June 28--After reaching a lifetime cap of $300,000 on his student insurance plan in January, 31-year-old colon cancer patient Arijit Guha did fundraising in between chemo treatments to pay for thousands of dollars in medical bills.

No wonder then that the Arizona State University doctoral student was so focused on Thursday's U.S. Supreme Court decision, which upheld most provisions of the 2010 Patient Protection and Affordable Care Act.

"I was actually up until 3 in the morning and then I woke up at 7 a.m. Obviously, it was personal to me," said Guha, who has received treatment at the University of Arizona Cancer Center in Tucson since his diagnosis in February 2011. "It is clearly a win for so many millions of Americans. Many others have been denied insurance, maxed out on their plans and would have been in pretty dire straits had the ACA (Affordable Care Act) not passed."

With the constitutionality of the law intact as a result of Thursday's ruling, sick Americans like Guha will no longer need to worry about reaching into their own pockets to pay expensive medical bills because of a lifetime cap, or because of pre-existing condition. The court also upheld the individual mandate to buy insurance.

The health-care law, which the Supreme Court upheld in a 5-4 decision, includes government vouchers for families having trouble paying for mandated insurance. The mandate is expected to result in coverage for about 30 million more people.

Less clear, however, is the impact of the ruling on Medicaid in Arizona, which is for the state's most indigent residents. The ruling weakened the law's mandate that states expand their Medicaid programs.

In Arizona, the Medicaid program is called the Arizona Health Care Cost Containment System, or AHCCCS and it covers about 20 percent of Arizonans.

"The Supreme Court found it unconstitutional for the federal government to withhold federal funding for Medicaid programs to those states that elect to opt out of the Medicaid expansion. That means, essentially, that states have the right to decide whether they will go ahead with the Medicaid expansion," said AHCCS spokeswoman Monica Coury.

"At this point, we will review the Court's decision in detail and determine what options that presents to the state. We will work together with the governor, state policymakers and stakeholders as we move forward in the coming months."

Guha said he never knew about the lifetime cap on his student insurance plan when he purchased it at age 29. Even if he had known, he probably would have purchased the plan anyway. As a healthy 29-year-old, he could have never envisioned what the future would bring: a diagnosis of stage four colon cancer that had metastasized.

"I never expected I would be in a situation where I would be without health care," he said. "You hear about people who played the odds and went without insurance. That was not the case with me. I had insurance."

After reaching his $300,000 cap earlier this year, Guha set about fundraising. Though weak from treatments and surgeries, he managed to set up a website called PoopStrong, where he sells t-shirts, buttons and bracelets. Through the Tucson-based Arizona Cancer Center he also set up a patient assistance fund in his name.

He's managed to raise more than $50,000 for his care.

"These last few months it's been close to a full-time job for me to run the website, solicit donations of raffle items and spread the word about what is going on in any way possible. It was a lot of work," Guha said. "The larger issue is that without a doubt it is absolutely wrong that I or anyone else struggling with these medical issues should ever have to figure out this added burden of how to pay."

The federal health law ensures that student health insurance plans have no lifetime caps as of January, 2013. Guha's plan through ASU will have no lifetime caps beginning Aug. 1.

"Before the health law it would have been easier for the insurer to charge me a lot more for a plan with no caps. They would have all the bargaining power," Guha said. "The law will force insurers to spend more of the premiums on care rather than on bonuses to executives and dividends to shareholders. It is essentially a shift in power to some extent from insurance companies to patients."

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(c)2012 The Arizona Daily Star (Tucson, Ariz.)

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