- Associated Press - Wednesday, March 4, 2015

SIOUX FALLS, S.D. (AP) - Thousands of South Dakota residents are among the millions who have obtained financial assistance to pay for health insurance and could be affected by the latest challenge to President Barack Obama’s signature law before the U.S. Supreme Court.

The justices heard arguments Wednesday on whether residents in 37 states in which consumers signed up for coverage under the federal marketplace are eligible for tax subsidies to lessen the cost of insurance premiums. The lawsuit seeks to limit financial assistance only to people who live in states that created their own health insurance marketplaces.

The court’s decision could affect a staggering 88 percent of the 21,183 South Dakota consumers who signed up for insurance during the most recent enrollment season. More than 18,000 residents qualified for a federal subsidy that on average covers about $234 of their monthly premiums, according to the U.S. Department of Health and Human Services.

Avera, Sanford Health Plan and Dakotacare are the three insurers that sold plans in South Dakota through the federal marketplace. Avera and Sanford leaders say they are closely following the challenge and are willing to talk with state and federal officials to ensure that individuals remain insured.

“We simply need to see what their interpretation and what their ruling will be,” said Debra Muller, chief administrative officer for Avera Health Plans.

Dakotacare didn’t return messages left Wednesday.

The case focuses on four words in the law, “established by the state.” The challengers say those words are clear and conclusive evidence that Congress wanted to limit subsidies to those consumers who get their insurance through a marketplace, or exchange, that was established by a state.

The states that opted against their own marketplace, mostly Republican states, are relying on the federal version.

Independent studies estimate that 8 million people could lose insurance coverage if the nation’s high court rules against the law because they’ll no longer be able to afford it. A decision in the case is expected by late June.

Ruth Krystopolski, president of Sanford Health Plan, said the law has “had lots of changes,” including rules and timelines, so the insurer is treating this legal challenge “as one more potential change.”

“I don’t have any concerns over the outcome,” Krystopolski said. “There are so many people subsidized at the present time that irrespective of what happens with the Supreme Court decision, I think there are multiple ways for both the state and the federal government to figure out ways to get those people who are receiving subsidies to continue.”

Leading congressional Republicans have said they are readying plans to temporarily help subsidy recipients, perhaps until the GOP can permanently revamp the law, but haven’t provided specifics.

At the state level, Gov. Dennis Daugaard’s office said Wednesday he “is monitoring this case and the administration continues to evaluate the state’s options.”

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Follow Regina Garcia Cano on Twitter at https://twitter.com/reginagarciakNO

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