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For Joanne Lefebvre, a breast cancer survivor from St. Louis Park, this week's Supreme Court battle over President Obama's health care overhaul is a now-or-never moment.
Lefebvre, who owns a small marketing business, pays into a state program with a $10,000 deductible after her private insurance became too expensive. If the new law is overturned, "I have no hope of getting better coverage," she said.
For Dr. Lee Beecher, a St. Louis Park psychiatrist, the Obama administration plan gives the government too much power to make decisions that should be left to consumers. "I don't think we've ever had a real consensus around this law -- ever," he said.
From small-business owners to uninsured residents to state health officials, knowing the fate of the health care law can't come soon enough. Advocates say the law will provide coverage to thousands of uninsured residents and lower costs for others. At the same time, a strong contingent of state residents, led by U.S. Rep. Michele Bachmann, believe the law is an unconstitutional assault on individual liberty.
"We don't know how much of the federal law will happen," said Kate Johansen, a lobbyist with the Minnesota Chamber of Commerce. "Basically, the states are put into a position where they have to keep following federal law, even though it may or may not be upheld in two years."
If the Supreme Court nullifies the law, it would mean about 300,000 of Minnesota's uninsured citizens would no longer be in line for health coverage, state officials say. Many small-business owners have placed their hopes on the health care exchanges that would be implemented, which would allow small companies to consolidate into larger risk pools to lower coverage rates.
"People are working full speed ahead to implement the law," said Lynn Blewett, a professor of public health at the University of Minnesota. "If it's ruled unconstitutional, that's a huge impact."
The critical component for the state is the plan's "individual mandate" that requires Americans to buy insurance or pay a penalty. Bachmann and others have criticized it because it would force some Americans to participate against their will. A state-paid consultant has estimated that roughly 95,000 Minnesotans would pay a penalty rather than participate.
Nevertheless, if the Supreme Court rejects the mandate, a lot of things fall apart in Minnesota, said Stefan Gildemeister, Minnesota's health economist. "Without the individual mandate, it is unlikely that there will be improvement in the number of uninsured," Gildemeister said.
Minnesota has been lauded as one of the nation's most innovative states for health care. The state revamped its health care system 2008, two years before Congress passed the embattled federal health care overhaul that the Supreme Court now debates.
Today, 9 percent of Minnesota residents are uninsured, well ahead of many states like Texas (26 percent uninsured). Minnesota has for decades required insurance providers to guarantee coverage to those who can pay the premiums, regardless of their health. MinnesotaCare is a nationally recognized program that lets single, low-income adults get coverage unavailable in many states.
Despite such efforts, Minnesota's uninsured population is growing. The state's population of uninsured citizens rose from 374,000 in 2007 to 490,000 in 2011, according to the Minnesota Health Access Survey. Meanwhile, MinnesotaCare has been curtailed by state budget cuts.
Kathy Meyer of Crosby, Minn., said her family has a safety net, but it feels tenuous. After her husband was laid off as a maintenance electrician at the University of Minnesota, his union picked up half his health insurance premium. The family is dipping into a retirement account to pay the rest of the $572 a month.
Meyer's husband, diagnosed with bladder cancer in 2007, already has fought back two recurrences of the illness. Meyer has looked into coverage with her employer, Cuyuna Regional Medical Center, but it was too expensive.
"All of this is like a slap in the face for us," Meyer said. "We have had his insurance since 1984. And now all of this. I find it hard to believe."
No matter how the court rules, the likely result will be more unknowns, Johansen said. Of the chamber's 2,300 members, about 70 percent are small businesses with 50 or fewer employees. Many of those companies simply can't plan ahead without knowing whether the new law will survive and, if it does, in what form, she said.
"Depending on how the court comes out, there will be great uncertainty," Johansen said. "That uncertainty will exacerbate our existing problems and lead to even higher health care costs."
State Rep. Steve Gottwalt, R-St. Cloud, chairman of the House and Human Services Reform Committee, said the health care law "has been like a big rock in the middle of the pond" where people have had a "visceral reaction." As a result, a practical conversation about health care has been lost.
"Whether the Supreme Court throws out [the health law] or upholds all or part of it, we still face the same challenge of how do we increase access to high-quality, low-cost health care?"