The U.S. Supreme Court, siding with New Jersey and 15 other states, on Thursday rejected a third Republican attempt to overturn the Affordable Care Act.

Seven of the nine justices said 18 Republican-controlled states, led by Texas, did not suffer the injuries that would entitle them to go to court. The Supreme Court twice previously rejected GOP efforts to declare the law unconstitutional.

The latest lawsuit, backed by former President Donald Trump, said the entire law should be thrown out because congressional Republicans, as part of their 2017 tax law, eliminated the penalty for not having health insurance.

But the court never addressed that issue, saying instead that the GOP-led states had no standing to bring the lawsuit in the first place

“The state plaintiffs have failed to show that the challenged minimum essential coverage provision, without any prospect of penalty, will harm them by leading more individuals to enroll in these programs,” Justice Stephen Breyer said in the opinion of the court.

The court action saved 760,000 people in New Jersey from losing coverage through Medicaid and another 270,000 people who bought their own policies, most with the help of tax credits and subsidies. The decision also protects all Americans from losing protections for pre-existing conditions, and the state from losing $2.7 billion in federal funds.

“The stakes could not have been higher in this case,” said Rep. Frank Pallone Jr., D-6th Dist.

“If the Supreme Court had overturned the ACA, tens of millions of Americans would have lost their health coverage in the middle of a pandemic and up to 130 million Americans would have lost their protections for pre-existing conditions overnight,” said Pallone, chair of the House Energy and Commerce Committee with jurisdiction over the issue.

And Democratic U.S. Sen. Robert Menendez, who helped write the original bill, said that “while the fight to expand and secure quality, affordable health insurance continues, today we can proudly say that the ACA is the law of the land.

Through January, 269,560 New Jerseyans bought a health insurance policy through Get Covered New Jersey, the state-run marketplace created by the Affordable Care Act.

The state’s uninsured rate dropped to 7.9% in 2019 from 13.2% in 2013, just before the full law took effect.

“The ACA has helped millions of people obtain health insurance by enabling states like New Jersey to expand Medicaid and by providing premium subsidies for lower income individuals buying their own insurance,” said Linda J. Schwimmer, president and chief executive of the New Jersey Health Care Quality Institute, a research and consumer organization.

“Today is a good day in America and hopefully this puts an end to these frivolous attacks on a law that has helped millions.”

Gov. Phil Murphy praised the ruling in a tweet, writing, “The Affordable Care Act remains the law of the land – a win for the health and economic security of millions of Americans.”

Had the landmark health law had been overturned, Murphy and the New Jersey Legislature already had enacted laws to preserve tenets of Obamacare, such as the individual mandate that everyone must buy insurance if they are not covered at work or through a government program, said Brittany Holom-Trundy, senior health analyst for New Jersey Policy Perspective, a progressive research group.

Had the court ruled the other way, the federal subsidies making monthly premiums affordable would have been gone, as would the legal basis for requiring the plans provide a minimum level of benefits, she said.

If people still need to be convinced the ACA is needed, Holom-Trundy said, “having better quality coverage and getting people covered has helped public health enormously in New Jersey. We should all celebrate that.”

Health care was a major issue in the 2018 midterm elections, where Democrats won back control of the House and in May 2019 voted to strengthen the Affordable Care Act.

During the 2020 elections, Joe Biden was elected president on a platform to expand and strengthen the ACA, not repeal it as Trump promised to do, and Democrats won both houses of Congress. They then passed a $1.9 trillion coronavirus stimulus law with no Republican support that provided additional subsidies for Americans to buy health insurance.

Biden, who was vice president when the ACA was enacted, called the Supreme Court decision “a major victory for all Americans benefitting from this groundbreaking and life-changing law” and “a victory for more than 130 million Americans with pre-existing conditions and millions more who were in immediate danger of losing their health care in the midst of a once-in-a-century pandemic.”

After failing to repeal the ACA by just one vote in the Senate in 2017, Republicans settled for addressing the individual mandate, eliminating the penalty for not having insurance.

That led Texas and other Republican states to file a third lawsuit against the health care law. While the federal government usually defends the law, the Trump administration supported efforts to throw it out.

So a separate group of states, led by California, sought to defend the law, an effort joined by New Jersey.

“Typically, it’s the responsibility of the U.S. Department of Justice to defend federal laws like the ACA from constitutional attack,” state Attorney Gurbir Grewal said in April 2018. “But unfortunately— given everything going on in Washington these days — it’s clear that New Jersey and other like-minded states need to step up to protect the law from yet another meritless legal challenge.”

The justices concurring with the ruling included Trump nominees Brett Kavanaugh and Amy Coney Barrett. Justices Samuel Alito of New Jersey and Neil Gorsuch dissented. Justice Clarence Thomas filed a concurring opinion.

In his dissent, Alito, joined by Gorsuch, said the law should not have been allowed to survive once the individual mandate was eliminated.

“No one can fail to be impressed by the lengths to which this Court has been willing to go to defend the ACA against all threats,” Alito wrote. “A penalty is a tax. The United States is a State. And 18 States who bear costly burdens under the ACA cannot even get a foot in the door to raise a constitutional challenge.”

This story has been updated with more recent enrollment figures for Medicaid.