JOPLIN, Mo. — Piper Spiva, of Seneca, has not had health insurance for about eight years because she hasn’t been able to afford it.

“After my bills are paid, I don’t have any money left” for insurance, she said Thursday while waiting to see a counselor at the Community Clinic in Joplin.

Spiva is one of millions of Americans targeted by President Barack Obama’s health care overhaul, most of which was upheld in a 5-4 decision Thursday by the Supreme Court. The law aims to broaden health coverage for uninsured Americans. The most controversial piece of the law mandates that nearly everyone buy health insurance or pay a penalty.

More than eight in 10 Americans already have health insurance. But for most of the 50 million who are uninsured, the ruling offers the promise of guaranteed coverage at affordable prices. Lower-income and many middle-class families will be eligible for subsidies to help pay premiums starting in 2014.

There’s an added safety net for all Americans. Starting in 2014, insurance companies will not be able to deny coverage for medical treatment, nor can they charge more to people with health problems. Those protections will be available to all, including people who get laid off or who leave a corporate job to launch a small business.

Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no co-payments for preventive care.

Illegal immigrants are not entitled to the new insurance coverage under the law, and they will remain one of the biggest groups uninsured.

Many Joplin-area residents said Thursday that they were unsure how the overhaul will affect them or whether they eventually will buy health insurance, as will be required. And many said affordability would be the key factor influencing their decision to buy insurance.

Spiva, who is self-employed at an in-home day care, said that thanks to her grandparents, she visits a doctor monthly and gets prescription medications. Her husband, she said, never sees a doctor because he is also uninsured.

She said she would prefer to have her own insurance plan — but it would have to be cheap enough.

“If it’s something that is offered and I can afford, then yeah, most definitely,” she said. “I’ll definitely look into it.”

After almost nine years of being uninsured, Stormy Coonce will be eligible for health insurance through her job beginning Aug. 1. But she said Thursday that she is still skeptical about how that will affect her finances, which are the reason she has gone uninsured for so long.

“I’m looking forward to having it, but if I can’t pay my bills, then it won’t do any good,” she said while visiting a chiropractor at the Community Clinic.

Because her 11-year-old daughter is covered by Medicaid, she plans to include her uninsured husband on her new plan in August — but only if they can afford it.

“If it gets to be more than we can pay, it’ll just be me,” she said.

Mark Oxford, of Carl Junction, works as a caregiver and is uninsured partly by choice. He said he does not want to be forced to buy health insurance for himself. His wife is also uninsured; the couple’s four children are covered by Medicaid.

“Will I be getting insurance? I don’t know,” he said while sitting in the lobby of the Community Clinic, where he was getting a cortisone shot for his knee. “I don’t really think that far ahead.”

Community clinics have been seeing the effects that being uninsured can bring. At least once a week, the medical staff at the Community Health Clinic of Southeast Kansas must tell a patient that he has cancer or heart disease, and that it’s been there a long time.

“It may be beyond the point of fixable and didn’t need to get to that point,” said Krista Postai, the center’s CEO. “I get calls every day from people with no insurance coverage who have found out they need to see a doctor and can’t get in, can’t afford the $75 upfront.”

The clinic opened in Pittsburg in 2003 with a patient load of 4,000 per year. Satellite offices now serve patients at seven other sites throughout Southeast Kansas, one of the poorest areas of the state. The center’s patient load has grown to 25,000 annually; at the Pittsburg site, the center serves one in four people in Crawford County.

Of those the clinic serves, 48 percent are uninsured.

“The vast majority of those patients are working; they are employed,” Postai said. “People in higher income brackets who don’t have to choose between making a house payment and a hospital payment maybe aren’t aware of how things are. There is a gap in understanding what it’s like to be barely making ends meet, living from paycheck to paycheck.”

Thirty-five percent of those the clinic serves are covered by Medicaid, primarily pregnant women, children and some disabled adults. An additional 6 to 7 percent are on Medicare. The remainder are commercially insured patients.

“It’s gotten worse. The last three years, people who used to be able to afford to go to the doctor can no longer afford to go,” Postai said. “We are seeing a new wave of people who can’t afford their percentage or their co-pay.”

Postai said the clinic staff’s first reaction Thursday morning to the Supreme Court’s ruling was relief.

“Hopefully it will redirect people away from (hospital) emergency rooms,” she said, giving the uninsured and underinsured the means to see a medical professional ahead of a health problem becoming acute.



STAFF WRITER ANDRA STEFANONI and The Associated Press contributed to this report.