The constitutionality of the federal health law is intact, but less clear is the effect of the U.S. Supreme Court's decision on some of Arizona's poorest residents.

The health-care law had called for states to expand Medicaid, which is for low-income Americans, including Americans who make up to 133 percent of the federal poverty level - about $30,000 for a family of four.

Arizona joined 25 other states in challenging the law.

Due to state budget cuts, Arizona has reduced enrollment in its Medicaid program, the Arizona Health Care Cost Containment System, or AHCCCS, which covers about 20 percent of state residents.

Among those who lost AHCCCS coverage in the last two years are single, childless adults and children of low-income parents who earn too much to qualify for Medicaid.

Tucson resident Mareya Bullard is one of the single, childless adults who did not qualify for AHCCCS and could not afford any other insurance. Bullard, 34, was diagnosed with breast cancer in March 2011 and has been relying on fundraising efforts by friends and relatives to pay her bills.

"I got $13,000 from a fundraiser in February and I use that for my medical expenses. It's starting to run out, but we're having a golf tournament in a couple of weeks," Bullard said. "I've kind of accepted I'll never get back on it (AHCCCS). I just think there's no way."

Thursday's Supreme Court decision said the law's expansion requirements were OK, but only if states have the option to opt out.

That means, essentially, that states will be able to decide whether they will go ahead with the Medicaid expansion, said AHCCCS spokeswoman Monica Coury.

"At this point, we will review the court's decision in detail and determine what options that presents to the state. We will work together with the governor, state policymakers and stakeholders as we move forward in the coming months," Coury said. "The state needs to look at what its options are."

Bullard, meanwhile, is hoping to qualify for a program for people with pre-existing conditions created by the federal health law in 2010. Arizona's Pre-Existing Condition Insurance Plan was created under the federal Affordable Care Act as a bridge to 2014, when under the law insurers no longer may deny coverage to people with pre-existing conditions such as cancer, diabetes and asthma.

"It will be nice to have health care," Bullard said.

Contact medical reporter Stephanie Innes at or 573-4134.