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The U.S. appeals court in New Orleans won’t review its ruling that found a key piece of the Affordable Care Act unconstitutional.

The judges voted 8-6, largely along party lines, with conservative judges outvoting more moderate ones. The ruling leaves intact access to health care for millions of Americans, who face the loss of coverage if the law is wiped out entirely.

In December, a three-judge panel ruled that the law lost its constitutional footing when Congress eliminated the penalty for individuals who refused to buy health insurance. A decision now lies with a trial judge to see if the rest of the law can survive without the mandate.

Final resolution on whether Obama’s signature health-care law lives or dies probably won’t come before the 2020 elections. Health care is a central issue in this year’s presidential election, with Democrats vying for their party’s nomination debating over how far-reaching government involvement should be. They’re united that ACA protections shouldn’t be undone though. President Donald Trump has also weighed in, even as his administration fights to dismantle Obamacare.

Typically the party that loses in the appeals court asks for the case to he heard again with the court’s full panel of judges, but Nicholas Bagley, a health law professor at the University of Michigan, said in this case the request came from one of the judges on the court. Because the ruling split so narrowly, he said it suggests at least six active judges on the court were concerned about the ruling from the three-judge panel.

“It’s really unusual, but nothing about this case is usual,” Bagley said.

Five of the six appellate judges who favored review were appointed by either Democratic presidents Barack Obama or Bill Clinton. One was appointed by former Republican President Ronald Reagan. All eight of the judges who voted against the review were appointed by Republican presidents.

The fight could still end up before the U.S. Supreme Court.

By leaving the law in limbo, the appeals court’s decision will stoke further political debate. On one side is a Texas-led coalition of mostly Republican states and the Trump administration fighting to kill Obamacare. On the other is a California-led band of mostly Democrat-led states and the U.S. House of Representatives. Democratic lawmakers jumped in to defend Obamacare when Trump refused.

The case is Texas v. U.S., 19-10011, U.S. Court of Appeals for the Fifth Circuit (New Orleans).

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