12,000 Californians with Pre-Existing Condition Insurance await Supreme Court health care ruling

People start to gather in front of the U.S. Supreme Court on June 28, 2012 in Washington, D.C.
People start to gather in front of the U.S. Supreme Court on June 28, 2012 in Washington, D.C.
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Thousands of Californians enrolled in the state-run Pre-Existing Condition Insurance Plan (PCIP) are among those anxiously awaiting the Supreme Court's decision on health reform, as their coverage may be in jeopardy depending on how the justices rule.

Carolyn Cunningham, 61, of Studio City is among the nearly 12,000 enrollees in the California PCIP. She's a grief and trauma counselor who suffers from glaucoma and from spinal stenosis, a narrowing of the spinal column which causes pressure on the spine and severe back pain.

"The medical conditions I have, nobody would insure me without costing a fortune," Cunningham said. "So I went without insurance for a while, and I couldn’t do that forever."

That’s because, without insurance, eyedrops for her glaucoma cost Cunningham $250 a month. And on top of that, the back pain she tried to ignore during the four years she went without health insurance became unbearable for her. Ultimately she had to visit a doctor on her own dime.

"And I had to pay for my own MRI," she said. "And you start doing that and financially, it’s horrible. You have to have insurance."

Cunningham now has coverage under PCIP, which is a federally-funded program that provides health insurance to nearly 12,000 Californians with pre-existing medical conditions that caused insurance companies to reject them as customers. PCIP is a temporary program that's supposed to last until Jan. 1, 2014, when a federal health reform law provision kicks in that would ban insurance companies from rejecting customers with pre-existing conditions and from charging them higher rates. It's a provision that even some insurance companies applaud.

"People who need health insurance coverage ought to be able to buy it," said Mike Brewer, president of Kansas City-based Lockton Benefit Group, the nation’s largest privately-owned insurance agency brokerage.

"Now the rub becomes: a lot of people who don’t buy health insurance are not unhealthy," Brewer said. "They just don’t buy health insurance because they don’t want to spend the money for it."

And that's a problem that the federal Affordable Care Act intended to solve with its "individual mandate" — the controversial provision that requires virtually every American to buy health insurance or face a tax penalty. The mandate is also considered by many to be the most likely portion of the law that the justices will overturn.

If that happens, the financial support for customers with pre-existing conditions would disappear. And that’s causing anxiety for Carolyn Cunningham and others who now have the coverage.

"I’m in back pain and I need to have it dealt with, and I don’t know what’s going to happen if I don’t have insurance," she said. "I mean I can’t get it dealt with and that’s going to be tragic."

Cunningham, meanwhile, said that at about the time the ruling is scheduled to be announced, she’ll be visiting her doctor — which she hopes won't be for the last time.