The politics of the Affordable Care Act in the state of Louisiana aren't subtle: The law isn't popular.

The state was part of the lawsuit to strike down Obamacare in 2012; it didn't expand Medicaid and has no plans to. Louisiana also didn't set up its own marketplace to sell health insurance.

Nevertheless, more than 186,000 people in Louisiana signed up for health coverage under the law and almost all of them got help from the federal government to pay their premiums.

The U.S. Supreme Court could soon rule illegal the insurance subsidies in Louisiana and more than 30 other states that use the federal website HealthCare.gov.

If the subsidies are eliminated, the number of uninsured people in the affected states would rise by 8.2 million in 2016, according to recent Senate testimony by Linda Blumberg, a senior fellow at the Urban Institute. In a Monday interview with All Things Considered's Audie Cornish, Blumberg said, "the reality is, is that the folks in states that are likely to be affected are the ones that needed the most assistance."

Jeff Cohen from member station WNPR spent three days driving around his home state of Louisiana talking with people who bought subsidized insurance under the law. Here are three of their stories.

Sheron Bazille

Sitting at her kitchen table in the Baton Rouge home she owns by herself, Sheron Bazille says she had a good job that offered benefits, including health insurance. But she got sick and had to stop working. "It was either me or my job," she says. "And my life and my health was more important,"

Bazille, 62, retired early, and she says leaving that job of 10 years meant losing her insurance — and some of her dignity, too. Now, under Obamacare, she's got subsidized insurance. She knows exactly how much her share is: "My monthly is $219. And one cent."

The coverage has given her a sense of security, because she can take care of her health and her health care bills.

Jimmy See had a lot of medical debt and hopes insurance means he never has to be in that position again.

Jimmy See had a lot of medical debt and hopes insurance means he never has to be in that position again.

Jeff Cohen/WNPR

"Peace. I have peace now that I know I have hospitalization [coverage]," says Bazille. "If anything happens, I can go to the hospital."

She worries the Supreme Court justices could take away that peace and asked what she would tell the justices if she could, she says: "Think about your kids, your family. If they could not afford to pay for health insurance. Wouldn't you want someone to help them?"

Jimmy See

At a coffee shop in Zachary, half an hour north of Bazille's home in Baton Rouge, Jimmy See says he never felt like he needed health insurance — until he did. He's 54, a self-employed housing and maintenance worker. He'd always felt like health insurance was too expensive. But then he started having trouble breathing and he went to the hospital.

"They said, 'Well do you have any insurance?' " He recalls. "And I said, 'No.' "

Rather than pay a lump sum upfront, he went home and got worse. Eventually, he collapsed, went to the emergency room and had to be hospitalized for close to two weeks for pneumonia. His remembers his bill being between $8,000 and $9,000. See negotiated with the hospital and received financial assistance.

"If I hadn't gotten that, I'd be looking for bill collectors after me," See says. "And bill collectors don't play. They come after you."

See's Obamacare subsidy covers all of his premium. He says having insurance is a relief.

James Marks pays about $180 a month for his insurance and is happy he doesn't have to depend on his parents for help with medical costs.

James Marks pays about $180 a month for his insurance and is happy he doesn't have to depend on his parents for help with medical costs.

Jeff Cohen/WNPR

"If I had a big operation or whatever, you can't afford no $70,000, $80,000, $90,000," he says. "So, through the Affordable Care Act, the government's going to help you out with all that."

If the Supreme Court rules against subsidies, See says for him it would be, "Back to square one. No insurance."

James Marks

James Marks doesn't want to go back to square one, either.

Marks is 36 and lives four hours north of Baton Rouge in Shreveport. He works as a freelance computer technician and an after-school art teacher. Neither job provides insurance and being uninsured was a blow to his self-esteem.

"It made me feel lousy," Marks says. "It made me feel like I was sponging off my parents. It made me feel like I wasn't able to take care of myself."

Marks lives with a mental health issue. For the better part of 10 years, he says his parents paid for both his psychiatrist and his expensive medications. Now, he pays about $180 a month for a subsidized insurance policy and it makes him feel like an adult.

Asked what he would tell the justices, Marks says, "I know the Supreme Court tries to decide stuff based on the law and not based on the impact that it has on America. But it'll wind up making a lot of people who were insured, who had insurance, who were able to go to the doctor and pay for their pills, not be able to anymore. And that's just pretty lousy."

This story is part of a reporting partnership with NPR, WNPR and Kaiser Health News.

Copyright 2015 Connecticut Public Radio. To see more, visit http://www.wnpr.org.

Transcript

AUDIE CORNISH, HOST:

Millions of Americans get subsidized health insurance under the Affordable Care Act, but those subsidies are being challenged. And in the coming weeks, the Supreme Court could rule that in more than 30 states, the subsidies are illegal. In a few minutes, we'll talk about what federal and state lawmakers could do if those subsidies disappear. But first, Jeff Cohen from member station WNPR spent time in one of those states subject to this challenge, Louisiana. He talked to people about what health insurance means to them in a state where politicians are also firmly opposed to the health law.

JEFF COHEN, BYLINE: Leaving the politics aside is this reality - about 180,000 people in Louisiana signed up for the Affordable Care Act this year, and almost all of them got subsidies. Sheron Bazille is one of them. She's at her kitchen table in the Baton Rouge home she owns by herself. She says she had a good job that offered benefits like health insurance, but she got sick and had to stop working.

SHERON BAZILLE: It was either me or my job, and my life and my health was more important.

COHEN: Bazille is 62 and says leaving that job of 10 years behind meant leaving that insurance behind, too. And she says it felt like she lost some dignity. Now, under Obamacare, she's got subsidized insurance.

BAZILLE: My monthly is 219 and one cent.

COHEN: And she's got her sense of security back because now she can take care of her health and her health care bills.

BAZILLE: I have peace now that I know that I have hospitalization. And if anything happen, I can go to the hospital.

COHEN: But she worries the Supreme Court justices could take that peace away.

BAZILLE: Think about your family. If they could not afford health insurance, wouldn't you want someone to help them?

COHEN: And she's not the only one who sees the Affordable Care Act as a little bit of help. I spent three days driving around Louisiana, talking to people who had signed up and gotten subsidies under Obamacare. Jimmy See met me at a coffee shop in the town of Zachary, half-an-hour north of Bazille's home. He's 54, a self-employed housing and maintenance worker, and he says he'd never had health insurance. It was too expensive, and he didn't need it, until he did. He was having trouble breathing, and he went to the hospital.

JIMMY SEE: They said, oh, do you have any insurance? I said no.

COHEN: Rather than pay a lump sum upfront, he went home and got worse. Eventually, he collapsed.

When you did go into the hospital eventually and they took you, what kind of bills were you looking at?

SEE: Almost around 8 - $9,000 bills just to treat you with pneumonia because you was in the hospital running IVs in you for almost 14 days.

COHEN: See says he got a lot of financial assistance.

SEE: If I hadn't have gotten that, I'd be looking for bill collectors after me. You know, bill collectors don't play. They come after you.

COHEN: But now, Obamacare has given him an easier choice.

What do you pay?

SEE: Nothing.

COHEN: He says having insurance is a relief.

SEE: If I had to have a big operation or whatever, you can't afford no 70, 80, $90,000 operation. So through the Affordable Care Act, you know, the government's going to help you out with all of that.

COHEN: So losing that could mean what to you?

SEE: Back at square one - no insurance.

COHEN: About four hours north of Baton Rouge is Shreveport, and there, James Marks doesn't want to go back to square one either.

JAMES MARKS: It made me feel like I was sponging off my parents. It made me feel like I wasn't able to take care of myself.

COHEN: Marks is 36 and works as a freelance computer technician and an after-school art teacher. He lives with a mental health issue, and for the better part of 10 years, his parents paid for both his psychiatrist and his expensive medication. Now, he pays about $180 a month, and he says it makes him feel like an adult.

MARKS: I know the Supreme Court tries to decide stuff just based on the law and not based on the impact it has on America, but it'll wind up making a lot of people who are able to go to the doctor and able to pay for their pills not be able to anymore. And that's just pretty lousy.

COHEN: Experts say about 13 million people could lose their subsidies if the Supreme Court rules they're illegal in most states. For NPR News, I'm Jeff Cohen.

CORNISH: Jeff Cohen's reporting is part of a partnership with WNPR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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