For many, affordable healthcare hinges on Supreme Court vote

It remains anyone’s guess how the Supreme Court will vote this year on whether Congress can require people to buy insurance as part of President Obama’s healthcare reform law.

At this point, the smart money is on a 4-4 split between the court’s conservative and progressive factions, with Justice Anthony M. Kennedy the likely swing vote. And he hasn’t tipped his hand on how he feels about the issue.

With this in mind, it’s helpful to remember why this is even being discussed. It’s not because of arcane matters of law that require judicial review.

It’s because of people like Sharon Scott, a 47-year-old single mom in Anaheim who pays nearly half her $24,000 annual income to her insurer, Health Net, and is unable to shop around for a cheaper policy because she has cataracts.

“Many people think that if you have a preexisting condition, insurers will just charge you more,” she told me. “The reality is that they won’t even sell you a policy. You get shut out of the insurance system.”

That’s what is really on the line as healthcare reform makes its way to the high court. The law includes a provision halting insurers’ practice of denying coverage to anyone deemed to represent a greater financial risk because of a past or present medical condition.

But to prevent people from simply waiting until they get sick before buying insurance, the law also requires nearly everyone to join the risk pool by purchasing at least a minimum amount of coverage.

The thinking is that because everyone will need healthcare at some point in their lives, it’s not as though people are being forced to buy something they won’t use. Drivers in California and elsewhere, for example, are required to buy insurance before they can get behind the wheel of a vehicle. It’s just common sense.

But Republican attorneys general at the state level have objected to the so-called mandate, arguing that Congress lacks the authority to impose such a requirement on a nationwide basis. That’s a key question the Supreme Court must tackle.

If the court rejects the mandate, profit-minded insurers could try to back off from creating so-called health insurance exchanges in 2014. The exchanges are intended to provide an online marketplace for people without employer-provided insurance to purchase coverage.

Insurers have viewed the mandate as a quid pro quo for not turning away people with preexisting conditions. Without the mandate, insurers face the prospect of healthy people purchasing coverage only when they need it, thus draining the risk pool.

This would almost certainly result in significantly higher premiums for everyone, making insurance even less accessible than it is now. And people like Scott would be trapped in their current predicaments — ever-escalating rates and no alternatives.

Health Net says it sympathizes with Scott’s situation, but there’s little it can do to help.

“This is a gap in the present system,” said Amy Sheyer, a spokeswoman for the insurer. “That gap can be remedied through market reforms the industry supported both in California and at the national level.

“Most observers agree that the reforms cannot be implemented in a manner affordable to consumers unless all people are included in the coverage pool,” Sheyer said.

A former teacher, Scott purchased her individual policy in 2000. At the time, her premiums ran about $60 a month.

Since then, Health Net decided to stop offering the plan to new customers, meaning that the risk pool is static or shrinking. That typically means higher premiums for those who remain with the policy — or can’t go elsewhere.

In Scott’s case, her monthly rate has soared more than 1,300% to about $875, or $10,500 a year.

Is she chronically ill? No. Scott gave birth to a son six years ago and needed several stitches for a cut finger in 2010, but that’s basically it. She doesn’t smoke. She doesn’t drink. “I’m in excellent health,” she said.

That is, except for the cataract in her right eye that was removed in 2009 and the cataract in her left eye that needs to be removed now. According to the National Eye Institute, cataracts affect nearly 22 million Americans age 40 and over, and half of all Americans who make it to 80.

Yet when Scott tried to lower her insurance costs by applying to Kaiser last year, she was rejected because of a “history of cataracts.” An insurance broker subsequently confirmed that no one would take her with this on her medical record.

“If the economy were better, maybe I could find a job that offers insurance,” Scott said. “But jobs don’t grow on trees right now.”

To get by, she and her son have rented out their modest house. They live a vagabond existence shuttling between the homes of friends and relatives.

“The choice was either stay in the house or pay for insurance,” Scott said. “So we moved out.”

Her son is covered by the state’s Healthy Families program, which provides insurance for kids in low-income households. Scott has looked into state insurance programs for herself, but they wouldn’t cover her in the event of a catastrophic illness.

So she sticks with her costly policy from Health Net and keeps her fingers crossed that new insurance opportunities will arise once the healthcare reform law opens up those exchanges in a couple of years — that is, if the law survives the high court’s decision.

“I feel like I’m just holding my breath,” Scott said.

Millions of others are holding their breath, too.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com.