The Oregonian: Portland student, Grants Pass gardener show rift as federal health reform goes on trial Monday
Author: Nick Budnick, The Oregonian
Posted: March 26, 2012

Read the original story in The Oregonian here. 

Portland college student Jacob Voegele thinks health care is a basic human right. Grants Pass professional gardener Rycke Brown, however, treasures her right to decide whether or not to buy something. 

Those two beliefs are clashing before the U.S. Supreme Court on Monday, when the controversial 2010 federal health care reforms and requirement to have health insurance go on trial. 

The changes passed by Congress have divided the country, much as they do Voegele and Brown. 

Though the law hasn't fully taken effect, elements have already kicked in and helped Oregonians like Voegele. Others, like Brown, could feel its effects by 2014, despite their disapproval. Their individual stories give a clue as to what's at stake nationwide. 

A lump sent Voegele, 21, to the doctor last June and gave him a new appreciation for the Patient Protection and Affordable Care Act. The political junkie already supported the law, but the painful protrusion made it real. 

"It was basically kind of in the groin region, actually," says the Portland State University junior. "Anytime you see something in that area, you're like, 'Whoa, I gotta get this checked out.' " 

The Act let Voegele do two things he couldn't have otherwise: See a doctor with a minimal copay, and have surgery to repair his hernia, which would have otherwise cost $7,000 that he doesn't have. 

"I work about 25 to 30 hours a week so I'm pretty self sufficient. I can pay for my food, my rent, gas, things like that" says Voegele, a political science major, who serves food at a retirement community and gives tours to prospective students. "But if I had to worry about insurance on top of that, I wouldn't be able to." 

Voegele says he would have lost his coverage at age 19 without the law. Instead, he fell under a new requirement that insurers extend coverage to policyholders' dependent adult children until they turn 26. Voegele has Providence insurance under his mother's policy. 

Brown, 53, expects to fall under another part of the law, requiring those who can to buy health insurance by 2014 or face a penalty. Not only can't she afford insurance now, she opposes it on principle. 

Brown makes $21 an hour as a gardener who uses natural methods to design and install landscapes. Her ailments have been few. There was pruner's elbow a while back, but $130 to an urgent care clinic did the trick. A twisted ankle was paid for with the help of homeowners insurance. She borrows money from her mother to pay for dental care. She attributes her low-cost health history to home remedies and living healthfully to avoid traditional medical care. 

Supporters of the health law "have gone way beyond the function of government," Brown says. "They have already created an unsustainable insurance system, and now they want to sustain it on the back of poor gardeners like me." 

Brown acknowledges that because she usually works 25 hours a week, she probably would qualify for federal subsidies to help pay for the required insurance -- but she'd have to apply first. "I would have to beg them for money to purchase a product they're forcing me to buy," she says. She buys car insurance because she drives and it comes in handy, but "the idea that I have to purchase a product in order to live and breathe inside the United States is, I think, competely outside the realm of law." 

The individual mandate for health insurance that Brown opposes is at the center of the lawsuit brought by a coalition of states and a small business group. Even if the Supreme Court finds that particular provision unconstitutional, it's unclear if other parts of the law would survive. Those include not only the expansion of insurance coverage that Voegele enjoyed, but other new rules for insurers, such as a ban on annual and lifetime coverage caps or discriminating against those with pre-existing conditions. The law also includes increased eligibility for Medicaid and new limits on prescription drug costs for Medicare enrollees. 

In Oregon, Medicaid reforms approved by the Legislature last year would not be directly affected by the Supreme Court's ruling. The state's coordinated care organizations -- set up to provide more efficient care to low-income Oregon Health Plan members -- would continue regardless. However, the viability of the state's health insurance exchange, a marketplace for consumers and small businesses to buy insurance, could be in doubt if the requirement to have insurance is struck down. 

The Supreme Court will hear arguments through Wednesday, and is expected to issue a ruling by summer. 

Federal health reform by the numbers

34,532 Number of young adults in Oregon who gained coverage thanks to provision allowing parents to keep children under age 26 without job-based coverage on their family's coverage.

692,000 Oregonians with private health insurance who gained increased preventive service coverage with no cost-sharing in 2011.

$1.1 trillion Net cost of Affordable Care Act law nationwide. Congressional budget analysts say it actually improves the country's long-term budget picture, however, thanks to Medicare savings as well as the law's inclusion of health care fees, insurance taxes and higher Medicare taxes on individuals making more than $200,000 a year and married couples making more than $250,000 a year.

44,877 People with Medicare in Oregon who received a 50 percent discount on covered brand-name prescription drugs when they hit the "donut hole, " the period after costs exceed coverage limits but haven't hit out-of-pocket caps triggered by catastrophic coverage rules.

Sources: Health Management Associates; U.S. Department of Health and Human Services; Congressional Budget Office.