A second federal judge has ruled that the federal health reform law passed last year violates the US Constitution, matching the two judges who have affirmed the law’s legality. The dueling opinions all but ensure that the matter will be decided in the Supreme Court.

Federal District Judge Roger Vinson in Florida ruled that the law’s provision requiring most Americans to buy insurance coverage violates the Commerce clause of the Constitution because it would regulate not what people buy but what they decide not to buy. If Congress can require Americans to buy a product when they prefer not to, Vinson wrote, than the federal government’s powers would be essentially unlimited.

Vinson allowed the law to remain in effect while the appeals to his ruling are heard, but he also wrote that if his opinion stands, the entire law, not just the mandate to buy insurance, would be struck down. Without the mandate, he said, the rest of the law would not work.

The case was brought by the attorneys general of 26 states, not including California, which has been a leader in implementing the law’s earliest provisions. The mandate to purchase insurance that was at issue in the Florida case would not take effect until 2014.

California consumer advocates reacted harshly to the ruling.

“Judge Vinson has produced a stunningly ideological and extreme opinion, legislating from the bench to reopen the health care debate by going well beyond precedent,” said Anthony Wright, director of Health Access California. “Fortunately, the judge’s partisan findings are of limited impact because the U.S. Supreme Court will have the final say on the legal challenge to the Affordable Care Act.”

Michael Russo, a health care advocate for CALPIRG, called the ruling just “one step” in a long legal process.

“Consumers and small businesses would face significantly higher insurance premiums, if higher courts ultimately uphold Judge’s Vinson ruling to reverse last year’s federal health care law,” he said. He said his group’s research suggests that consumers who buy their own coverage would face premiums up to 20 percent higher per-employee cost of providing employer-sponsored insurance would be $3,000 a year higher by the end of the decade.

Many parts of the law are already in effect.

One provision allows parents to keep their children on their family policy until age 26. Another sets new standards for when insurance companies can rescind coverage. Carriers must now sell families insurance for their children without regard to pre-existing conditions, and adults who can’t find coverage because of their medical histories have new options through a state-run high-risk pool. Small businesses that cover their workers are eligible for new tax credits, and seniors have more help paying for prescription drugs.

California was the first state in the nation to create a new Health Insurance Exchange, which beginning in 2014 will offer a regulated clearing house for health plans for individuals and small businesses that don’t buy their coverage through a large group plan.

“What’s important for patients to know is that the consumer protections under the new federal law are still in place, and are likely to stay,” Wright said. “The implementation of the new federal law will and should continue, especially in California, where we need all the help with our health system we can get.”