In a surprise 7-2 ruling, the Supreme Court upheld the Affordable Care Act, rejecting a challenge for lack of standing.

The practical result–the continuation of the landmark legislation’s expansion of healthcare access–therefore continues unabated, a result that will be lauded by hospitals, health departments, health and human services agencies around the country.

Striking down the Affordable Care Act would have expanded the ranks of the uninsured in the United States by about 21 million people — a nearly 70 percent increase — according to recent estimates from the Urban Institute.

The biggest loss of coverage would have been among low-income adults who became eligible for Medicaid under the law after most expanded the program to include them. But millions of Americans would also have lost private insurance, including young adults whom the law allowed to stay on their parents’ plans until they turned 26 and families whose income was modest enough to qualify for subsidies that help pay their monthly premiums.

A ruling against the law would also have doomed its protections for Americans with past or current health problems — or pre-existing conditions. The protections bar insurers from denying them coverage or charging them more for it.

This is the third time the Supreme Court has upheld the ACA, and the most resounding win yet. The prior rulings were 5-4 and 6-3, respectfully.