Nicole Peterson already struggles to provide for her three daughters with the $36,000 she makes managing a Kenneth City day care center.
If she were to lose her $150-a-month health insurance subsidy from the federal government?
"That's an electric or a water bill, or groceries and gas," Peterson said. "These aren't luxuries. These are things we need for survival."
So in between 11-hour days at the child care center and the demands of being a single mom, Peterson looks for updates on the U.S. Supreme Court case known as King vs. Burwell. The decision, expected this month, will determine whether she and 6.4 million other Americans continue receiving the subsidies associated with the Affordable Care Act.
The stakes are particularly high in Florida. A ruling against the health care law could cause more than 1.3 million Floridians to lose their financial assistance. That's more people than in any other state, according to the federal government.
Other consumers could also feel the sting. Experts say the elimination of subsidies would prompt thousands to leave the individual health insurance market, causing premiums and out-of-pocket costs to climb for those who keep their coverage.
"I could see the insurance market really caving under this pressure," said Dr. Mona Mangat, a St. Petersburg allergist and chairwoman of the pro-Obamacare group Doctors for America. "It is a very, very dire situation."
Not everybody buys the doomsday predictions. Some conservative think tanks say the situation will be manageable. But there is widespread consensus that a ruling against the subsidies would ratchet up pressure on both Washington and Tallahassee.
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The case before the court centers on four words in the 900-page Affordable Care Act. The law guarantees financial aid to low-income people who buy coverage on insurance exchanges "established by the state."
Here's the rub: Thirty-four states, including Florida, didn't establish exchanges. They opted instead to use an insurance marketplace run by the federal government.
Federal health officials have been giving the subsidies to people in all 50 states. But the plaintiffs in King vs. Burwell say the law should be read literally, meaning the aid should go only to those in the state exchanges — not the federal ones.
A ruling against the subsidies would shock the market for individual insurance. A recent analysis by the RAND Corp. predicted enrollment would plunge by 70 percent in states on the federal exchanges. That could cause premiums to rise by an average of 47 percent, or about $1,610 a year for a 40-year-old who doesn't smoke.
"It's going to affect the people who don't get the tax credits and pay out of pocket for their insurance today," said Laura Brennaman, a registered nurse and health policy consultant for the consumer advocacy group Florida CHAIN. "Those premiums are going to become unaffordable to them."
Edmund Haislmaier, a senior research fellow at the conservative Heritage Foundation, envisions a less dramatic scenario. He noted that people who receive subsidies make up only a small fraction of the private insurance market, and predicted that some of them would keep their plans.
"Some subset of these people will be able to afford it," he said.
Beverly Borrelli says she won't be one of them.
A 63-year-old Tarpon Springs resident who was laid off by her longtime employer in 2012, she receives $625 a month to help offset the cost of health insurance. It's the only way she can afford the $670 monthly premium for her "silver" plan living on a fixed income, she said.
"If they eliminate the (subsidies), I will have no medical insurance until I qualify for Medicare," Borrelli said, naming the federal health insurance program for adults 65 and older. "It's that simple."
Borrelli worries about the potential consequences. She suffers from chronic bronchitis and arthritis. She's also allergic to insect bites. Last year, she needed steroid shots five times.
"I'm going to gamble with my life," Borrelli said. "Hopefully, I won't get critically ill."
Peterson, the mother of three from Kenneth City, isn't willing to go without coverage. "If I'm not healthy, I can't take care of my kids," she said.
She could switch to a plan with lower premiums, but that could be more expensive over the long run. She chose her current plan — a "platinum" plan with a $468 monthly premium — because there is no deductible, and she is prone to injuries and long bouts of bronchitis.
The family budget is already tight. Peterson and her daughters are moving into a townhouse because their single-family home is in foreclosure.
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President Barack Obama is predicting the Supreme Court will uphold the law.
"For years what we've heard is the biggest problem on the bench was judicial activism or the lack of judicial restraint, that an unelected group of people would somehow overturn a duly constituted and passed law," he said this week. "Well, there's a good example, and I'm pretty confident that this court will recognize that and not take that step."
If he's wrong, lawmakers will have the chance to intervene.
Congress could tweak the health law to allow subsidies in every state. But the Republican-led House, which has voted more than 50 times to repeal or water down the law, seems unlikely to take any action that would strengthen it.
Haislmaier, of the Heritage Foundation, sees a chance for Congress to remove some of the law's mandates, including the so-called age-rating restrictions that place limitations on premium differences by age. Doing so could reduce annual premiums for Floridians to the tune of $1,241 for a 21-year-old and $650 for a 64-year-old, according to a foundation analysis.
The state Legislature could also take action.
Florida already has a state-run exchange for private health insurance known as Florida Health Choices that enrolls about 80 people. State lawmakers could make the marketplace compliant with the Affordable Care Act, and in turn, make Floridans eligible for the subsidies.
A spokeswoman for Senate President Andy Gardiner, R-Orlando, said Gardiner would be "open to making (Florida Health Choices) the state's ACA exchange."
"Preserving and expanding access to affordable coverage options is a top priority for President Gardiner, so he will view the ruling and resulting impacts from that standpoint," Katie Betta said.
A spokesman for Republican House Speaker Steve Crisafulli would not speculate how the Legislature would respond to the Supreme Court ruling. It is no secret, however, that the House opposes the politically charged health care law. House leaders torpedoed recent efforts to expand Medicaid by tying the plan to Obamacare.
Republican Gov. Rick Scott declined to answer questions from the Tampa Bay Times. He, too, has been a vocal opponent of Obamacare. In an op-ed published in Politico Magazine in March, Scott said state-run exchanges were "collapsing under their own weight throughout the country."
Peterson hopes it doesn't come to a legislative fight.
"It's scary what could happen," she said. "I hope (the Supreme Court justices) take all the information, look at the facts and make the right decision."
Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.