Hospital and health insurer stocks plunged Monday after a federal judge in Texas ruled former President Barack Obama’s signature health law, the Affordable Care Act, unconstitutional.

Shares of HCA Healthcare, the largest for-profit U.S. hospital operator, fell more than 4.5 percent early Monday. Shares of insurers Cigna and Humana were both down 4 percent each. Health-care service company Centene slid 7.9 percent and managed health company Molina Healthcare plunged more than 8 percent.

The Health Care Select Sector SPDR (XLV) was down 1.3 percent, on pace for its second negative day and worst month since February 2009.

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