On Tuesday Department of Justice attorneys appeared at federal appeals court in Virginia to defend the constitutionality of a provision in the Affordable Care Act that mandates all individuals to have some form of healthcare coverage. Set to go into effect in 2014, it’s a key component to making healthcare affordable, the Obama administration argues, because it creates large pools of paying customers, thereby lowering costs. Critics counter that the federal government shouldn’t be allowed to force people to buy anything, including healthcare insurance.

So far, five federal judges have ruled on the legislation’s constitutionality. Three, who were appointed by Democratic presidents, ruled in favor of the bill, while two others, who were appointed by Republican presidents, struck it down. All of those cases have been appealed. Tuesday’s three-judge panel is made up of Democratic appointees, but there’s no guarantee they’ll uphold the provision. Moreover, it is widely believed that the U.S. Supreme Court ultimately will make a final ruling on the matter.

According to Reuters, Virginia and other states have passed or are considering legislation prohibiting the healthcare law from being enforced. And, it reports, state legislators in Maine, Montana, Nebraska, Oregon, Texas and Wyoming have introduced bills that would make enforcement of the law a criminal offense and at least 24 lawsuits have been filed in federal courts.

According to a report issued Tuesday by the U.S. Department of Health and Human Services, approximately 50 million people are uninsured and nearly two million uninsured people are hospitalized each year.

“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth,” said HHS Secretary Kathleen Sebelius. “The result is families going without care—or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”

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