The U.S. Supreme Court has upheld government subsidies that help more than 6.4 million Americans in Texas and 33 other states purchase health insurance policies through federal exchanges created under the Obama administration's signature health care law.
Here's a look at what the decision means in a state where top Republican leaders were loudly hoping it would go the other way.
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Q: Texas Republicans have rejected the health care law. Why does the ruling still have an effect here?
A: Texas refused to expand Medicaid coverage as part of President Barack Obama's signature law, and the state Legislature also balked at creating a state exchange for Texans to purchase health insurance plans. But that just meant Texas became one of the 34 states relying on a federal health insurance exchange. That exchange offers health coverage at reduced prices by giving tax credits to people who couldn't otherwise afford insurance -- and Thursday's ruling means those subsides can continue unchanged.
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Q: How many Texans get subsidies?
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A: Nearly 1 million people statewide have purchased health insurance through the federal exchange, the nation's second-most behind only Florida. Of those, more than 832,000 get tax credits worth an average of $247 per month per policyholder.
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Q: What happens now?
A: Nothing. Things will continue as normal for Texans who get tax credits to help pay for health insurance. Texas also still has the highest uninsured rate in America, with about a fifth of its residents lacking health coverage, according to most studies.
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Q: How are Texans who would have lost subsides reacting?
A: With relief. "Oh thank God," declared Dawn Erin, an Austin actor and massage therapist who couldn't previously get health insurance because she has for decades suffered from a pre-existing condition, Hepatitis C. She enrolled in a subsidized health insurance plan last year and would have seen its monthly cost climb from $125 to $300 had the subsidies been struck down by the Supreme Court -- meaning she could likely no longer have afforded coverage. The plan allows Erin to take medication that may soon effectively cure her illness, and would otherwise cost $75,000 for a two months' supply. "Living with something for over 20 years that you expect to kill you and suddenly there is medication available and I have the insurance to pay for it?," Erin said. "It's like a miracle." The Texas Hospital Association called the ruling "a huge opportunity for patients and hospitals."
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Q: Given the latest Supreme Court decision favoring the health care law, might Texas Republicans soften their opposition to it?
A: No. After Thursday's ruling, some Democrats in the Legislature gleefully suggested it was time for Texas to stop fighting the law. But Republicans have controlled every statewide office since 1994 and scrambled to again declare how much they detest what they call "Obamacare." Gov. Greg Abbott said the high court "abandoned the Constitution," while Attorney General Ken Paxton said the health care law "remains one of the broadest overreaches of federal authority in our nation's history." Texas Republican Party Chairman Tom Mechler said the ruling "doesn't change the fact that Obamacare is broken."
