SPRINGFIELD, Ore. - Asthma and allergies give Springfield resident Victoria Zilm some trouble.
"I need medication for asthma," she said. "If I don't have it, then I have to go to the hospital to get breathing treatments, which is ... I just can't afford it."
Zilm has a job - but doesn't have insurance.
"I can't afford it," Zilm said. Instead, Zilm visits the Volunteers in Medicine clinic in Springfield for free.
The clinic serves uninsured, low-income people.
With the Supreme Court stamp of approval on the heart of the Affordable Care Act, Zilm must carry coverage by 2014 or face a penalty.
"I would pay for it because I have to," she said. "I mean, it just means cutting somewhere down the lines."
People like Zilm - who have a job but no health insurance - can buy coverage on the insurance exchange.
If you earn more than $88,200 with a family of four, or $43,320 if you're single, you will be responsible for your premiums and out-of-pocket expenses.
But if you make less than that, you will be eligible for help through a tax credit to offset those costs.
Thursday's big decision also gives states the option to expand the number of people who receive Medicaid (in Oregon, the Oregon Health Plan is the same as Medicaid).
"It's a tremendous win for Oregonians," said Bruce Goldberg, director of the Oregon Health Authority. "We have over 600,000 Oregonians who today don't have basic health care coverage, and this creates an opportunity for additional people in Oregon to get vital health care coverage."
Currently, a lottery determines who will be part of the Oregon Health Plan. But if the state opts to expand the Oregon Health Plan, federal dollars will pay for the care of thousands more for the first two years.
"The lottery would go away. Everybody under 133 percent of poverty would be eligible for the Oregon Health Plan," said Goldberg.
He said the poverty threshold is about $22,000 per year for a family of four.
But for those that are above that poverty threshold, carrying health insurance is still a difficult balance.
"I just can't afford to pay out, but at the same time, I absolutely need the services. Without it, I suffer," said Zilm.
Goldberg said he expects the Oregon legislature to take up the issue of whether or not to expand OHP during the next session.
For other patients at the Volunteers in Medicine clinic, response to the upheld mandate was mixed.
"I think this is an historic day, this is just the most awesome thing for poor people like us," said uninsured Cottage Grove resident Kathleen Vineyard. "It is wonderful that we're going to have health insurance, that everybody is going to be able to go to the doctor."
"I just don't think that people should be made to do something that they don't want to do," said Veronica Jones, an uninsured resident of Springfield. "If they can't afford it, why force them to do something they can't afford?"