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Feelings were running high outside the Supreme Court after the decision which upheld the bulk of the Obama administration healthcare policy, with supporters of the law ecstatic while opponents vowed to continue fighting it.

“This is unprecedented. The government is taking over one-sixth of the American economy,” said Michele Bachmann, a Republican lawmaker from Minnesota and former presidential candidate.

“It is incomprehensible that this court has today decided that this law will stand,” she said.

FreedomWorks, the conservative group that supports the Tea Party movement, vowed to push for the repeal of the law through Congress.

“We are disappointed and shocked, especially about John Roberts leaning to the authoritarian side, not the libertarian side,” said Brendan Steinhauser of FreedomWorks about the decision by the chief justice to side with the court’s liberal justices.

“More than anything we realise we have to work towards a full repeal. We are going to run against this as bad healthcare policy but also as the Obama administration breaking their promise not to raise taxes on the middle class,” Mr Steinhauser said.

Others predicted the ruling would hurt Mr Obama’s re-election prospects. “This will be detrimental for the president in November,” said Mark Roepke, a Virginia man with diabetes and an artificial leg, who protested against the ruling outside the court.

“This law is extremely unpopular with the people,” he said.

But supporters of the law were overjoyed. “Already we have seen so much change since 2010,” said Reshma Ramahandran of the American Medical Student Association, adding that there had been a big increase in preventive care in particular.

“We won’t have to worry about finding insurance loopholes and access any more, we can just focus on providing care,” she said.

People had begun queueing on Wednesday to get into the public gallery of the court for the decision, and the line spread down two blocks and across an intersection.

Among those who had been protesting in the sweltering Washington weather was Jane Pauk, a 74-year-old recipient of the government backed medical instance system for the elderly, who had travelled from Phoenix, Arizona for the decision.

“The mandate just enlarges the private insurance industry. Their tremendous profits are stopping us from having a universal healthcare system,” Mrs Pauk said.

Copyright The Financial Times Limited 2017. All rights reserved.
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