His ruling was based on the fact that the government can't force people to buy or face a fine for not having health insurance. The government passed that clause with the argument it is the exact same as car insurance requirement, you must have car insurance if you drive or face a fine... The reason they could make this comparison is hospitals bills increase in price when people default on the payments, since they are legally required to help everyone they have to charge those who can pay more to make up for those who can't/don't pay. The idea behind this was that this would prevent hospitals from having to charge more because everyone could pay therefore bringing down hospital cost, the exact theory behind car insurance, if everyone has car insurance yours will be cheaper because yours will not always have to pick up the bill on accidents(only if your at fault, otherwise the other will). You'll notice the judge said it was illegal but made no act to repel it, this is because it would open up the flood gates for lawyers to represent those opposed to car insurance. I'll admit i am pro-national health insurance, although the current form we have is worse than nothing actually... It just needs to be challenged legally in other areas, this area will be a disaster.