The president said he has given responsibility over implementing the law to Burr Q. Lohses, his newly appointed health insurance czar. Lohses said he will concentrate his efforts in states with a low percentage of insured citizens, beginning with the least insured state, West Dakota.

The ruling came as a shock to U.S. Surgeon General Billy Rubin, who appeared jaundiced under special lights at a news conference in Walter Reed Army Medical Center as he announced his plans to support Lohses despite Taupp's ruling.

"Our biggest concern is that servicemen and vets buy their own health insurance," he said. "Many of them are relying on the government for medical care, so an insurance mandate could save the government billions."

Democrat leaders in Congress have promised to fight efforts by Republicans to overturn health insurance reform. Retired dentist Sen. Les Pullham (D-East Carolina) said health insurance reform is the chief accomplishment of Democrats in the past 40 years and must be saved.

"Originally we passed health insurance reform because we thought it would reduce the cost of medical insurance," he said. "Even though we've since learned that costs are rising sharply for most citizens, it will be a huge benefit for those who previously did not have health insurance, such as undocumented migrants and unmarried mothers."

Some industries support the health insurance reform bill even though they are being forced to raise deductibles and employee contributions toward their coverage. Barry D. Hatchett of the American Electronic Gaming Council said the federal bill benefits most of their customers.

"A high percentage of our customers are unemployed high school graduates and college dropouts who still live with their parents," he said. "Before last year these customers had to get a job to get health insurance, and so we were losing a lot of customers to the job market. The federal bill requires insurance companies to cover independent children until they're 27 years old along with any children they might have, so this bill enables our industry to sell more games."

Another benefit of health insurance reform is that it has reduced unemployment, said Iris K. Anne-Audet, director of the Internal Revenue Service.

"We have hired 16,000 new agents to make sure people buy the type of health insurance that our great leader says is best for them," Audet said.

He said the agency has had no trouble in finding employees who have experience in the health insurance industry.

"Many small insurance companies threw in the towel when reform was passed," he said. "We have our pick of former insurance adjusters, sales personnel and office workers."

Dr. Ginger Veitas, president of the pro-reform group, Independent Dentists Iculcating Oral Trauma (IDIOT) said her group wants to reform the health insurance reform bill.

"We can do many things to make it work," she said. "For example, we can reduce the cost of federal health insurance if it covered everything but trips to the pharmacy, the doctor or the hospital."

Dr. Holder N. Bender of the Acupuncturists and Chiropractors Insurance Division said federal medical insurance could work if it required patients to use chiropractors and acupuncturists rather than medical doctors.

"A lot of illnesses can be cured by chiropractors and acupuncturists," he said. "If we can hold them and bend them or stick them with a few pins and needles rather than operate on them or medicate them, we can save tons of money."

House minority leader Dan Saul Knight, the Democrat congressman who was cut from the hit television show "Dancing with the Stars" when he fell during a waltz, said health insurance reform is not as bad as some Republicans said.

"We're not going to pull the plug on Grandma," he insisted. "To ensure that, we won't allow Grandma to be plugged in. If everybody is paying everybody else's health costs, nobody would want to waste money prolonging an inevitable death."

Gree C. Freiss, Chief Executive Officer of the McDonald's restaurant firm, said health insurance reform could work if all companies and individuals were given waivers exempting them from complying with the health insurance reform bill.

Freiss said that his company and 28 other organizations would have had to drop health insurance coverage entirely if they had not received such waivers.

"Let's just be glad it was just a health insurance bill instead of an actual health care reform bill," Freiss said. "Can you imagine the mess we would all be in if the feds took over our doctors, drugstores and hospitals?"