Libertarian Paul Ruffino, 55, has been looking for an insurance plan since leaving his previous job. Several insurance companies refuse to cover him because he has pre-existing conditions. (Photo: Sarah Varney)

Today marks the second anniversary of the federal health care law, and, unless you’ve been depriving yourself of news for the last several weeks, that same law will be front and center before the Supreme Court starting Monday. Here in California, uninsured Californians have a particular stake in the Court’s actions.

Madera County is a largely conservative and agricultural area where one in every three people lacks coverage. While many people say they want the Supreme Court to throw out the federal health law, I found that many there are struggling to reconcile their political views with the basic need for health insurance.

I started off in Oakhurst. Here, just a few miles from the entrance to Yosemite National Park, is the Sweetwater Steakhouse, a local watering hole where no one is shy about their opinions of President Obama’s signature initiative, including people like Joe Stern. ”ObamaCare is absolutely horrible, horrible, horrible. It should struck down immediately.”

Stern sips on a glass of pinot noir. He’s 66 years old, a registered Republican and owns a small water conditioning company. He is covered by Medicare, and he says he’s thankful for the program. Before he turned 65, Stern paid mightily for his health insurance.

“I, a single person, was paying $670 a month,” he told me. “I thought it was pretty brutal but I was still against ObamaCare by far, ‘cause I saw how they did it in the middle of the night. It was just totally, it’s not how you do a radical change like that. You do it slowly.”

If at all. Like many conservative voters I interviewed in Madera County, Stern despises the individual mandate included in the law, the requirement that all Americans have health coverage.

There is a lot of suspicion here about whether the health insurance system is really all that broken. Stern thinks many people choose to be uninsured, and in a sentiment I heard from nearly everyone I interviewed, Stern says no one is denied medical care.

“I don’t know of anyone that was left on the street to bleed to death,” he says. “I don’t know anyone that is really left out.”

I asked Stern if he knew anyone at the bar who is uninsured. He turned cheerfully to his friend Mary Westover sitting next to him. Westover was coy about her age. She’s maybe 50-ish. She’s a registered Republican and self-employed artist and businesswoman. She’s been uninsured for 17 years.

“When I was married I had insurance through my husband. Since we got divorced, I was self employed. I just couldn’t afford it. I couldn’t afford the premiums. I was flying by the seat of my pants every inch of the way,” Westover said.

It’s been nearly two decades since Westover has had a pap smear or a mammogram. She says she just tries to take care of herself. She’s opposed to the individual mandate but says she wasn’t aware the federal government would give subsidies to people like her to buy a policy.

“If it were subsidized, if it were made, you know, manageable, I would want that,” Westover told me. “And I don’t know how people who can afford it, can sit there and say that we shouldn’t have that. Because there are a lot more of us, than them.”

The ranks of the uninsured in Oakhurst, like everywhere else in California, are indeed growing. Employers continue to shed health insurance benefits or pass on rising health care costs to their employees.

Doug Macaulay, a Republican, has sold insurance to the residents of Oakhurst for nearly three decades, and, in that role, has heard just about everyone’s opinion of the federal health law.

“I think there’s just a certain lack of knowledge of how health care works,” he said.

Macaulay says people get mad at the insurance companies, but they don’t see ‘ObamaCare’, as they derisively call it, as the answer.

“I get this all the time,” Macaulay says, “where there’s not really a connection between, ‘Ok, here’s what the government is trying to do for you. You’re complaining over here that you don’t have health insurance and you can’t buy it. And over here they’re trying to provide you with it but that’s the worst thing… ever.’ So there seems to be a disconnect in the thinking there because it gets in the way of what I want to think about my government.

Down the road from Doug Macaulay’s office, meanwhile, Paul Ruffino is preparing to welcome guests to Chateau du Sureau, a five-star, luxury inn that looks over the mountains of Yosemite.

Inside, there’s a fire burning in the grand salon and painted frescoes on the ceiling. Ruffino, the inn’s manager, is 55 years old. He’s a Libertarian. He finds the Republican party too liberal.

“I’m uninsured! It’s the first time in my life and it’s probably when I need it the most,” he said.

Ruffino says the plans he’s looked at are expensive and won’t cover his pre-existing conditions. Still, he says it was his decision to leave a previous job in Southern California that came with insurance and move to Oakhurst.

“Do I make the government responsible for my choices,” he asked rhetorically. “I made the choice. I knew beforehand. I knew beforehand what was going on.”

Ruffino seems torn between his unsparing self-reliance and a sense that the insurance industry is unfair. ”Would I like it to be better? There’s a greedy part of me that says that it would.”

He thinks the insurance companies should NOT be allowed to pick out only the healthy and leave guys like him behind.

“And that’s where I have to then ask: Does there come a time when government has to get involved and at what levels? But when you are distrustful of the system in whole it makes it difficult. I go back and forth. I ping pong on this issue all the time.

These conflicts – both personal and political – will be amplified next week when the Supreme Court considers just what role the government should play in re-making the country’s health insurance system.

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