Reactions mixed as Supreme Court backs federal health law's subsidies in NC, most other states

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RALEIGH, North Carolina — Substitute teacher Kim Jones of Wake Forest said Thursday's U.S. Supreme Court decision allows her to keep receiving help to pay for the health insurance she credits for saving her life.

North Carolina's Sen. Thom Tillis and U.S. Reps. Patrick McHenry and Mark Walker said they and fellow Republicans will continue working to repeal the health insurance overhaul law championed by President Barack Obama.

"I think there's a lot of free-market proposals that Congressional Republicans should keep harping on" like allowing lower-coverage, lower-cost plans, said Katherine Restrepo, a health policy analyst at the conservative John Locke Foundation. "Subsidies make health insurance more expensive because somebody is paying for somebody else's health care in some way or another."

The high court's decision leaves unchanged the ability of residents in North Carolina and 33 other states to receive a tax credit based on their income that helps them pay monthly health insurance premiums. Only Florida and Texas had more consumers who faced losing subsidies.

Nearly 460,000 North Carolina residents risked losing tax credits and seeing average premiums more than triple, according to an analysis by the Kaiser Family Foundation, which tracks health care issues.

Gov. Pat McCrory said earlier this year he was waiting for Thursday's ruling before recommending whether the state should expand Medicaid to more of North Carolina's uninsured with help from the same federal law.

McCrory said Thursday whether he urges lawmakers to expand Medicaid depends on Washington allowing waivers and exceptions he wants. Senate leader Phil Berger, R-Rockingham, and House Speaker Tim Moore, R-Cleveland, said Thursday that they continue to oppose expansion.

About 500,000 individuals and families in North Carolina can't access regular medical care because they're too poor to qualify for the subsidies under the federal law that assumed all states would expand Medicaid, the insurance program for the poor and disabled, said Adam Linker, of the Health Access Coalition at the liberal North Carolina Justice Center.

The law committed Washington to covering 100 percent of the cost of adding new Medicaid recipients through 2016 and at least 90 percent thereafter. North Carolina lawmakers have refused, saying Medicaid costs consistently exceed spending forecasts and shouldn't be expanded.

For many people able to buy health insurance thanks to the subsidy, the Supreme Court decision was welcomed.

Jones, 60, said she was without health insurance for about a decade because of the part-time jobs she took to allow her to care for an elderly parent. Before buying coverage for herself, she got free care through an urban ministry and "using the emergency room all the time for my care," Jones said. "I need the insurance. I cannot afford it on my own."

Jones said she was diagnosed with a brain tumor in 2013. She bought coverage as soon as it was available in 2014, which opened her access to specialists such as neurosurgeons and endocrinologists. Coverage costs her about $27 a month with a subsidy of more than $500. She continues to take medication after surgery last summer and worried about losing coverage.

"I know it helped so many people, and a lot of folks like myself who had fallen through the cracks were finally getting some kind of help with health issues," Jones said after the ruling.

Diana Rojas, 29, of Charlotte, is one of the younger and healthier people insured under the federal law who balance out the risk to insurers from older and sicker consumers. She signed up for an individual policy as soon as it was available in 2013 after five years without coverage.

"I was without it for so long and I was desperate to just have a check-up, go to a primary-care physician. The things that normal people do," said Rojas, who is self-employed and pays $20 a month after a $199 monthly subsidy.

She lives with her mother, who has health insurance through her job; a grandfather covered by Medicare, and an uncle who is still uninsured.

"We are a Latino family. We kind of stick together, so if anything were to happen to me, and I didn't have health care, that would just be another burden on my family," Rojas said.

Emery P. Dalesio can be reached at

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