US healthcare reforms battle moves to supreme court US healthcare reforms - the principal challenge focuses on a legal requirement for almost every American to buy health insurance. Photograph: Jessica Rinaldi/Reuters The bitter political battle over Barack Obama's healthcare reforms moves to the supreme court on Monday as more than half of states in the US seek to get the legislation declared unconstitutional. The court will hear a challenge by attorney generals representing 26 states, who argue that the healthcare law violates the constitution and tramples on individual liberties by requiring almost all Americans to buy health insurance. Both sides have described the case as the most politically significant since the supreme court handed George Bush the presidential election over Al Gore in 2000. The outcome could shape the future of Obama's presidency in an election year. The hearings are scheduled to be the longest in recent history with nearly six hours set aside for arguments over three days.Michael Dorf, a professor and constitutional law scholar at Cornell law school, said: "I think the court recognises the extraordinary importance of the case, not so much because of the jurisprudential issues but because of the political impact. Suppose the justices agree with the plaintiffs and say that this law exceeds the power of Congress - Congress could get around that limitation and still have all of the power it has. The reason it's important is because it could strike down the signature domestic policy accomplishment of a president. In that sense, the political stakes are higher than in any case since Bush v Gore. The law, known as the Patient Protection and Affordable Care Act, but derided by its opponents as "Obamacare," was passed two years ago as a sweeping reform of the healthcare insurance industry. The reforms are intended to cover more than 50 million Americans who have been priced out of the market, and to end a slew of practices that lead to some people losing their homes to pay for their medical bills. The new law ends higher insurance rates for women and people with chronic illnesses. It also bars insurance companies from cutting off coverage when people fall ill, and any limits on the long-term cost of providing care. But the reforms have become a rallying point for large numbers of conservatives - Republicans and Democrats - who claim the changes will lead to bureaucrats replacing doctors in medical decision-making, and that the quality of health care will diminish. . The legislation is also widely unpopular among many less political Americans who have so far seen few benefits as the changes kick in over several years. Popular opposition helped galvanise the rightwing Tea Party movement, which has portrayed the reforms as an assault on American freedom. The House of Representatives, now under Republican control, has held a largely symbolic vote to repeal the legislation. Obama's Republican opponents have promised to overturn the law if elected. Political fights have flared over individual elements such as the requirement for health insurance to cover contraception. But in the supreme court, the assault on the legislation is narrower even if the outcome could lead to the collapse of the all the reforms. The principal challenge at the supreme court focuses on a legal requirement for almost every American to buy health insurance, a move designed to make provision affordable for millions by spreading the risks and costs. Randy Barnett, a lawyer for business interests that are also part of the legal action, said the legislation was unconstitutional because for the first time Congress was obliging most Americans to buy a product from the private sector with no means of opting out. "They're trying to funnel money out of people's pockets into the pocket of the private insurance companies," he said. It's a difference between a tax, which is a power the Congress has, and the power to take money from a person and direct it to a private company - which is a power they don't have. It's a constitutional power that if recognised would be a fundamentally dangerous new power [for] the government. Some critics say that if Washington can force people to buy health insurance it can oblige them to join a weight-loss programme - or buy other things. "If the government can force us to buy health insurance it can force us to buy cars to prop up Detroit, or stocks and bonds to prop up Wall Street," said Betsy McCaughey, a conservative Democrat and former lieutenant governor of New York. The Obama administration argues that the healthcare industry, which accounts for 18% of the US economy, differs because just about everyone would use a hospital or clinic at some point in their lives. A justice department brief for the supreme court argues that people who do not pay for health insurance are not opting out but shifting responsibility to those who do. It estimates that people without insurance add $1,000 to the average family's health bill by using hospitals and clinics without paying for them. The constitutional decision largely hangs on the legislative powers of Congress government under what is known as the "commerce clause" in the constitution and a 1942 ruling that the federal government had the right to regulate how much wheat farmers could grow. The legal challenges have been dismissed as politicking by some judicial conservatives. Charles Fried, solicitor general under Ronald Reagan, now a Harvard law school professor, has described the lawsuits as "grandstanding in a preposterous way," adding: "It's simply a political ploy and a pathetic one at that."