Republicans showed no sign they would heed him. In South Carolina, where about 15 percent of residents lacked insurance in 2013, Governor Nikki Haley said in a statement that the state will continue to work around Obamacare “as best we can.”

Ohio Governor John Kasich, a two-term Republican exploring a presidential run, expanded Medicaid but didn’t open an insurance exchange. About 13 percent of state residents lacked insurance in 2013.

“The law has driven up Ohio’s health insurance costs significantly and I remain convinced that Congress should repeal it and replace it with something that actually reduces costs,” Kasich said in a statement. “In the meantime, we’re developing innovations to help reduce the law’s ongoing negative impact.”

For people like Maluf, the Miami Pilates instructor, the politics were unimportant. The ruling offered only relief, and a continuation of her $500 monthly subsidy.

“Not even if I squeeze, I do not have $860 every month to pay for health care,” she said. Had the court ruled against the law, “I would go back to nothing, back to everyday scared that I would have something happen.”

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