Lashonda Edwards

Lashonda Edwards of Windsor Mill, lost her health coverage when she was laid off from her receptionist job in 2010. (Algerina Perna, Baltimore Sun / June 26, 2012)

States including Maryland can move with more certainty to insure their poor, and the federal government can require others to buy health coverage after the Supreme Court upheld President Barack Obama's landmark health care law Thursday.

The highly anticipated decision is expected to add millions to the health insurance rolls, including Lashonda Edwards of Windsor Mill, who lost her coverage when she was laid off from her receptionist job in 2010.

"I should be able to get the care I need," she said. "Health insurance should be for everybody because everybody needs it."

The court case had stalled efforts across the country to fully implement the Affordable Care Act and had called into question benefits already put in place, such as coverage for young adults on their parents' policies, more generous benefits as caps on coverage were lifted, and insurance for children with pre-existing conditions.

Maryland had banked heavily on the law's withstanding judicial scrutiny, moving ahead of other states in creating an exchange where individuals and small businesses could buy coverage, and expanding its Medicaid rolls.

The state's leaders said the high court's decision gives them the authority and funding to finally implement provisions of the law, which mostly takes effect in 2014. In the first year, they estimate that one-third of 750,000 uninsured residents will gain coverage.

"Today is a big victory for millions of Americans who don't have access to health care and will be able to afford care," said Lt. Gov. Anthony G. Brown, who has led the state's reform efforts. "This will make a difference in the lives of that 26-year-old with a pre-existing condition or that person who couldn't afford care. No one will worry that the cost of care will drive them into bankruptcy. Those days are over."

Critics of the law, including 26 states that brought the Supreme Court case as well as local conservatives, expressed disappointment with the ruling. Some called for Congress to repeal the entire law, and others denounced it as a new tax.

The law hinged on an "individual mandate," or a requirement that all Americans buy health insurance or face a penalty. The court, led by Chief Justice John G. Roberts Jr., ruled 5-4 that Congress had the power to implement such a tax. The challengers had said the mandate was an unconstitutional overreach.

Congress also authorized the creation of statewide exchanges where the nation's 50 million uninsured Americans could buy coverage, many with the help of federal subsidies included in the law. Maryland stands to gain more than $400 million through these subsides, according to local estimates.

Others living under 138 percent of the federally established poverty level — about $30,000 for a family of four — will gain coverage through an expansion of Medicaid, though the court limited Congress' ability to force the states to add to their rolls. The court said the states could reject new federal money for Medicaid without jeopardizing the funding they already receive for the federal-state program.

Edwards expects to gain coverage either through the Medicaid expansion or with a subsidy on the exchange.

The 29-year-old was born with sickle cell anemia but can't get proper treatment because her insurance is too limited. It does not cover the specialists she needs to control her disease, which she fears will grow worse and lead to expensive emergency room visits.

"I was told to see a hematologist, but it's $200 just for one visit, not including the tests," she said.

Rodney Williams, 51, also expects to gain coverage with the court decision, which means no more non-emergency trips to the hospital for care.

The Baltimore man lost his job two years ago as a case manager at a social-services organization, along with health care for himself and his wife, Darline. Both have pre-existing conditions and have limited options for treatment.

"Health care is so important," he said. "It's scary to watch your health decline. And we know it's not ideal, but we've been using the emergency room as a conduit to care. That puts the burden on the taxpayers. … Now we are optimistic we can get good insurance."

There are plenty of Marylanders and Americans in the same situation as Edwards and Williams, said Kathleen Westcoat, president and CEO of HealthCare Access Maryland, which helps people connect with coverage. Once they lose their jobs, they still may not qualify for Medicaid or for private insurance because of a pre-existing condition.

HealthCare Access' client list jumped to 125,000 this year from 90,000 just a couple of years ago because of the downturn in the economy, she said.