The case, known as King v Burwell, was the second major challenge the law has faced in the US's highest court.
Unlike in many other western countries, the US does not have a single-payer healthcare system. Private companies, rather than the US government, provide health insurance for US citizens.
The enactment of the Affordable Care Act (ACA) - one of Mr Obama's most significant and controversial domestic achievements - in 2010 mandated that every American had to purchase private insurance. It provided the subsidies to allow many to do so.
In 2012, the mandate portion of the law was challenged in the court. The justices ruled to preserve it.
In that decision, as in the decision on Thursday, Chief Justice John Roberts surprised observers by siding with his liberal colleagues in support of the law.
"Congress passed the Affordable Care act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the opinion.
Justice Anthony Kennedy dissented in 2012, but sided with the majority on Thursday
The ruling preserves the law known as Obamacare, which US President Barack Obama considers a major part of his presidential legacy.
Republicans have vowed to continue fighting the law
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