Sarah Lewis is fed up with American health care: "I've completely removed myself from the system," she said. "I don't want to be a patient anymore."

Lewis, a 55-year-old single mother of two daughters, has been through the wringer. It started with a diagnosis of anal cancer in September 2010. Then came the denials from her insurance company, the fights with the insurer, the hospitals and the doctors over money, and the debt collectors chasing at least $20,000 that she owes. Not to mention the grueling chemotherapy and radiation therapy that, so far, have saved her life. She ultimately gave up on health insurance this year.

"I'm hoping that I don't get sick again or anything happens because I’m trying to stay out of the system because the system failed me," said Lewis, who lives in Dover, N.H., and was self-employed as an book indexer but has not worked since she got sick.

The system will likely fail Americans like Lewis again and again, if the Supreme Court overturns President Barack Obama's health care reform law next week. Without its rules that will prohibit health insurance companies from discriminating against people with pre-existing conditions starting in 2014, Lewis and others who are sick or have suffered serious illnesses in the past can be shut out of the health insurance market. As many as 122 million working-age Americans have pre-existing conditions that could get them rejected by health insurance companies, according to a Government Accountability Office analysis issued in March.

When Lewis got cancer, she dumped her health insurance -- which she describes as "bogus" and "useless" -- and enrolled in New Hampshire's state plan for people with pre-existing conditions. Even thought it's $1,000 a month and has a $2,500 annual deductible, she said it was better than the private health insurance plan she had before. But it still didn't cover all of the bills from her treatments and, out of frustration, she dropped the plan two months ago. She knew she would get hit by huge bills if she got sick again. "It's like I'm flirting with disaster," she said.

President Barack Obama's health care reform law aims to ease the way for people like Lewis by implementing new regulations and financial assistance. The law will forbid health insurance companies from turning away people with pre-existing conditions or kicking them out when they become ill, and established a temporary program called the Pre-Existing Condition Insurance Plan. Beginning in 2014, Obama's law will also expand coverage to about 30 million uninsured people by setting up "exchange" marketplaces where insurance companies compete for business, providing tax credits to help pay for coverage for people earning up to four times the federal poverty level, and expanding Medicaid to include people who earn 133 percent of the poverty level or less.

"It would be better for me and I would get coverage and, hopefully, it would be more affordable," Lewis said. "Someone who's gotten cancer [today] has no options."

The future of those plans now lies in the hands of the Supreme Court, which is expected to issue a decision as soon as Monday about whether elements of the law are unconstitutional.

The Justices could uphold the law, strike down the whole thing, or eliminate parts of it, such as the Medicaid expansion, the individual mandate that most Americans must obtain health coverage, and the rules protecting people with pre-existing conditions.

Nearly 50 million Americans are uninsured, and the numbers are climbing. Fewer companies are providing workers with health benefits. Health insurance plans cost more every year, even though benefits are getting less generous. And American households, companies and taxpayers shelled out an estimated $2.7 trillion last year for health care that is reportedly not as good as the care given to citizens of other nations.

If the health care reform law goes down, so does the best chance yet to stem the rising tide of Americans without health insurance, said Andrew Hyman, director of health care coverage for the Robert Wood Johnson Foundation, a health care research institution in Princeton, N.J.

"We go back to what the problems were that brought us here in the first place. We go back to the fact that the number of uninsured is going to continue to go up, and it'll go up at greater rates because health spending is going to continue to go up," Hyman said.

Mitt Romney, the former Massachusetts governor and Republican presidential nominee, has hinted he has a plan to protect people with pre-existing conditions, but it's clear he would not go as far as Obama's law. He has described an approach that would leave health care up to the states, and his proposal appears to apply to people moving between jobs, which would not include self-employed workers like Lewis.

Several big health insurance companies have pledged to retain parts of the health care reform law if it gets overturned, but stopped short of saying that they would accept adults or children with pre-existing conditions. And while congressional Republicans are mulling some sort of legislation to replace the law, their plans don't seek a broad expansion of insurance coverage. Legislative gridlock also stands in the way.

"It will be quite some time before this highly polarized Congress is able to deal with health reform again," said Drew Altman, president and CEO of the Henry J. Kaiser Family Foundation in Menlo Park, Calif. "You cannot cover the uninsured without spending big money," which Republicans don't want to do, he said.

Meanwhile, Martha Olson, 56, can't do anything but wait. "It is kind of scary and it's kind of upsetting but right now, it's out of my hands," said Olson, who is self-employed as a rental property manager in Knoxville, Tenn. Olson has diabetes and is covered by the Pre-Existing Condition Insurance Plan. That program was meant as a bridge to 2014, when Olson and people like her would be able to buy health insurance on the exchanges despite their illnesses.

If the Supreme Court strikes down the law, "I'm not sure what I'd do," Olson said. "I don't think private insurance is an option for me."

Related on HuffPost:

Below, the history of the legal challenge against Obama's health care reform law:

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  • Round 1: The District Courts Divide

    U.S. District Judge George Caram Steeh, a Clinton appointee sitting in the Eastern District of Michigan, released the first major Affordable Care Act decision in October 2010. In <a href="http://www.mied.uscourts.gov/news/docs/09714485866.pdf" target="_hplink"><em>Thomas More Law Center v. Obama</em></a>, Steeh sided with the government to hold the law constitutional. "The decision whether to purchase insurance or to attempt to pay for health care out of pocket is plainly economic," Steeh wrote. "These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers and the insured population, who ultimately pay for the care provided to those without insurance."

  • Round 1: The District Courts Divide

    At the end of November 2010, another Clinton appointee, Judge Norman Moon of the Western District of Virginia, agreed with Judge Steeh. In <a href="http://www.vawd.uscourts.gov/OPINIONS/MOON/LIBERTYUNIVERSITYVGEITHNER.PDF" target="_hplink"><em>Liberty University v. Geithner</em></a>, Moon wrote that "by choosing to forgo insurance, plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance."

  • Round 1: The District Courts Divide

    In December 2010, however, Judge Henry Hudson, a George W. Bush appointee sitting in the Eastern District of Virginia, ruled otherwise. In <a href="http://media.washingtonpost.com/wp-srv/metro/docs/Hudson_ruling.pdf?hpid=topnews" target="_hplink"><em>Virginia v. Sebelius</em></a>, Hudson struck down the individual mandate, writing that "an individual's personal decision to purchase -- or decline to purchase -- health insurance from a private provider is beyond the historical reach of the commerce clause." Importantly, Hudson also held that the individual mandate is severable from the rest of the Affordable Care Act, which means a court can strike it down while allowing the law's remaining provisions to stand.

  • Round 1: The District Courts Divide

    Finally in January 2011, Judge Roger Vinson, a Reagan appointee in the Northern District of Florida, evened the score but upped the ante. In <a href="http://www.scribd.com/doc/47905937/Health-Care-Ruling-by-Judge-Vinson" target="_hplink"><em>Florida v. Department of Health and Human Services</em></a>, not only did he strike down the individual mandate as exceeding Congress' power under the commerce clause, but he also took the whole health care law down with it. "The act," Vinson wrote, "like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker."

  • Round 2: The Appeals Courts Split

    In June 2011, the U.S. Court of Appeals for the 6th Circuit <a href="http://www.ca6.uscourts.gov/opinions.pdf/11a0168p-06.pdf" target="_hplink">upheld, by a 2-1 vote</a>, Judge Steeh's decision in <em>Thomas More Law Center</em>. Circuit Judge Jeffrey Sutton, a George W. Bush appointee, was the first judge chosen by a Republican president to reject the commerce clause challenge, writing that "no one must 'pile inference upon inference' to recognize that the national regulation of a $2.5 trillion industry, much of it financed through" national health insurance companies, "is economic in nature." He joined Judge Boyce Martin, a Jimmy Carter appointee, in the majority, while Judge James L. Graham, a Reagan appointee, wrote a vigorous dissent. In August, the 11th Circuit, reviewing <em>Florida v. HHS</em>, <a href="http://www.uscourts.gov/uscourts/courts/ca11/201111021.pdf" target="_hplink">produced a near mirror-image result</a>. Judge Frank Hull, a Clinton appointee, joined the Reagan-appointed Judge Joel Dubina to affirm District Judge Vinson's decision to strike down the individual mandate. Judge Stanley Marcus, a Clinton appointee, dissented, quoting heavily from Sutton's 6th Circuit concurring opinion. All three 11th Circuit judges found the mandate severable from the rest of the Affordable Care Act, reversing District Judge Hudson's decision to deep-six the entire law. Both appeals courts unanimously rejected the government's taxing power argument, insisting that if Congress had thought the penalty for not buying insurance was a tax, it would have explicitly called it a tax. On this issue, a third appeals court created another circuit split.

  • Round 2: The Appeals Courts Split

    In September 2011, the 4th Circuit dismissed two challenges to the health care law, finding that the plaintiffs did not have standing to bring their lawsuits. The panel did find that <a href="http://pacer.ca4.uscourts.gov/opinion.pdf/102347.P.pdf" target="_hplink">the penalty for not buying insurance was a tax</a> -- a good sign for the government's defense of the law. But rather than hold that the individual mandate was a valid exercise of Congress' taxing power, Judges Diana Gribbon Motz, a Clinton appointee, and James Wynn, an Obama appointee, said that another federal law, the Anti-Injunction Act, prevented the plaintiffs from challenging the mandate until they actually had to pay the tax -- which cannot happen before the provision goes into effect in 2014. The third judge, Obama appointee Andre Davis, said he wouldn't have dismissed the lawsuits and would have upheld the individual mandate based primarily on commerce clause ground. Regardless of the methodology, the Obama administration was now winning 2-1 in the courts of appeals against the Affordable Care Act's challengers.

  • Final Round: The Supreme Court Takes The Case

    The Supreme Court is most likely to choose to hear a case for one of three reasons: The constitutionality of a federal law hangs in the balance, the circuit courts disagree on the same issue, or the solicitor general advises the Court to take the case. Cases that fulfill just one of these considerations stand a good chance of reaching the justices. The health care cases had all three. In November 2011, the justices <a href="http://www.huffingtonpost.com/2011/11/14/obama-health-care-law_n_1092387.html" target="_hplink">agreed to review</a> the 11th Circuit's decision. To signal how seriously it took the challenges, the Court soon thereafter scheduled six hours of oral argument to take place from March 26 to 28, 2012. Normally, even for blockbuster cases, the justices only allot one hour for oral argument.

  • Final Round: The Supreme Court Hears Oral Argument

    All eyes turned to the Supreme Court in late March 2012 when the justices heard oral argument and gave their first public hints of where they stood on the Affordable Care Act's constitutionality. On the first day, March 26, liberal and conservative justices alike <a href="http://www.huffingtonpost.com/2012/03/26/health-care-law-supreme-court_n_1373455.html" target="_hplink">showed little interest</a> in following the 4th Circuit's decision to throw out the challenge to the health care law on a technicality before ever reaching the constitutional merits of the individual mandate. That display of unity disappeared on Tuesday, March 27, as the Court took on the <a href="http://www.huffingtonpost.com/2012/03/27/supreme-court-health-care_n_1373469.html" target="_hplink">main event</a>: two hours of argument over the mandate. The Court's four Democratic appointees all appeared to find the mandate well within Congress' powers to regulate interstate commerce, as the 6th Circuit had held; the Court's five Republican appointees, in concert with the 11th Circuit, seemed to think otherwise. Only in the final moments did swing vote Justice Anthony Kennedy soften his tone by musing aloud whether the health insurance market is different enough, after all, to allow a mandate to prevent cost-shifting where it might not be permissible in another market. "[M]ost questions in life are matters of degree," he said. On Wednesday, March 28, the justices <a href="http://www.huffingtonpost.com/2012/03/28/health-care-case-supreme-court-john-roberts_n_1386692.html" target="_hplink">considered</a> what other parts of the Affordable Care Act would fall if they found the mandate unconstitutional. No majority emerged. Several justices agreed with the challengers that the whole law must fall. Several others agreed with the Obama administration that two key (and popular) provisions could not survive without the mandate. Still others indicated some sympathy for severing the mandate alone and allowing the rest of the law to stand. A decision is expected by the end of June.