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Like any college student, Vanessa Ramirez never expected chemotherapy would be part of her busy school schedule.
“I don’t have any history of cancer in my family, so it wasn’t something I was on the lookout for,” Ramirez says, sitting outside the library of her alma mater, Arizona State University.
Ramirez was diagnosed with ovarian cancer when she was 23. Now, more than a decade later, she’s healthy and so are her children.
“But there’s also emergencies that happen. I have two young kids who are running around. They are rambunctious. I have a daughter who likes to climb trees,” Ramirez says, explaining the priority she places on health insurance.
Overcoming her illness at such a young age, Ramirez doesn’t take healthcare for granted. And the Affordable Care Act (ACA) has given her security. She bought insurance through healthcare.gov, even with her preexisting condition, and her children got covered, too.
“I want them to be able to have health insurance and doctors to monitor them, in case something unfortunate comes up,” Ramirez says.
Ramirez’s kids are covered through the federal Children’s Health Insurance Program, which is for working families who don’t quite qualify for Medicaid. Arizona’s version is called KidsCare.
Arizona lawmakers froze enrollment back in 2010. And until last year, Arizona was the only state without an active program. But Obamacare helped revive it by covering the entire cost in Arizona and a handful of other states, at least through 2017.
“A lot of people don’t realize that a repeal of the Affordable Care Act could wipe out KidsCare that we just got back,” says Dana Wolfe Naimark, chief executive officer of the advocacy group Children’s Action Alliance.
Since Arizona’s governor — Doug Ducey — and the legislature reopened KidsCare last year, enrollment has already surpassed 13,000. But now Naimark worries about the fallout if the ACA is repealed.
“It would be up to the state legislature whether they could invest state dollars to keep it going, or whether the coverage would go away,” Naimark says.
In recent years, Arizona has had one of the highest rates of uninsured children in the country. But Obamacare has begun to change that, bringing coverage to thousands of children. It was also one of the Republican-led states that expanded Medicaid under the ACA, but only after fierce infighting about growing federal influence; the same was true for reinstating KidsCare. State law halts or shuts down Medicaid expansion and KidsCare if federal funding dips too low.
“Whenever you take a look at some of these top-down Washington approaches, you really do lard up these insurance policies with a lot of benefits that individuals and families would not go out and buy on their own,” says Naomi Lopez Bauman of the conservative Goldwater Institute. Her organization sued to stop the state’s Medicaid expansion.
One of the proposals favored by Republican leadership is giving states a fixed amount of money, called a block grant, and letting them have more say in who and what they cover. Bauman says with enough flexibility, she believes the state could save money.
“How do you make it easier and better for individuals and families to get the coverage and care that best meets their own needs and preferences?” Bauman says.
But other conservatives say changing how these programs are funded could backfire. Heather Carter is a Republican state representative who voted for Medicaid expansion and for restarting KidsCare.
“What I hope does not happen is that decisions are made nationally that actually penalize us for being efficient and effective,” she says.
Carter says Arizona already has one of the lowest-cost Medicaid programs in the country. And Medicaid officials here caution that block grants could actually shortchange the state because it has a fast-growing population and a large share of people living around the poverty line. Less federal funding would most likely force lawmakers to cut back services.
“We will have to make very difficult decisions in Arizona on who will and will not receive coverage,” Carter says.
It would cost Arizona hundreds of millions of dollars to keep everyone on Medicaid covered like they are now. And even Democrats like state Senate Minority Leader Katie Hobbs concede that’s not realistic.
“I don’t see anyone in the state coming forward and saying we will cover this, because [we] don’t have the money to do it,” Hobbs says.
Arizona has more children enrolled in the federal marketplace than almost any other state. Add in Medicaid and KidsCare, and 130,000 kids or more could be at risk of losing their coverage if Congress doesn’t come up with a replacement that includes similar coverage.
This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News. It originally appeared on Kaiser Health News and has been slightly modified to reflect Spectrum’s style.