Amy Moreno-Sills loves sustainable farming. It's a passion. A core of her beliefs. The life work of her and her husband, Augustin.

And she faces possibly giving it up to get health insurance.

Augustin 29, and Amy, 37, are both managers for  produce farms in Pierce County — earning about $60,000 annually as a couple, an income that just dropped significantly with the recent brth of their second child, Hector. With a 4-year-old daughter Gabriela, Amy  had to switch to a part-time administrative job at Terry's Berry Farm — cutting more than $15,000 from the couple's annual income..

So far, the family has lived on the edge of having adequate health insurance. In fact, maybe beyond the edge.

Neither parent has health insurance. Particularly with day-care costs taking up a lot of their income, they can't afford it. "It's super-pricey. What are we gonna have to give up to have health insurance?" Amy said recently. 

The Washington Community Action Network and Northwest Health Law Advocates, both based in Seattle, point to a recent Urban Institute study (the institute is a Washington D.C.-based think tank tackling social research work) that concluded that the federal Affordable Care Act — also know as "Obamacare" — would provide health insurance for an extra 75,000 to 110,000 people in Washington, allowing people like the Moreno-Sillses to stay in farming. 

"It reaffirms what we've beeen saying all along," said Rachael DeCruz, communication coordinator for Washington CAN.

A key factor will be how the U.S. Supreme Court rules court on a legal challenge to the Affordable Care Act — a challenge in which  Washington Attorney General Rob McKenna has joined some 20 other states' attorneys general in pursuing. 

Amy Moreno-Sills got through pregnancy on Medicaid, which covers a pregnancy in her income bracket from beginning through two months after birth. Gabriela is on, with Hector to follow along, the state's Apple Program for Kids, which is a group of state health insurance programs for children only for families beneath certain income levels. The Moreno-Sills famliy's income is slightly below that  cut-off level.

The couple themselves applied to the state's Basic Health insurance program, but never got beyond the waiting list. It will likely be a long wait. The program serves about 34,000 people with a waiting list of roughly 150,000. 

Their employers, tiny farm operators, can't afford to provide health insurance. "Sustainable farming — it's not a lucrative business," Amy said. 

Bottom line is that Amy and Augustin have gambled that they would be healthy without picking up significant medical care costs beyond their children. So far, they've lucked out.

But the couple has decided they can't gamble any more, and, when interviewed recently, Amy was already thinking about getting out of farming to get a job that provides health insurance.

"At my age and having kids, it'd be irresponsible not to have health insurance. I'll be one of the people getting kicked out of farming because of a health care kind of thing. I don't want to be a burden on welfare while being a farmer," she said. "To me, it would be heartbreaking to have to leave farming." 

Meanwhile, with the U.S. Supreme Court set to rule as early as Monday (June 25), many involved with health issues are looking toward the nation's capital. "We're anxiously awaiting their decision," said Washington CAN's DeCruz.

The law is supposed to go into general effect in 2014. It could add another potential 500,000 Medicaid patients to the roughly 1.2  million Washingtonians currently on Medicaid, according to the state Health Care Authority.