<u+201c>i<u+2019>ve got my six-month, regular cancer checkup in june, and so i<u+2019>m saying i hope they don<u+2019>t come out with any kind of decision, just in case it<u+2019>s bad news, until after,<u+201d> hines said. <u+201c>you always get nervous, usually a day before or day of, going for a checkup. but i think i started a little more on the worrying ahead of time.<u+201d>









hines, 59, has been relying on health insurance purchased through the affordable care act marketplaces to help cover the costs of those checkups. but she has the misfortune of residing in a state, virginia, where the federal government is operating that marketplace. because of that, she could end up losing her tax subsidy to help purchase coverage right at the time her health takes a dive for the worse.









the supreme court will issue a ruling this month on a lawsuit engineered by conservative activists alleging that a brief phrase in the law -- <u+201c>exchange established by the state<u+201d> -- means subsidies can only be provided to individuals residing in states that set up their own health insurance exchanges. should the justices side with obamacare's critics, hines would be one of an estimated 6.4 million people in 34 states whose subsidies will disappear. many will be forced to drop their health insurance because of heightened cost.









for someone like hines, who has had breast cancer three times, most recently in 2009, this presents a hobson's choice. she considers health care coverage essential and must get screenings twice a year to ensure her cancer doesn't come back. but she has little money to afford insurance on her own. a former public relations professional, she<u+2019>s devoted her life to caring for her ailing, octogenarian mother, and currently works part-time as an educator at the aquarium near her home in virginia beach. her low income qualifies hines for a subsidy that cuts the price she pays by about half, to $200 a month.









<u+201c>i could probably manage another year,<u+201d> hines said when asked if she could afford the coverage without the subsidy. she would have to draw down more of her retirement savings to pay for health care. but doesn<u+2019>t have enough money to hold on to health insurance until she turns 65 and becomes eligible for medicare, she said.









hines was one of six people the huffington post featured in a report this march on the case surrounding obamacare's subsidies. at the time, the supreme court was hearing oral arguments on the case and the prospect of those subsidies potentially disappearing was becoming less abstract for those in states with federally run exchanges. the clock is ticking even louder now. and so, we decided to catch up with those we interviewed to see how their circumstances, health and mental well-being has changed.









lucas had an aortic aneurysm in 2010, so he has to keep monitoring his heart condition. even though his most recent tests came up clean in may, lucas knows the computed tomography (ct) scan he needs as part of his checkup every two years would cost him $11,000 without insurance, instead of $50 now. he also knows his prescriptions would run to $2,600 every three months rather than $65 with insurance. lucas, who is self-employed, earns $25,000 to $30,000 a year, he said.









lucas might be shielded from the ramifications of a ruling against the subsidy if pennsylvania gov. tom wolf (d) persuades the gop-majority state legislature to go along with his proposal to set up a state-run exchange. but as lucas takes stock of the court decision to come, he's struck by what he sees as dramatically misplaced priorities among lawmakers in washington.









<u+201c>billions of dollars in corporate welfare to oil companies and whatnot, you know, and that<u+2019>s not a problem for them, but i<u+2019>m a person who gets $2,400 a year in subsidies to help pay for my insurance -- and i pay almost three times that much in taxes, so it<u+2019>s not like i<u+2019>m taking them on the negative side,<u+201d> lucas said.









blitz turns 33 on monday. since birth, he has dealt with aortic valve stenosis, meaning he has a heart valve that is too narrow. he recently received good news from his cardiologist that he can delay an expensive major operation he thought he<u+2019>d need this year. but he will have to undergo a less serious procedure at a later date.









all this would be difficult to handle on its own. but it's compounded by the problems blitz has had in navigating the health care law. he ended up with a plan he doesn't recall picking. he lost his subsidy of $30 a month even though his income level should qualify him for some tax credit. and he assumed that his home state would get rid of all obamacare exchanges entirely if the court ruled against the subsidies (in fact, state republicans have passed a bill saying that arizona won't set up a state exchange. the federal one will remain regardless).









were he to ultimately lose the subsidy, blitz would figure out a way to pay for his insurance. he calls himself "fortunate" in that regard, compared to those who don't have savings to dip into or expenses to cut or friends to rely on. but blitz's fortune -- if you want to call it that -- comes at a cost, and it underscores how the damage from a supreme court ruling for the plaintiffs extends beyond those who currently receive tax credits.









without the subsidies, most of the low- and moderate-income people using the health insurance exchanges will exit the exchanges, leaving those with the greatest health care needs -- people like blitz with medical conditions -- as an increasing share of the market. because people with greater medical needs generate more medical bills, that would increase expenses for insurance companies, forcing them to increase premiums. those higher premiums, in turn, would lead more people to drop coverage. in the industry, they call this a <u+201c>death spiral.<u+201d>
obamacare enrollees anxiously await supreme court decision that threatens their coverage
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