Protected But Priced Out: Unease Over ACA Debate In Arizona
For years, shopping for health insurance went like this for Corinne Bobbie.
“'Sorry, we’re not covering that kid. She’s a liability,'” Bobbie said.
Outside, her 8-year-old daughter Sophia bounces on the trampoline in the family’s backyard north of Phoenix. You’d never know about her complex congenital heart disease and multiple surgeries.
“She’s a kid whose clock is ticking every day, but she goes to school, she rides horses,” Bobbie said. “She does everything a regular kid can do with a certain level of limitation.”
Sophia’s pre-existing condition kept Bobbie and her husband, who runs a sub shop, on a constant quest for coverage. And it cost them. They racked up debt, lost their car and home.
Then the Affordable Care Act (ACA) came along.
“For the first time in her life, we had a choice. I didn’t know what do. My head was spinning,” she said.
Arizona’s federally-run marketplace was a success early on. There were lots of insurers, multiple plans and low premiums. But it didn’t last. This past year, when she, her husband and son tried to finally buy insurance for themselves, they couldn’t afford it.
“It’s more disappointing to be so in favor of something, but to have such animosity towards it at the time same because I’m angry about it,” Bobbie said. “Why can’t I have insurance, too?”
There was only one insurer to choose from in Maricopa County. The networks were narrow, and Bobbie was looking at hundreds more in premiums and $6,000 deductibles each.
Protected by the law and priced out by it: the Bobbies represent both sides of the ACA. They’re the kind of consumers that should be the target audience for Republicans repealing the law, but so far Bobbie is not sold on the replacement bill, the American Health Care Act.
“They could be the hero. And instead it just became this nonsense. It’s a bunch of garbage,” she said.
And opponents of the repeal effort are tapping into this unease, running TV ads accusing moderates like Congresswoman Martha McSally of voting for “a disastrous health care repeal bill.”
“They are trying to put her in league with the extreme hardcore Republicans in Congress,” said GOP consultant Jaime Molera, who’s a partner at Molera Alvarez.
Democrats think McSally and Sen. Jeff Flake, both up for re-election, are vulnerable.
“It’s a balancing act between being aggressive in wanting to repeal Obamacare with the fact that there’s a lot of components of it that people like,” Molera said.
In Arizona, those components include protections for pre-existing conditions and Medicaid expansion, which has covered more than 400,000 people here.
The replacement bill would scale that back — a concern for many in Arizona like Governor Doug Ducey.
The major cuts to Medicaid, however, probably won't survive the U.S. Senate, and Molera said that could actually help out Flake.
“So he doesn’t have to take that extreme position in order to get out of a Republican primary and then that affords him the opportunity to be more of a centrist running against the Democrats,” he said.
Flake’s likely to face the toughest re-election, but Democrats are even taking aim at those in safer districts like conservative Congressman David Schweikert, a member of the Freedom Caucus.
Schweikert said the bill he voted for gives states flexibility to transform Medicaid, for example through block grants, even though that means less money for the state.
He admits that makes some in the health care industry here nervous.
“They are concerned because they are quite comfortable with the current Medicaid model instead of a model that would provide a lot more choices,” Schweikert said.
The state’s health care industry cautions that the GOP bill would result in more people showing up in the emergency room without coverage, leaving hospitals and ultimately consumers to pick up the tab.
Schweikert also said the bill will help salvage the state’s marketplace, which is “imploding.”
“We can lower the price so much for that fifty percent that’s healthy, that they’ll start to participate in the system because that’s the only way the math works,” Schweikert said, adding that the ACA’s penalty system is not getting enough young people to join.
About 20 percent of Arizona’s marketplace is between the ages of 18 and 34, according to data from Kaiser Health.
The bill is expected to bring down some premiums, but prices could rise significantly for those who are older or have pre-existing conditions, according to the Congressional Budget Office.
Schweikert warns that the marketplace will not survive for much longer, given the exodus of insurers in recent years.
“Today you’re lucky we have one and tomorrow you may have zero. So this is also trying to assemble something back together while running,” he said.
But the market is not necessarily in free fall, said Allen Gjersvig, who oversees enrollment for the Arizona Alliance for Community Health Centers.
“We believe that the two insurance companies that are covering Arizona will be back next year with the same footprint,” Gjersvig said.
He doesn’t expect Arizona will see the same dramatic rate hikes like last year, either, saying he believes that was an adjustment for underpricing in previous years.
But all of this is still unknown because of the “uncertainty for the insurance companies.”
Gjersvig said the biggest unknown is whether the Trump administration will withhold key payments, known as cost sharing reductions, to insurers, which help low-income people afford coverage. If they lose those, Gjersvig said the rates will go up.
Uncertainty is also a problem for Corinne Bobbie.
She said the health care debate over the ACA has become a political game in which her family and others have been forgotten.
“We are potentially in a position where this time next year, nobody in this house will have insurance,” Bobbie said.
She pauses and then adds, “If that happens, it’s going to be ugly. It’s going to be real ugly.”
Political fortunes in Arizona and across the country will depend on voters like her getting the care they need.