June 29, 2012: Minnesota already is feeling effects, for better and worse

Abby Schanfield wept for joy when she heard the news. Devin Wiley groaned. Nancy Peyton scratched her head in frustration.

Across Minnesota on Thursday, reactions to the Supreme Court's historic health care ruling varied widely -- reflecting the diverse circumstances in the state and the range of opinions toward the U.S. medical system.

While the battle over health reform seems destined to enter a new phase politically, the court's ruling is already affecting tens of thousands of Minnesotans. Some are furious, some resigned, some ecstatic. Here are the reactions of five people intimately touched by the law.

Feeling healthy, less wealthy

Devin Wiley, who installs security cameras and servers for a living, considers the ruling a disappointment.

Wiley rarely gets sick and hasn't seen a doctor in more than a year. To him, health insurance is an unnecessary expense. Premiums of $300 to $400 a month represent money that he could spend building his business.

"I don't think it's right to require people to buy health insurance," he said. "I think we're taking too many steps forward with so much government intervention."

Wiley often travels from his home in River Falls, Wis., for his work, going as far as Winona. "There is money in this business, but it takes time to build up to that," he said.

Wiley lost health insurance when he lost his full-time job last year. He used to earn $32,000 a year. Since January, he's made less than half that as a subcontractor.

Wiley acknowledged that his job can be dangerous. He sometimes climbs 8- to 10-foot ladders and squeezes himself into ceilings to work with cables. He also drives a lot, which raises his chances of getting into a car accident.

"I just take that risk," Wiley said.

WENDY LEE

Easing a student's anxiety

For Abby Schanfield, the ruling was a godsend.

Schanfield, who grew up in Golden Valley, was born with toxoplasmosis, a parasitic infection that her mother unwittingly passed on during pregnancy. Without the Affordable Care Act, she said, her chances of buying insurance on her own were slim to none.

The law, among other things, says that as of 2014 insurers can no longer turn away people like her with preexisting conditions.

"I understand why businesses don't want to insure people like me," she said, "because I'm extremely expensive."

Schanfield's illness set the stage for lifelong medical problems; she had her first brain operation at 10 months, her last one in January. At 17, she lost sight in her left eye.

Most kids never think about health insurance; Schanfield worried for years what would happen when she was no longer covered by her parents.

"These are things that healthy people don't quite understand," she said.

Now, even though she graduates from the University of Minnesota in December, she can stay on her parents' policy until she is 26 and fend for herself after that.

Schanfield says the new law isn't perfect; she'd rather see universal health care. But as a volunteer with TakeAction Minnesota, she's spoken out in favor of the law locally and nationally. "It's not a policy issue; this is seriously people's lives," she said.

MAURA LERNER

Uninsured at 62

"Yes! Yes!" Jeannie Gatlin exclaimed when she heard about the ruling Thursday morning.

Gatlin, 62, lost her health insurance in February after being laid off. She now has two-part time jobs, but neither offers coverage. She has a history of diabetes and high cholesterol and quit smoking five years ago.

"It's going to help people like me ... [who] can't afford insurance," said Gatlin, who was waiting to have "intense" chest pain checked out at United Family Medicine, a community health center in St. Paul.

Gatlin is one of about 490,000 Minnesotans without health insurance, according to the latest estimates by the Minnesota Department of Health.

The court's decision will give these patients options they wouldn't have without the Affordable Care Act, said Jaeson Fournier, chief executive officer of West Side Community Health Services, which serves almost 18,000 uninsured patients each year.

Nationally, about 26 million non-elderly uninsured people are expected to obtain coverage through an expansion of Medicaid, the state-federal program for low-income families. Another 18 million are expected to get coverage from their employers or by buying it, using federal subsidies, on soon-to-be-created health insurance exchanges.

DANIELA HERNANDEZ

Franchisee figures big costs

When Nancy Peyton learned the law had been ruled constitutional, her first thought turned to hiring a consultant.

"I can't even begin to figure out how much it's going to cost me," said Peyton, who owns 15 Great Clips franchises in the Twin Cities area.

With more than 165 employees spread across multiple salons, Peyton is considered a large employer by the standards of the federal law. That means she'll have to provide a certain level of insurance to her workers -- either through group coverage or by giving them a stipend to shop on new state-run exchanges -- or else pay a penalty.

"It could double the cost of my health insurance," Peyton said. "That's probably going to mean a price increase, which I haven't done for nine years."

Peyton currently offers to pay half of her employees' health care premiums, about $400 a month for a basic plan. But many of her employees work part time or tell her they could get better care if she didn't offer insurance, which would allow them to qualify for MinnesotaCare, a state program for low-income workers.

Critics of the heath overhaul say businesses such as Peyton's will have the hardest time living up to the law's provisions. They're not big enough to have human resources departments, and they compete in retail, hospitality or service industries, where wages are relatively low and many workers are part time.

"I've provided insurance for 30 years," Peyton said. "I feel like I'm doing a stewardship. But this is a tax increase. There are no freebies."

JACKIE CROSBY

Retired, with high drug costs

For Donald Rust and his wife, Sharon, who spent more than $5,000 last year on medications, the Supreme Court decision meant the peace of mind of keeping a Medicare benefit that has cushioned them from rising drug costs.

Among about 800,000 Minnesotans on Medicare, that provision saved $37 million last year for those who hit the "doughnut hole," a gap in prescription coverage where the patient's out-of-pocket costs can skyrocket.

"I think we were just a little worried it might go away," said Rust, 74, a machinist who was forced to leave work at age 52 when he became disabled. "We hit that doughnut thing last summer, and we're about there again."

Now unable to walk, he entered hospice care in Rosemount two weeks ago with chronic obstructive pulmonary disease.

Last year, with 20 prescriptions between them, Rust hit the doughnut hole in July and his wife reached it soon after.

But it could have been worse. Under the Affordable Care Act, drug companies in 2011 had to offer discounts to people in the doughnut hole. This year the discounts increased, and by 2020, the doughnut hole is scheduled to disappear.

The federal law also expanded coverage of some preventive care for people on Medicare, such as annual wellness doctor visits and screenings for such conditions as cancer and diabetes.

"We don't need any additional costs now," Rust said. "That decision today, that's a pretty big thing, I guess."

WARREN WOLFE