Mary Duffy is worried that if the Supreme Court strikes down health care reform, she will lose her health insurance.
Duffy, who is 62 and lives in Redwood City, Calif., signed up for the Affordable Care Act's insurance plan for people with pre-existing conditions as soon as it launched in 2010.
It's not clear what would happen to the 50,000 people enrolled in the Pre-Existing Condition Insurance Plan, as it is known, if the nation's highest court rules unfavorably on health care reform. On Wednesday, the court concluded three days of oral arguments on the new law, and to many observers, five of the court's nine justices seemed deeply skeptical of its constitutionality.
For Duffy and people like her, there's real cause for concern. The conservatives on the Supreme Court pushed hard against the Obama administration's defense of the so-called individual mandate in the law, which will require nearly all U.S. residents to obtain health insurance coverage starting in 2014. The Court could strike only the mandate or other specific provisions of the law, but justices could also overturn the entire thing, which would eradicate the promise of benefits for people with pre-existing conditions.
Duffy figures that's bad news for her, since her status as a three-time cancer survivor makes her virtually uninsurable. The PCIP, which is open to anyone who's been uninsured for at least six months and has a pre-existing condition of any kind, covers Duffy for $557 a month.
"I'm very nervous," she said. "I think the insurance companies, certainly those involved in PCIP, would be very quick to rearrange our premiums. Why would they not be? Within 90 days I'll be getting an extraordinary premium increase and I'll be dropping the insurance."
The Obama administration, for its part, has said repeatedly that it has no backup plan if the law is partially or completely struck down. A spokeswoman for the U.S. Department of Health and Human Services did not immediately respond to a request for comment on what would happen to PCIP enrollees.
After losing her job in 2008, Duffy maintained her company health insurance for 18 months via the government's COBRA program. She has since launched her own food service consulting business but has no idea how she'd buy insurance if the government weren't making it possible.
Duffy said that in December, she started feeling bad and having trouble breathing. She called her doctor, who told her to go immediately to an emergency room in case she was experiencing symptoms of complications from a recent hysterectomy. It turned out to be the start of a bronchial infection, not a complication from surgery, but Duffy wouldn't have known either way if she hadn't had insurance.
"My god, I never would have gone if I didn't have PCIP," she said.
The health care reform law is supposed to make it possible for Duffy and others with pre-existing conditions to obtain good, affordable health insurance beginning in 2014. From that year on, all legal U.S. residents who don't get insurance at work or through a government program like Medicare or Medicaid will be able to shop for plans on state-based "networks." The plans on those networks can't turn anyone away, are limited in how much extra they can charge older or sicker people, and must cover "essential health benefits" as defined by state and federal guidelines.
That system is in jeopardy because of the Supreme Court case. If the justices repeal the entire law, the new insurance market will never be created and consumer protections already in place, such as a rule against refusing to cover children with pre-existing conditions or a prohibition against dropping customers when they become ill, will go away. Another possible outcome would be the elimination of only the individual mandate, which would disrupt the health insurance market but still require plans to accept people with pre-existing conditions and offer subsidies to low- and middle-income people.