NAVAJO & APACHE COUNTIES — The lawsuit seeking to overturn the Affordable Care Act poses the most immediate threat, with a federal appeals court decision due at virtually any moment.
Congress has whittled away at the program ever since gaining control of Congress and the White House. The repeal of the mandate for coverage and cutting the money for subsidies and marketing has reversed a steady decline in the number of people without medical insurance in the past two years – while driving up the cost of the ACA insurance plans still available.
The ACA remains broadly popular, with support of 77 percent of voters in some recent polls. The overwhelming majority of voters also support key provisions of the ACA, including allowing children to remain on their parent’s health plan until the age of 26 and barring insurance companies from denying coverage to people with pre-existing conditions. This helped blunt efforts to “repeal and replace” the ACA in Congress, but the court case could overturn the act by the back door, threatening coverage for about 10 percent of Arizona’s population.
The foes of the ACA argued before the 5th Circuit Court of Appeals in Texas v Azar that when Congress in 2017 eliminated the penalty for not having insurance, it effectively rendered the whole ACA unconstitutional. The US Supreme Court in 2012 had held that the penalty for not having insurance was key to making the whole act constitutional. A lower court in Texas has already ruled against the ACA. If the appeals court agrees, the case would almost surely go to the US Supreme Court next year – which would be the third time the court has been asked to rule on the constitutionality of the act.
Even if the expansion of Medicaid survives that legal challenge, healthcare experts have predicted a continued rise in the number of uninsured as the various federal and state modifications of AHCCCS and other programs take effect.
For starters, the administration has imposed a new rule barring eventual citizenship for any legal immigrant who receives benefits. Current law allows a legal immigrant to qualify for AHCCCS after five years in the country.
Moreover, experts say the work requirement will likely reduce the number of people who can receive benefits – especially in rural areas like Navajo and Apache counties.
The new rules will require anyone on AHCCCS to either report they’re looking actively for work or performing specified community service. Experts say not many people on AHCCCS can work – they’re either single mothers with children who would pay more in childcare than a job would produce or they are medically disabled or too sick to work.
In Arkansas, one in four Medicaid beneficiaries subject to work requirements lost coverage in the first seven months of the program – mostly due to difficulties in filling out the paperwork and providing the required documentation. Despite the loss of coverage by 18,000 people and the work requirement imposed on those who didn’t lose coverage – the program had no impact on the underlying employment rate. Studies suggest that about 60 percent of the people receiving AHCCCS already work and most of those who don’t aren’t able to work.
The new Arizona rules will exempt from the work requirement pregnant women up to the 60th day after they give birth, former foster children up to the age of 26, tribal members, people with a serious mental illness, people with a federally recognized disability, people who are medically frail, survivors of domestic violence, the homeless, the designated caretaker of a child under 18, people on unemployment, people in treatment for substance abuse and full-time students.
AHCCCS estimates only 120,000 people on the program now will end up having to comply with the new requirements, which includes at least 80 hours a month of “community engagement activities.” That would include a job, training, job search activities, community service and education.
Nonetheless, the need for a slew of new documents could cost perhaps 30,000 of those people their healthcare, according to national studies.
Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at email@example.com