Washington (CNN) -- Another federal judge has upheld the legality of the sweeping health care reform requirement that most Americans purchase health insurance by 2014.
Wednesday's decision from Virginia adds to the legal muddle over the constitutionality of the landmark legislation championed by President Obama and the Democratic Congress.
In a 54-page decision, Judge Norman Moon dismissed a pending lawsuit and ruled that government authority to oversee "individuals' decisions about how and when to pay for health care are activities that in the aggregate substantially affect the interstate health care market."
His decision mirrors that of a federal judge in Michigan in late October. But two judicial counterparts in Michigan and Virginia have reached the opposite conclusions, raising strong doubts about the government's authority to mandate the purchase of insurance coverage for individuals and employers.
The latest case emerged from a lawsuit filed by Liberty University and five Virginia residents. The Lynchburg-based Christian school objected to the health care bill, saying it "does not protect against the mandatory insurance payments being used to fund abortion coverage," a procedure that the university says is "immoral." Supporters of the bill have disagreed with that interpretation.
More broadly, the plaintiffs also argued that the Commerce Clause of the Constitution does not give the government the authority to force Americans to purchase a commercial product, like health insurance, that they may not want or need. They equated that to a burdensome regulation of "inactivity."
But Moon, a 1997 Clinton appointee, disagreed. "Regardless of whether one relies on an insurance policy, one's savings, or the backstop of free or reduced-cost emergency room services, one has made a choice regarding the method of payment for the health care services one expects to receive. Far from 'inactivity,' " he said, "by choosing to forgo insurance, plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance."
The judge also said most larger employers too have a responsibility to provide some basic health coverage for their workers, comparing that to minimum wage and benefit requirements.
"The opportunity provided to an employee to enroll in an employer-sponsored health care plan is a valuable benefit offered in exchange for the employee's labor, much like a wage or salary," Moon wrote.
But the Christian plaintiffs did achieve two significant victories in their ability to sue the government. Moon rejected the Justice Department's argument that individuals or states lacked "standing" to challenge the law and that any challenge is premature because large parts of the law have not gone into effect, including the insurance purchase requirement.
Obama signed the Patient Protection and Affordable Care Act in March, after promoting health reform efforts for months after taking office. The law was designed to help the millions of uninsured and underinsured Americans receive adequate and affordable health care, through government-imposed mandates and subsidies. Critics have equated it to socialized medicine, fearing that a bloated government bureaucracy will result in higher taxes and diminished health care services.
About two dozen challenges have been filed in federal courts nationwide.
On November 8, the Supreme Court rejected the first constitutional challenge to the health care reform effort, resisting a California conservative group's appeal. The justices did not comment but refused to get involved at this early stage, while various state and federal challenges are continuing. The high court rarely accepts cases before they have been thoroughly reviewed by lower courts.
Legal experts say they expect the larger issues to ultimately end up before the Supreme Court, but that may not happen for at least a year or two.
The highest-profile lawsuit may come from Florida. Officials there object to the purchase mandate, as well as the requirement forcing states to expand Medicaid. That litigation is supported by 19 other states: Alabama, Alaska, Arizona, Colorado, Georgia, Idaho, Indiana, Louisiana, Michigan, Mississippi, Nebraska, Nevada, North and South Dakota, Pennsylvania, South Carolina, Texas, Utah and Washington.
The legislation was passed by the Democratic-majority Congress but was derisively labeled "Obamacare" by opponents. Now, House Republicans leaders -- who gained the majority in the midterm elections -- have vowed to overturn or severely trim the law.