Mary Duffy has been volunteering for President Barack Obama's reelection campaign in California's San Mateo County, talking to voters at fairs and supermarkets on Sunday mornings about why they should vote for the president.
People are surprised, Duffy said, that one of her talking points is herself.
"I say I'm protecting my health care," Duffy said. "The two words that scare me more than anything else in my life are 'President Romney.'"
Duffy has health insurance thanks to the Affordable Care Act, the health care reform law Obama championed. She is one of more than 86,000 Americans who have enrolled in the Pre-Existing Condition Plan, a health insurance program for people locked out of the individual insurance market because of conditions like diabetes and heart disease. Tuesday's presidential election could determine whether the program lives or dies.
The program is not terribly successful; far fewer people have enrolled than the hundreds of thousands the administration expected. Nearly 50 million Americans lack health insurance, and as many as 25 million of them have pre-existing conditions, according to an administration estimate.
The point of the Pre-Existing Condition Insurance Plan was to offer some immediate relief to the uninsurable, as the health care law's major reforms don't take effect until 2014. At that time, the PCIP will be phased out as insurance companies will no longer be allowed to discriminate against the sick, and everyone will be required to buy insurance or else pay a penalty. The law should eventually extend coverage to 30 million previously uninsured Americans.
Republican presidential nominee Mitt Romney has said he would repeal the law. He has also said he would allow people with pre-existing conditions to keep their insurance. His campaign did not respond to a query about what would happen to the PCIP under a Romney administration.
Olivia Pritchard, owner of a photography business in New Orleans, said she doesn't really know what to expect from Romney on health care, but figured he would find a way to squirm out of full repeal.
"I believe at this point he'll say anything, but I also think he's got a lot of people who are voting for him because he said he will repeal this," she said. "If he is elected I don’t think he’d have much of a choice but to repeal it -- and then re-enact 85 percent of it."
Pritchard, 31, said she'd been uninsured for nearly a year because of a benign tumor. She signed up for the PCIP in January.
People are only eligible for the program, which offers market-rate premiums and manageable deductibles, if they have been uninsured for six months. Confronted with unaffordable policies on the private insurance market, some people decide to gamble on spending half a year with no coverage in order to qualify.
Keith Colmar of Tustin, Calif., lost his job as a plumber in the summer of 2011. He said he could have continued his former company's health insurance policy via the federal government's COBRA program, but the monthly premiums would have been nearly $1,000. He received similar offers on the private market. Colmar, 61, took the PCIP gamble and won.
"I was able to go six months," he said. "Luckily, I didn't have any major health issues in that period."
Colmar, a lifelong Democrat, said Romney's health care plans frighten him, even if a President Romney would be unable to follow through completely with his campaign promise for lack of a Republican majority in the U.S. Senate. "The thing Romney says is on Day One he wants to repeal Obamacare. He's not going to repeal that whole thing, but he can sure muck it up."
A three-time cancer survivor, Mary Duffy lacked health insurance after losing her job in 2008. HuffPost has chronicled her quest for health insurance since 2009. She volunteered for Obama's first presidential campaign because of his promise to reform the health care system, spoke out at a town hall in favor of health care reform, waited nervously for the program to launch, and waited nervously once again for the Supreme Court's decision on the law's constitutionality.
Duffy, 63, now runs her own food service consulting company. She said that when she volunteers for the Obama campaign, people are surprised to hear she has health insurance because of Obamacare. "I didn’t know that it was working. How did you get that?" she said people tell her. "They know nothing about it. It’s 100 percent ignorance."
Despite disappointment that Obama did not deliver a more progressive package of reforms that included a public insurance option, Duffy said she is campaigning more vigorously for Obama this year than she did in 2008.
"I have no illusions about Obama being a progressive anymore," she said. But without Obamacare, "I simply wouldn't have health insurance."