NAVAJO & APACHE COUNTIES — Recent court rulings have dealt a blow to the Affordable Care Act’s coverage of millions of people, leaving the law in a limbo likely to extend past the upcoming election.

Arizona joined a group of states suing to overturn the act, which cut the percentage of Americans without medical insurance from about 20 percent to about 10 percent.

Overturning the law could have a big impact on Navajo and Apache counties, who rely more heavily on government-sponsored healthcare than almost any other area of the state – and still have the largest percentage of people without medical insurance in Arizona.

Even with the Affordable Care Act and the resulting expansion of the state’s Arizona Health Care Cost Containment system, only 85 percent of Navajo County residents and 77 percent of Apache County residents have health insurance. The only other county that’s close is Yuma, at 84 percent.

That compares to 89 percent statewide and 90 percent nation-wide.

A Texas judge a year ago declared unconstitutional the act’s requirement people buy medical insurance, which the judge also ruled made the whole act unconstitutional. This month an appeals court also declared the mandate unconstitutional, but sent the case back to the lower court to reconsider whether that makes the whole law unconstitutional.

The Affordable Care Act’s provisions includes a requirement that insurance companies cover pre-existing conditions and allow young people to remain on their parent’s insurance until the age of 26. The act also paid for the expansion of state Medicaid programs like the Arizona Health Care Cost Containment System.

The act extended coverage to about 600,000 previously uninsured Arizona residents. Nationally, some 17 million Americans could lose insurance and 50 million coverage for pre-existing conditions if the law is eventually overturned.

Congress made repeated efforts to repeal the Affordable Care Act, but ultimately settled for some key changes. Congress eliminated the insurance mandate, cut the budget to advertise the insurance plans and authorized the sale of lower-cost plans that didn’t have to meet all the coverage requirements of the initial plans. However, the effort to “repeal and replace” fell short.

The number of uninsured Arizona residents has dropped significantly since passage of the Affordable Care Act. Studies show that the expansion slashed uncompensated care bills in hospitals and resulted in a big increase in coverage and treatment for chronic health conditions (see sidebar).

Between 2013 and 2017, the percentage of Arizona residents with insurance rose from 83 percent to 89 percent, which was still slightly lower than the US average of 90 percent in 2017. Arizona remains much more reliant on coverage through programs like Medicare, AHCCCS and the Affordable Care Act, since only 41 percent of Arizona residents get insurance through work compared to 49 percent nationally.

The 2017 figures showed that 21 percent of Arizonans between the ages of 19 and 25 had no insurance. That compares to about 1 percent of those older than 65, who can generally get Medicare.

The lack of insurance in Arizona affects some groups much more, including:

• 27 percent of those without a high school degree

• 23 percent of Native Americans

• 20 percent of Hispanics

• 8 percent of children, compared to 5 percent nationally

Arizona remains part of the legal effort to overturn the entire Affordable Care Act, along with a group of 17 other Republican-controlled states. The Trump Administration, in an unusual move, sided with the states seeking to overturn the law. So a group of 21 Democratic-controlled states have taken on the task of defending the law.

The federal district court judge ruled that the whole act was unconstitutional due to the inclusion of the insurance mandate, which the federal government is no longer enforcing.

On a 2-1 vote this month, a federal appeals court agreed – but only partially. The justices agreed the requirement that people get insurance or pay a fine was unconstitutional. However, the majority sent it back to the district court to provide a fully developed argument for why the whole act was unconstitutional if the mandate is stricken.

That means the lower court will have to issue a new ruling before the case returns to the appeals court. Only after the appeals court rules can the case go to the US Supreme Court, which has narrowly ruled the Affordable Care Act constitutional in previous cases. The court has a new lineup now, which could change the outcome. The last time the US Supreme Court ruled, the existence of the fine attached to the insurance mandate was a key factor in the ruling, since it involved Congress’ ability to tax.

The ambiguous appellate court ruling means the Affordable Care Act will remain under threat and in limbo at least through the next national election.

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at paleshire@payson.com

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at paleshire@payson.com

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