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Supreme Court ruling brings stability to NC health insurance market

Health care activists applaud US Supreme Court's 'King v Burwell' decision

Health care advocates, including Former Solicitor General under the Obama administration, Neal Katyal, celebrate the Supreme Court's 6-3 decision on 'King v. Burwell' to uphold health care subsidies on June 25, 2015.
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Health care advocates, including Former Solicitor General under the Obama administration, Neal Katyal, celebrate the Supreme Court's 6-3 decision on 'King v. Burwell' to uphold health care subsidies on June 25, 2015.

The U.S. Supreme Court declared Thursday that more than 6 million Americans, including almost 459,000 in North Carolina, can keep the federal subsidies that help them pay for health insurance.

In a 6-3 ruling, the nation’s highest court said the 2010 law known as the Affordable Care Act was intended to provide subsidies to all eligible citizens, despite sloppy language in its text.

The long-anticipated ruling resolves a lawsuit challenging the legality of federal subsidies in 34 states that didn't set up their own insurance exchanges under the Affordable Care Act. Those states, including North Carolina, require their residents to rely on the federal exchange to buy health insurance.

Only two states, Florida and Texas, had more residents at risk of losing their subsidies in the King v. Burwell case, where the challenge contended that only state-run exchanges qualify for the federal subsidies. In North Carolina, 92.3 percent of residents who are enrolled in ACA policies are receiving subsidies, averaging $316 a month.

Among the heavily subsidized is Cole Brisson, a 26-year-old who makes about $15,000 a year as a bike mechanic in Carrboro. A hardcore bicyclist, Brisson has a “silver” insurance policy from Coventry Health Care of the Carolinas, for which he pays $15 a month and the federal government chips in about $220.

Brisson is a stunt rider whose flips, spins and other gravity-defying tricks have resulted in broken bones on a dozen occasions, including reconstructive wrist surgery last year. He is currently recovering from another injury, this one to his ankle, caused by falling from a height of about 10 feet, a mishap occasioned by riding backward on a ramp that reaches the roof of a shed.

He said merciless abuse is the occupational hazard of a BMX stunt rider. Brisson regards health insurance not as an option but a necessity that saves him from financial ruin.

“I’d go broke if I got injured,” he said. “I’d be pretty much destroyed if something happened to me.”

The subsidies offset the cost of health insurance for low- and moderate-income people who don’t have coverage through their employers or through a federal program such as Medicare and Medicaid.

If that financial aid had been eliminated by the Supreme Court, North Carolina residents would have seen their average premium costs go up more than fourfold, according to one study.

Experts had predicted chaos if the subsidies had been overturned, prompting massive insurance cancellations and disruptions in the insurance market that could lead some insurers to stop writing policies in North Carolina.

While the court ruling for the government averts an immediate crisis for the nearly half-million North Carolinians who have coverage under the ACA, intense opposition remains across the country to the health insurance law. The Affordable Care Act passed in 2010 without a single Republican vote and has faced more than 50 repeal attempts in Congress.

Among those who earn too much to qualify for subsidies, some saw their insurance costs double and triple, prompting President Barack Obama to allow insurers to reinstate insurance policies that predated the Affordable Care Act. Obama also delayed other provisions, giving employers more time to comply with a requirement to offer their employees health insurance.

Still, most experts had predicted that the court would rule for the Obama Administration in King vs. Burwell and keep the subsidies alive.

The law requires most Americans to buy health insurance and prohibits insurers from turning away applicants who are elderly or ill, practices common in past years.

The law also carries penalties for citizens who fail to obtain health insurance, though there are waivers available in many circumstances for those who remain uninsured.

Ann Lenhardt of Pittsboro said she and her husband Rodger absolutely depend on their subsidized insurance policy from Coventry Health Care of the Carolinas. The couple has purchased subsidized health insurance under the ACA since it became mandatory in 2014 and now the Lenhardts pay $77 a month, receiving a monthly subsidy of about $800.

“As much as it costs, it’s just so ridiculously expensive,” Ann Lenhardt said. “We are self-employed in a startup business that is going well, and we are mostly living off of savings, mileage reimbursement and part-time jobs.”

Lenhardt said she and her husband are infrequent users of the health care system, but if the subsidies had been eliminated they would have bought catastrophic coverage. She hasn’t required any doctor visits besides her annual checkup; he has seen a doctor a half-dozen times in the past two years for a staph infection.

“We are still a decade away from qualifying for Medicare so we are truly in the most vulnerable time of our lives when it comes to health insurance,” Lenhardt said. “It’s tough to get a job when you are in your mid to late 50’s as we are, so our options for getting health insurance through a future employer don’t look very promising either.”

Murawski: 919-829-8932

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