Friday’s decision could also give a boost to liberal Democrats who won hotly contested races running as advocates of “Medicare for all.” Even before the court decision on Friday, liberals were promising to make health care a central issue in the next presidential election.

“Democrats need to put a bright North Star in the sky for 2020 voters showing what Democrats would do with more power, and making clear that we’re moving toward ‘Medicare for all’ as a big part of a 2020 electoral strategy,” said Adam Green, a founder of the Progressive Change Campaign Committee, an advocacy group. “It seems pretty clear that the presidential nominee, whoever it is, will support Medicare for all.”

Recent polls have found that slightly more than half of Americans approve of the Affordable Care Act, with many more, across political persuasions, wanting to keep its provisions protecting people with pre-existing health conditions. But polls have also found that many Americans are unhappy with their health care and its costs, particularly drug prices, and both parties in Congress have taken note.

Under the Affordable Care Act, many people of modest means can obtain subsidies covering all of their premiums, so the insurance is essentially free. But for those whose income is too high to qualify for subsidies, the costs remain high — a problem that the Trump administration and congressional Republicans have seized on.

Encouraging enrollment has never been a priority for Trump administration officials, and confusion caused by the court decision in Texas could further depress enrollment, which was already lagging behind last year’s numbers.

From Nov. 1 to Dec. 8, about 4.1 million people had signed up for Affordable Care Act coverage through the federal marketplace. Since Nov. 1, new enrollment in the 39 states that use the federal website is down by 20 percent compared with the same period last year.

In all, 11.8 million people in all 50 states signed up for health insurance through the law’s marketplaces for 2018. This year’s enrollment period is now ending except for in Rhode Island, where it will end Dec. 23, and in California, Colorado, Massachusetts, Minnesota, New York and the District of Columbia, where it will end in January.

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