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Indy Medic Participates in Court to Decide Whether 'Obamacare' Lives or Dies

One is a young, healthy paramedic who can't afford health care coverage for himself. Another is a breast cancer survivor with leukemia bouncing from private insurance to Medicaid to Medicare. A third is an ailing ex-smoker who believes citizens, not the government, should buy insurance or pay the consequences. And then there is the feed store owner who cannot offer insurance to her employees.

During the course of the past three years, they and others enjoyed -- or endured -- their figurative 15 minutes of fame on the public stage as President Obama fought to pass his health care overhaul and protect it from legal and political challenges.

As the Supreme Court prepares to hear an unprecedented six hours of oral arguments over three days in the legal challenge to the law next week, these men and women will be watching with particular interest.

The case -- arguably the most important since Bush v. Gore in 2000 helped determine the president -- carries enormous implications for the nation's health care system, the 2012 elections and the balance of power between the executive, legislative and judicial branches of government. Polls show Americans remain deeply divided about the law, fully two years after it was signed.

The issues before the court -- the individual mandate and whether the law can survive without it, the penalty for not getting insurance, the expansion of Medicaid and more -- will decide the law's fate. The court's decision, expected in June, will determine the fates of people on both sides who face spiraling costs and coverage limits, rising business expenses and the prospect of extended government intervention.

These four people represent the larger forces still wrangling over the law. Their stories are very different, but their physical, financial and emotional situations are shared by millions:

Young, Healthy & Uninsured
Travis Ulerick is just the sort of person who would be required to buy insurance under the threat of financial penalty starting in 2014.

Ironically, he's also the person who introduced President Obama at his first White House health care event in March 2009, when Ulerick was a strong supporter of overhauling the system. In his remarks, Ulerick said, "People in my town can't afford health care costs. They can't afford doctors' visits, and they can't afford ambulance rides."

Since then, his support for the president's effort has waned somewhat. He wanted more compromise with Republicans on issues such as limiting medical malpractice awards and combating fraud. And he never imagined that after the bill became law, he would be without insurance.

Ulerick, 28, left his job as a paramedic with the Indianapolis International Airport Fire Department to take a similar position with his hometown fire department in Dublin, Ind. But the new job came without health insurance, and he couldn't afford COBRA coverage or a new policy on the individual market.

He's hoping that come 2014, the new health care exchanges planned under the law will help to bring down costs. In the meantime, he's also hoping that he doesn't get sick. His only serious brush with the health care system came in 2010, when an accident sent metal into his eye, and he went to the emergency room. "Luckily, I was insured at that point," he says.

Ulerick understands the need for the mandate. He also acknowledges that if he incurred big medical bills, he might not be able to pay them -- much like the people he transports to the hospital, whose ambulance and paramedic bills often go unpaid.

"I think it's a lot like car insurance," he says. "We're all out there taking a gamble on the road of life."

It's a gamble Ulerick's older brother, Nathan, 32, would rather take uninsured. An electrician, volunteer firefighter and Republican town board member, he is juggling about $6,000 in medical bills from his wife's pregnancies and a mortgage that's several months in arrears. Being forced to buy insurance, he says, would compound his financial problems.

"That makes us sort of look like a socialist country," he says. "If you want to purchase it, you can. It's not like you have to purchase it."

Facing Crises, Cousins Disagree
In his final public appeal before Congress passed his signature health care overhaul exactly two years ago this Friday, Obama cited three women worried about rising insurance premiums or pre-existing conditions who had brought their appeals to his doorstep.

One was Leslie Banks of Pennsylvania, a popular author who died last year of adrenal cancer. Another was Laura Klitzka of Wisconsin, whose breast cancer spread to her bones and who is no longer giving interviews.

The third was Ohio's Natoma Canfield, a breast cancer survivor who was too sick to introduce the president as planned at an event in Strongsville, Ohio, a week before the law was passed. Shortly thereafter, she was diagnosed with leukemia, received a bone marrow transplant and went on Medicaid, which is now running out. Next stop for Canfield, based on her disability, is Medicare.

"When her insurance company raised her rates, she had to give up her coverage, even though she had been paying thousands of dollars in premiums for years, because she had beaten cancer 11 years earlier," Obama said on March 19, 2010, just days before Congress acted. "They kept on jacking up her rates. Finally, she thought she was going to lose her home. She was scared that a sudden illness would lead to financial ruin, but she had no choice."

Canfield, 52, was then and remains today a steadfast supporter of the law. For her, the ban on denial of coverage for pre-existing conditions, the expansion of Medicaid and the mandate that nearly all Americans buy insurance are potential lifesavers.

"To me, it's a no-brainer," Canfield says. "You know, I was brought up where you pay your bills and you do whatever you can to protect your home and your life." Not getting health insurance, she says, "is irresponsible. It's like not wearing seat belts."

Even in Canfield's family, however, there are differences of opinion. Her cousin Kimberly Correll has faced similar health care crises: Her husband has battled cancer, been denied health insurance and just last month had a heart attack. For nearly seven years, he's been unable to get insurance because of his health history. He was healthy between the cancer scare and the heart attack but now faces another round of medical bills.

Correll, 57, pays $259 per month for an individual policy that she tries not to use because of deductibles and co-payments. Two of the couple's four children are married with insurance; the other two have none. Despite the potential benefits to her family, she opposes the individual mandate.

"In the predicament that we have right now, yes, we're in a scary spot," Correll says. "But I don't want the government to say, 'You've got to take this.'"

Protesting Obama, Then & Now
The Tea Party was born largely in reaction to the president's health care plan, and Gordon Cavis was on the front lines. For Cavis, a Dover, N.H., resident, it was his first protest since his college days during the Nixon administration.

Now 63 and ailing from decades of smoking, Cavis brought a chair, cooler and brand new bullhorn to protest Obama's town hall meeting on health care in Portsmouth, N.H., in August 2009. He sat outside with about 1,000 demonstrators while the president spoke inside to a ticketed, largely supportive crowd.

"I'm really upset about what's happening in this country," he said at the time, contending the proposed health care overhaul would cover illegal immigrants, cut Medicare and lead to rationing. (The law does reduce the growth rate of Medicare but does not cover illegal immigrants.) "I feel that this administration is subverting the Constitution on the same level as Richard Nixon."

Today, Cavis isn't marching in the streets, but he is no less perturbed by the law and is rooting for the Supreme Court to toss it out -- particularly the individual mandate.

"There's nothing in the Constitution that says you will have health care," he says. "You have no right to require people to do this and then fine them if they don't."

That's not to say Cavis lacks health insurance. He always has carried it for himself and his family, often at exorbitant costs. His four grown children all have some coverage. He believes the uninsured should pay off any health care debt they incur, rather than shift the burden to others.

"I'm taking responsibility for my own life, and the life and health of my own family," he says. "I'm a Yankee. I was raised this way."

The problem isn't insurance, Cavis says, but government overreach.

"It was done behind closed doors. It was done without the bill being read. It was done by excluding the people who might object to it," he says of the health care law. "It was basically pushed upon the people of the United States."

'Where Does It Stop?'
The law actually had the opposite effect on Rose Corona's employees that it was supposed to have. It stopped her from offering coverage.

A farmer and owner of a ranch and feed store in Temecula, Calif., Corona was on the verge of providing insurance when the health care debate in Washington scared her away. Now she's rooting against the new law in court.

"No one knows what this thing is going to do," Corona says -- but she doesn't think it will be good for her or her 23 employees.

The law exempts businesses with fewer than 50 workers from its employer mandate and penalties, and it offers tax credits to those that purchase insurance. Still, the National Federation of Independent Business to which Corona belongs is leading the opposition in court, arguing that the law will raise costs and regulatory burdens on small businesses.

That's what Corona believes will happen to her small business, which already has been forced to downsize from 34 workers because of the recession. She fears the exemption will be changed, the penalty applied, and the tax credits turned into loans.

"This whole thing has to be scrapped, and let's start over. In the free market system, there are ways to handle this," she says. On the other hand, "If you mandate to somebody that they have to do a certain thing, where does it stop?"

Corona, 53, has her own insurance policy. She pays more than $600 a month, a premium she says has more than doubled in two years for a plan with a $5,000 deductible.

It's one of the costs that prevents her from covering her employees.

In a new system, she says, she would be willing to pay into a pool to cover people with pre-existing conditions. But she doesn't want any mandates.

"I believe very strongly," she says, "that the Constitution should be followed."

Health Care Timeline

Nov. 4, 2008: President Obama elected.

Jan. 20, 2009: Obama inaugurated.

March 5, 2009: Obama holds health care forum at White House.

March 24, 2009: The nation's health insurers say they would be willing to cover people with pre-existing conditions if everyone was required to get insurance.

August 2009: Obama and members of Congress holding town hall meetings during the summer recess encounter constituents angry about the proposed health care changes. Tea Party activists hold protests in several states.

Aug. 25, 2009: Democratic Sen. Edward Kennedy of Massachusetts, a longtime champion of national health insurance, dies.

Sept. 9, 2009: Obama urges action on health care in address to joint session of Congress. "The time for bickering is over," he says. "The time for games has passed. Now is the season for action."

Nov. 7, 2009: House passes its version, including a government insurance plan, in 220-215 vote. Thirty-nine Democrats oppose the bill; one Republican supports it.

Dec. 24, 2009: Senate passes its version, without the government insurance plan, 60-39. All Democrats and two independents vote for the bill; all Republicans oppose it.

Jan. 19, 2010: Republican Scott Brown wins special Senate election in Massachusetts to replace Kennedy, depriving Democrats of the 60 votes needed to overcome Republicans' procedural hurdles.

Feb. 22, 2010: Obama unveils his own plan, drawn heavily from the Senate bill.

Feb. 25, 2010: Obama holds bipartisan summit at Blair House, across from the White House; little progress is made on reaching a compromise.

March 21, 2010: House approves Senate's December overhaul, 219-212, because any changes would require another Senate vote, and proponents no longer have 60 votes needed for passage; 34 Democrats join all Republicans in opposition. House passes separate bill including changes.

March 23, 2010: President Obama signs the Patient Protection and Affordable Care Act at a White House ceremony. Thirteen states join together to file suit in Florida; Virginia files suit separately.

Oct. 7, 2010: U.S. District Court Judge George Steeh rules in Michigan that the law is constitutional.

Nov. 30, 2010: U.S. District Court Judge Norman Moon rules the individual mandate is constitutional in a Virginia case.

Dec. 13, 2010: U.S. District Court Judge Henry Hudson upholds Virginia's claim that the individual mandate is unconstitutional and the penalty for non-compliance is beyond Congress' authority.

Jan. 31, 2011: U.S. District Court Judge Roger Vinson declares the law unconstitutional because of its mandate that people buy insurance, giving Florida and 25 other states a victory.

Feb. 22, 2011: U.S. District Court Judge Gladys Kessler rules in the District of Columbia that the law is constitutional.

June 29, 2011: A divided three-judge panel of the Sixth Circuit Court of Appeals upholds Steeh's decision. Judge Jeffrey Sutton becomes the first judge appointed by a Republican president to rule in favor of the law.

Aug. 12, 2011: A three-judge panel of the 11th Circuit Court of Appeals agrees with Vinson that the mandate was unconstitutional but does not throw out the entire law.

Sept. 8, 2011: A three-judge panel of the 4th Circuit Court of Appeals overturns Hudson, ruling unanimously that Virginia did not have the authority to challenge the law.

Sept. 28, 2011: The Obama administration, 26 states and the National Federation of Independent Business ask the Supreme Court to rule on the law's constitutionality.

Nov. 8, 2011: The U.S. Court of Appeals for the District of Columbia upholds Kessler's decision. Judge Laurence Silberman becomes the second prominent conservative jurist to side with the Obama administration.

Nov. 14, 2011: The Supreme Court agrees to hear the case.

Monday: Three days of oral arguments set to begin.

June 29: Final day of court's term -- and most likely day for a decision.


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