to reinstate the insurance protections,” wrote KFF.

The Supreme Court has now adopted its position. And Obamacare lives yet again.