What does Supreme Court health care ruling mean here?

Hollye Reid of Rock Hill wants you to know she is not a bum.

“I don’t get welfare or food stamps or anything like that from the government, because I know there are people out there who need it more than we do,” she said.

But Reid is one of millions of Americans who are paying for their health insurance thanks to federal subsidies provided by the Affordable Care Act. Reid left her job – and her health coverage – in 2013 to care for her husband while he battles Stage 4 cancer. Her husband’s care is covered by disability payments, but Reid can no longer pay for the medication she needs for her osteoarthritis and fibromyalgia, or the anti-depressants she takes to cope with the stress of her family’s situation.

“You can’t imagine choosing between paying the electric bill or a medical bill,” she said.

Reid and more than 150,000 other South Carolina residents will keep their health insurance, thanks to Thursday’s U.S. Supreme Court ruling on health care subsidies.

Six justices rejected a challenge to President Obama’s Affordable Care Act that would have eliminated the ability of people who purchase their insurance through the federal government exchange rather than a state-run exchange from receiving federal subsidies.

South Carolina declined to establish its own health care exchange after the Affordable Care Act passed in 2010. Many, if not most, of those who purchased their insurance under the ACA would have lost the subsidy that makes those policies affordable.

Many hospitals were afraid a different Supreme Court decision would have hit health care providers hard.

“Hospitals are the insurer of last resort,” said Rozalynn Goodwin, a vice president with the S.C. Hospital Association. “Hospital emergency rooms are open to people whether they are able to pay or not.”

Reimbursements from programs such as Medicare and Medicaid have been reduced, Goodwin said, and hospitals are more dependent on revenue from newly insured customers.

Health care providers are already losing some expected revenue under the Affordable Care Act because South Carolina declined to expand the state’s Medicaid program, which Goodwin estimates would make an additional 200,000 people eligible for coverage.

If the court had eliminated the subsidies, those with federal insurance plans could have seen an estimated 335 percent increase in their monthly premiums, according to the S.C. Hospital Association.

“The anxiety attack is over,” said Lynn Bailey, a Columbia-based health care economist. “An estimated 8 million people nationwide may no longer be able to afford their coverage, and that would be a major disruption to the system, particularly for hospitals that have made a significant financial commitment to support health care reform.”

The ACA has reduced the number of uninsured among young and low-income people, Bailey said. In Reid’s case, her prescription medication now costs her $100 a month, compared to the $400 she was paying before. She recently had an MRI for her lower back pain that cost $525 instead of $1,800.

“I’m so thankful I was able to find good coverage,” she said. “My co-pays are less now than with the insurance I had before.”

Subsidies have not only helped people like Reid, they’ve helped insurance companies deal with a changing insurance market.

“If (those who depend on subsidies) start to drop out, it could lead to a death spiral in the private insurance market,” Bailey said. “Some companies that are on the exchanges now might have to withdraw from the market completely.”

Rock Hill’s Piedmont Medical Center issued a statement Thursday that said:

“With this ruling, more than 6 million of those Americans can rest easy knowing that they will not lose access to the subsidies that help them maintain their insurance coverage. Piedmont Medical Center will continue supporting education and enrollment under the Affordable Care Act through our Path to Health program, which seeks to inform uninsured populations about their options under the law and how to enroll.”

The health care industry still faces struggles with accessibility and rising costs that go beyond this week’s decision, some said. Even with her coverage, Reid said she had trouble finding a doctor in Rock Hill willing to accept “Obamacare.”

“They won’t get reimbursed the same,” she said. “Even my own doctor that I’d been going to wouldn’t take it. It’s like they were scared of it or something.”

Watts Huckabee, a Rock Hill insurance agent, said if subsidies are needed to get people into the insurance market, he’d like to see the law changed to set a better definition of need.

If most of those who used a subsidy would cancel their policy without it, “that raises the concern with me that if they’re not given coverage at no cost, they don’t value it enough to pay for it on their own,” he said.

Huckabee said he worries the Affordable Care Act will ultimately be unaffordable to the taxpayer and that the law puts an undue burden on employers, who must cover their employees if they have more than 50 full-time workers. He said the law doesn’t include enough incentives for individuals themselves to seek coverage.

“We need to look at who qualifies, and for how long, whether this should be an indefinite subsidy,” Huckabee said.

While Thursday’s ruling helps those who need to be able to afford health care today, Bailey agrees the health care industry ultimately needs to change.

“If it had gone the other way, then maybe we could have replaced it with a single-payer, publicly funded model,” she said. “As it is, the ruling preserves a private health insurance market that’s part of the reason we have such a disorganized health care system.”

One reason health care reform has been so bumpy, she said, is that reform efforts haven’t gone far enough in changing the way the system works now.

“We’ve never had a real discussion in this country,” Bailey said, “about whether health care is a private good or a public good.”

But for Reid, all that matters now is that she won’t lose her coverage again.

“It would be a struggle if I didn’t have it,” she said. “I hear people who are able to work and have good insurance say their rates are going up because of us, because we’re using subsidies. ... But there are a lot of people like me who need to be able to have this.”

This story was originally published June 25, 2015 at 8:29 PM with the headline "What does Supreme Court health care ruling mean here?."