The Affordable Care Act mandates that all Americans get health coverage or pay a penalty. To help people pay for that insurance, the federal government subsidizes insurance premiums for millions of Americans.
In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question is whether the law allowed for them across the country or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could without insurance.
Attorney Tom Goldstein, who runs , has been following the case and says the law is ambiguous. 鈥淭his is a real, serious question,鈥 he says. 鈥淭he law doesn鈥檛 tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange or whether Congress wanted everybody who needed the help to be able to get the subsidies.鈥
Louisiana is a state where a lot of people could be affected. It runs healthcare.gov and about there have used the site to buy health insurance. Nearly 90 percent of them in Louisiana get subsidies.
We traveled to the state to interview many of these people who could lose subsidies if the Supreme Court rules against them. Here are our first three profiles:
Carlton Scott, 63, at his house in Prairieville, Louisiana. Scott is too young for Medicare and Louisiana hasn鈥檛 expanded Medicaid, so Obamacare was a good option for him (Photo by Jeff Cohen/WNPR).
Carlton Scott
Carlton Scott is 63. Sitting at his kitchen table at the house he owns in Prairieville, near Baton Rouge, he says he worked at a chemical plant for 30 years before he retired. He found out last fall that his company was scaling back his retiree benefits.
鈥溾橰ound October they wrote me a letter saying, in December we鈥檒l no longer be covered,鈥 he says.
That included his health insurance, which he was really counting on.
鈥淚 thought they would take me to my grave. I really thought the company would take me to my grave,鈥 he says. When it went away, 鈥淭hat pissed me off. Because, god鈥斺, I been through 30 years and you come with this bullsh鈥? That pissed me off.鈥
And he was in a bind. At 63 he is too young for Medicare and Louisiana hasn鈥檛 expanded Medicaid. Obamacare was a good option for him.
He signed up for a BlueCross BlueShield of Louisiana plan. He says he pays $266.99 per month, 鈥渢o the penny.鈥 Like a lot of people, he could rattle off the exact amount. Money is tight and people track their expenses carefully.
Scott could be in a position to lose his subsidy and his health insurance. He says if he had to pay more, he could for a while. He gets $2,600 a month between Social Security and his pension. But he worries about his friends.
鈥淓verybody don鈥檛 make the same amount of money, that鈥檚 what I鈥檓 saying. I got a friend of mine, stay down the street. He gets Social Security and pension, too. But it鈥檚 not as much as mine, not half as [much].鈥
When asked about the case in front of the Supreme Court, he laughs.
鈥淭hey all got insurance, too. I guarantee you that. They all got insurance.鈥
He says the court should, 鈥淟eave it like it is. I mean, what are people going to do? Get sick, go to the hospital, 鈥業 don鈥檛 have insurance. Won鈥檛 you please help me anyway?鈥 Hell, no. That ain鈥檛 going to happen,鈥 he says.
LaTasha Perry
LaTasha Perry is at the other end of her career. She鈥檚 31 and works at the front desk of a community health center in Plaquemine, La. She got covered under Obamacare because it was cheaper than paying the penalty.
LaTasha Perry, 31, works at a community health center in Plaquemine, Louisiana. Perry says getting insured under Obamacare was cheaper than paying the penalty (Photo by Jeff Cohen/WNPR).
鈥淚 would pay at least $100 a month for the insurance here,鈥 she says. 鈥淲ith my subsidy, I pay $13.鈥
Now she鈥檚 got money left over for necessities: 鈥淔ood for my kids. I鈥檓 a single parent, so it鈥檚 hard.鈥
听
Charles Dalton
Charles Dalton wanted health coverage. He鈥檚 64 and after he retired as a paramedic, he didn鈥檛 have health insurance. Then he got sick. He says his condition is too personal to talk about. 鈥淚鈥檓 disabled,鈥 he says. 鈥淏ut I would be totally incapacitated without seeing this doctor.鈥
Charles Dalton, 64, a retired paramedic says losing his insurance was not an option (Photo by Jeff Cohen/WNPR).
The Affordable Care Act says insurers can鈥檛 take into account whether somebody is sick, like they used to. That made insurance unavailable or unaffordable for many sick people. And now 鈥 with subsidies 鈥 Dalton says he pays $149 a month. He hopes the Supreme Court doesn鈥檛 touch the subsidies.
鈥淭hey鈥檙e just going to make a difficult situation more difficult,鈥 he explains. 鈥淏ecause of the Affordable Care Act, it鈥檚 helping me to be able to make this existence more livable. You鈥檙e not asking for a handout. But if you get a helping hand, the last thing you need is for it to be snatched out from under you.鈥
Regardless of the politics, there are a lot of people like Dalton who could feel that the Supreme Court would be taking something away. Goldstein of SCOTUSblog says the court has a tough job.
鈥淭his is a case that requires the justices to be both lawyers and try and look at the words that Congress used, but also to struggle with the human dimension of the case,鈥 he says. 鈥淭he consequences are so real and so powerful that, if the challengers win here 鈥 and maybe they deserve to win, maybe it鈥檚 what Congress intended 鈥 but it鈥檚 hard to avoid the conclusion that millions of people would lose access to health insurance.鈥
This story is part of a reporting partnership that includes , NPR and Kaiser Health News.