Alan Sorkowitz of Tucson, Ariz., had been planning a road trip to see family this summer, but now that it seems the Supreme Court might strike down the health care reform law, his travel plans are in doubt.
"If, all of a sudden, we may be faced with health premiums that are God knows what," Sorkowitz said, "it throws all of our budgeting, all of our plans into limbo."
Sorkowitz and his wife, Michele Rappaport, both 59, enrolled last year in a new government program for the uninsured called the Pre-Existing Condition Insurance Plan (PCIP). The Affordable Care Act created the program in 2010. It's open to any U.S. citizen with a medical condition who has been uninsured for at least six months. The program has not performed well, enrolling fewer people and costing more money than expected.
The Obama administration has described PCIP as just a "bridge" to 2014, when the health care law bans the insurance industry's discrimination against adults with pre-existing conditions. If the Supreme Court strikes down the law, the PCIP may be a bridge to nowhere.
"It's a lot to try to plan your life when this health care thing is just a great big question mark," Sorkowitz said.
Officials with the Arizona PCIP did not immediately respond to a request for comment. The U.S. Department of Health and Human Services, which oversees the program, declined to comment on what might happen to the PCIP's 50,000 enrollees if the Supreme Court rules unfavorably on the health care law. The Obama administration has insisted that it has no backup plan.
During oral arguments this week, enough of the nine justices expressed skepticism about the constitutionality of the law -- particularly its requirement that every American purchase insurance or pay a penalty -- that many observers think the court might strike down part or all of the law in the coming months.
Such an outcome would be especially disappointing to Sorkowitz and Rappaport, who went through a harrowing ordeal just to qualify for the new program. In 2010, the retired couple saw their monthly health insurance premiums jump from $1,700 to nearly $2,500. Worried they'd have no money to pay for things like food and shelter, at the beginning of 2011 they dropped their policies and spent six months uninsured so they could qualify for the PCIP. During that time, they limited their hiking, biking and dancing so as to reduce the risk of costly injuries.
The plan worked. Sorkowitz and Rappaport enrolled last year, and their respective monthly premiums are $450 and $334. The program caps out-of-pocket costs and has lower deductibles than anything available to them as individual consumers.
"It's been great," Sorkowitz said. "All of my doctors have been participating. They're included in the network, and it's just given us tremendous peace of mind."
To make sure their plan was feasible, the couple consulted with their congressional representative -- at the time, Rep. Gabrielle Giffords (D-Ariz.). Her staffers assured them that the $5 billion program, which was modeled on high-risk insurance pools already operating in 35 states, was not controversial since Republicans had supported it. In fact, expanding high-risk pools was a central part of Republicans' alternative plan for health care reform.
But past Republican support for the PCIP isn't much comfort to Sorkowitz and Rappaport now. Senate Minority Leader Mitch McConnell (R-Ky.) told Bloomberg News that Republicans would be happy to repeal Obamacare without replacing it. McConnell mentioned the possibility of rewriting medical malpractice laws and allowing consumers to purchase insurance across state lines, but he didn't say anything about high-risk pools.
Sorkowitz said he is hoping the Supreme Court's swing vote, Justice Anthony Kennedy, will recognize that the insurance market is different from other markets and that Congress didn't overstep its authority with the Affordable Care Act. He said he was heartened by Kennedy's comment Tuesday that people who don't buy health insurance affect "the rates of insurance and the costs of providing medical care in a way that is not true in other industries."
"Everybody needs to see a doctor at some point or another," Sorkowitz said. "Insurance is something you take out hoping you're not going to have to use it. You hope your house won't burn down, your car won't be in an accident. You hope you won't get sick, but you will. You're not protecting against a potentiality; you're trying to protect against a certainty."