After a decade-long battle to contain his HIV, Chicago graphic designer Will Wilson views President Barack Obama’s landmark health-care law as a “big ray of hope” that could be lost if the U.S. Supreme Court strikes down the president’s massive overhaul of health care.

A decision that figures to be the high court’s most significant in more than a decade is expected to come down by month’s end — possibly as early as Thursday — and could dictate whether Wilson, driven close to bankruptcy by his condition, can get affordable health insurance.

It also will determine whether he can return to full-time work, after he was forced to cut back to make sure he could qualify for his life-saving medical care.

“We’ve been on pins and needles for months waiting on the Supreme Court’s decision,” he said. “It’s extremely frustrating — there’s times when you want to throw your hands up because it’s been such a nightmare.”

Wilson isn’t the only one with a lot riding on an opinion from the court that undoubtedly will influence whether Obama wins a second term in November or gets displaced by Republican Mitt Romney, who along with Republicans in Congress has called for the health-care law’s dismantling.

Opponents say it’s an overly-broad, unconstitutional intrusion by the government. They also question the law’s efficiency and whether it will truly serve to reduce costs and deliver better care without hurting businesses, small and large.

The Court’s decision also will determine if hundreds of thousands of uninsured Illinoisans could have access to affordable health care and whether cash-strapped governments in Springfield and Cook County would keep getting tens of millions of federal health-care dollars through what both sides of the epic health-care debate now call “Obamacare.”

“There is a human cost here,” Gov. Pat Quinn told the Chicago Sun-Times Wednesday. “We’re talking about thousands of people with pre-existing conditions who now have insurance and thousands of young adults who are now covered by their parents’ insurance. We’re talking about people who are finally receiving the preventative care they need to lead healthier lives and avoid illnesses.

“If the Supreme Court turns its back on the millions of people in Illinois whose lives have been improved by the Affordable Care Act, it would be a shame and a setback,” he said. “This law has allowed us to make progress and improve health in Illinois — our working families can’t afford to fall backwards.”

What could happen

Enacted March 23, 2010, Obama’s Affordable Care Act could be upheld, struck down or, more likely to observers, upheld in parts. One possibility is that a key element of the law — the mandate that individuals obtain health insurance by 2014 or pay a penalty — is struck down as unconstitutional while the other parts survive.

Also at issue is a part of the law expanding Medicaid by making more of the medically needy eligible for the federal/state program, a change that could mean Cook County gets up to $70 million a year from the feds for treating previously uninsured adults whose care had been subsidized by the county and state.

“If the Medicaid expansion is thrown out, that would have a devastating impact for the county health system,” said Marisa Kollias, spokeswoman for the Cook County Health that operates the John H. Stroger, Jr. Hospital of Cook County.

The sweeping law would require health insurers to allow parents to keep their unmarried children on their health-insurance policies until they reach 26 and bar insurers from denying coverage to those with a litany of pre-existing conditions. It also would do away with lifetime caps on insurance payouts for those fighting chronic conditions and gives the elderly discounts on prescription drugs and free preventive services like colonoscopies.

A ruling invalidating those provisions will “have a dramatic impact to small businesses and hard-working families across the state. People will see their health-care costs increase. There will be an increase in cost-shifting and the security and peace of mind that families have been starting to see directly and indirectly because of Obamacare will vanish,” said Jim Duffett, executive director of the Campaign for Better Health Care, an Illinois-based consumer advocacy group.

The challenge to the law is led by 26 GOP-led states. Illinois, with a Democratic governor and Democrats in control of the Illinois General Assembly, embraced the new law, getting a $32 million federal grant last May to help plan for the creation of health-care marketplaces called exchanges.

Another $6.5 million in grants tied to the Affordable Care Act entered the state Wednesday, going to health centers in Chicago, Bloomington, East St. Louis, Galesburg and Springfield.

“It’s huge for us,” said Daniel Fulwiler, chief executive officer for Centro de Salud Esperanza, a health center in Little Village that will get $650,000 annually through the grant.

That money will be used to hire a pediatrician and an OB-GYN that will enable the Southwest Side clinic to see about 2,000 more low-income patients, he said.

“I am a little worried about the Supreme Court decision. I am kind of assuming it’s hard to take away the money once it’s given, but I don’t really know,” Fulwiler told the Sun-Times. “We intend to hire new staff with this. If the money gets yanked, we’d have to look at that decision.”

Broad implications

While the court’s decision could affect the Little Village clinic’s bottom line and its ability to serve its patients, the ruling’s broader implications figure to affect the political direction of the country.

If the court holds the entire law is unconstitutional, it will represent a significant defeat for Obama and his party. But Republicans in Congress and Romney, who all have been running on repealing what initially was termed derisively as “Obamacare,” will have to start explaining how they will replace it.

“I’m going to make sure we get rid of Obamacare,”  Romney said Tuesday in DeWitt, Mich.

House Speaker John Boehner (R-Ohio) said this week, “Unless the Supreme Court throws out the entire Obamacare bill, the House will move to repeal all of it because it is driving up health care costs and making it harder for small employers to hire people.

“And then what we’ll do is move … in a step-by-step approach to common-sense reforms that will lower the cost of health insurance and ensure that the American people can go to the doctor of their choice,” he said.

Sen. John Barrasso (R-Wy.) said, “if any of the health-care law continues to be standing after the Supreme Court ruling, we will continue to work to repeal whatever is left and then replace it with a step-by-step approach to get for American people what they’ve wanted from the beginning, which is the care that they need from the doctor that they choose at a lower cost.”

A White House official confirmed for the Sun-Times that even if the mandate is struck down, the Obama administration is mapping plans to keep alive other parts of the law.

House Democratic Leader Nancy Pelosi told Charlie Rose in a recent interview: “So there are a couple of options. One is that they declare the whole bill unconstitutional. The other is that they sever. It’s severable and they do take pieces. We’ll be prepared for other any eventuality.”

A court ruling against the law also figures to trigger legislative activity in Springfield. Republicans say they intend to pressure Democrats to toughen income- and residency-verification requirements for Medicaid recipients, which the GOP says the health-care law now makes difficult.

“You’ll see a lot of people like myself who’ve been proponents of changing Medicaid above and beyond what the federal law allows to call upon the administration to bring us into session and let us do more to try to combat the waste, fraud and abuse in the system and try to do a more efficient job of cleaning up the Medicaid rolls,” said state Sen. Dale Righter (R-Charleston), a key GOP voice on health care.

‘I want to work’

For Edgewater resident Wilson, the Supreme Court’s imminent ruling goes beyond just the politics of the day and even a potential matter of life and death.

It’s also a question of dignity.

The 58-year-old, unemployed graphic designer said he dropped his own private health insurance while he was working after it wouldn’t cover his $3,000-a-month HIV medicine costs.

Though the federal government stepped in to cover his treatment under the Ryan White Care Act, it doesn’t cover any other medical costs.

And federal funds are only available to HIV patients who earn less than $30,000 a year — meaning Wilson can’t work full time without losing his benefits.

“I’m qualified for a job that pays $50,000 to $60,000, but I can’t take it,” he said. “I want to work and contribute to society, but the way it’s set up, I can’t. It’s very frustrating.”

Even if he did return to work, mainstream insurers wouldn’t take him on in the absence of the Obama health-care law, thanks to his condition. And at more than $900-per-month, the state’s “high-risk pool” insurance isn’t a realistic option, he said.

For the last two years, he’s walked with a limp — the result of a chip of bone lodged under his kneecap when he was knocked off his bike in Greektown.

“With no insurance, surgery to remove the bone chip would cost me $5,000,” he said. “Whatever the Supreme Court rules, I’m not going to stop fighting.”

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