If we intend to make healthcare work for more Hoosiers, we must lower costs and increase accessibility to quality care. The U.S. Supreme Court’s ruling last month in King vs. Burwell signals a positive step in that direction by upholding the promise of affordable health care for more than 200,000 Hoosiers and millions more across the country.

The size and scope of this decision is large, but the impact of the ruling is hyper local as it determines what the future of healthcare looks like for many of our neighbors and friends.

As you may recall, the 2010 Affordable Care Act sought to lower the number of uninsured Americans. The ACA did this in two ways. First, it required states to expand Medicaid coverage to those making less than $25,974 and supporting a family of three. Second, it created a tax subsidy – for people making between $25,974 – $78,120 and supporting a family of three – to purchase insurance in a state-based health exchange. 

The Supreme Court’s recent ruling upholds the subsidy provision of the Affordable Care Act for individuals in the 34 States –including Indiana– that have Federally Facilitated Marketplaces (rather than state-based). That’s positive news for Hoosiers who can now keep their subsidies. Without such assistance, health coverage once again would have become unaffordable for too many.

As a member of Ascension Health – the largest Catholic health care system in America – our mission is to care for the bodies, minds and spirits of those in need, regardless of their personal means or religious view. So, this decision is personal for us. We serve people in 57 counties through 20 health ministries across Indiana, and we’ve heard many stories of how the ACA has made healthcare work for our patients and their families. 

At one of our ministries in western Indiana we met a 64-year-old disabled man with serious health issues and an annual income of $20,500. Without the tax subsidy, the monthly premium for his plan would have been $856.00, more than half of his yearly income. With the subsidy, he found an affordable option of $131.00 a month.

In central Indiana we met a married couple with part time jobs who had never had insurance. When they realized they could afford their premium with the assistance of tax credits, the husband tried to hide his tears and the wife cried, saying over and over, "I get to see a doctor. I finally get to see a doctor."

In Warren County, we helped one couple find coverage for them both at a price that was less than what they were paying for one. The husband had never had health insurance, and they told us that without the premium tax credit, they would not be able to afford the healthcare they needed.

In east central Indiana, we know several patients too young for Medicare who are living on social security and in need of insurance. They focus on their immediate needs of food and shelter first, and without the ACA tax subsidy, coverage simply wouldn’t be an option. 

While the national spotlight shines on D.C. following this Supreme Court ruling, it’s important to remember that there’s a reason to be celebrating in Indiana, too. As a result of the ACA, more Hoosiers are receiving the care they need, and fewer struggle to pay for it. Upholding the law helps preserve subsidies that have made a life-changing impact for so many Hoosiers. 

Now we must forge ahead in pushing for ways to further advance the mission of affordable, quality healthcare for more residents. It’s what our nation needs, and it’s what Hoosiers deserve.

Jonathan Nalli is chief executive officer of St. Vincent Health.

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