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Obamacare’s future at stake in election

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    And now we continue our coverage of the issues of this campaign. Tonight: health care, and specifically what's at stake for President Obama's signature domestic achievement, the Affordable Care Act, often referred to as Obamacare.

    It's turned into a significant issue in some states, like Arizona, where polls show Hillary Clinton in a tight contest with Donald Trump.

    Special correspondent Sarah Varney looks at those concerns and the candidates' plans. This story was produced in collaboration with our partner Kaiser Health News.


    Just weeks before the presidential election, Tempe, Arizona resident Josephine has spent nearly every morning driving, waiting, and back at home worrying.

    Once uninsured, she was recently diagnosed with breast cancer and gets health coverage through Obamacare. The 61-year-old, who goes by Jo, says she trusts just one candidate to keep her covered.

    HILLARY CLINTON (D), Presidential Nominee: I will continue to improve the Affordable Care Act. I will work to get the costs down, premiums, co-pays, deductibles, prescription drug costs.



    Hillary Clinton has offered detailed plans to preserve and expand the law, even pushing for a public option, a type of government-run insurance plan. She also wants to expand tax subsidies to reduce health care costs and allow people 55 and older to buy into Medicare.

    DONALD TRUMP (R), Presidential Nominee: We're going to repeal and replace Obamacare so quickly.



    Meanwhile, Donald Trump wants to replace the health law with a handful of smaller measures, like allowing insurance to be sold across state lines and tax deductions for premiums.

    Health policy experts say these approaches would cover far fewer people than the Affordable Care Act.

  • WOMAN:

    I hope you will consider voting Donald Trump for president. He's a businessman who will really shake things up in Washington.

  • MAN:

    I'm just calling Democrats like you to ask if you're going to join me in supporting Hillary Clinton this year in Arizona.


    As both campaigns ramp up their ground game here, this longtime red state is in play.

    Six years after the health law was signed, Arizona stands out as a good example of what's at stake this election. This staunchly conservative state expanded Medicaid to low-income adults. But in the health insurance marketplace, private insurance companies are pulling out, and Arizonans are facing steep premium increases, leaving many to wonder: What's next for the Affordable Care Act?

    At trivia night at Carly's Bistro in downtown Phoenix, which draws a younger crowd, many here have been able to get health coverage because of the law, and they say they will vote to protect it.


    Trump would so severely limit the care that many people could get that are in positions like me that have severe illnesses that would — that affect their lives.


    But there's plenty of criticism too.


    I think there's a lot of work that could be done, but it's still definitely better than how it used to be.


    My take is really less government is better. It seems like everything that the government decides to manage, they don't manage effectively or efficiently.


    In Phoenix's sprawling subdivisions, some of that frustration arises from the turbulent individual insurance market in Arizona, which has caused headaches for Joanne Ouellette and her insurance broker, Michael Malasnik.

  • MICHAEL MALASNIK, Insurance Broker:



    Hey, Mike. How are you?

    I wanted to know some information about, what am I going to do? My insurance company with the Affordable Care Act, Aetna, I hear they're pulling out of Arizona.


    When the marketplace for individual insurance coverage in Arizona first opened, eight companies vied for consumers. After three years of low enrollment and higher-than-expected medical claims, only one insurer remains in about half the counties.

    Malasnik says he's already getting calls for the upcoming enrollment period.


    Frustration and anger at this point. And then you also have a lot of people that are just getting worn down. It's like, it's more of the same to them.


    In her wood shop in Mesa, the exodus has raised questions for Leah Sondergeld about adequate access to medical care, the potential for price-gouging, and the durability of the marketplace.


    This is an example of one of the forms to fill out for Kate's medication.


    Sondergeld, who is self-employed, has been forced to switch plans each year as insurers have come and gone. Her eldest daughter, Kate, was diagnosed with epilepsy last year. And with each switch comes frantic questions.


    What if they won't cover her current medication? What if they won't keep her neurologist? What are we going to do? With one of the doctors, during that first transition with UnitedHealthcare, she was four days without medications. She was four days — I had to watch her have seizures.


    After a medical leave, Kate Sondergeld, age 25, is back to her astronomy classes at the University of Arizona in Tucson. Finding a medication that worked was no small matter.


    My first one, I was severely allergic to. I had a bad reaction to it, and then the second one was kind of when things started going downhill even more. I was blanking out. I have absent seizures.


    Kate doesn't want the health law repealed. She remembers when she was a child and was denied coverage because of a preexisting condition. Her mother, Leah, says Congress should prevent insurers from quitting the marketplace.


    I don't care about what the Republicans think. I don't care what the Democrats want to do to change. Just tell Blue Cross/Blue Shield, hey, guess what? You're going to keep this person.


    The drop in competition isn't just in Arizona, says Caroline Pearson from the Washington-based consulting firm Avalere Health.

    Pearson says more than a third of regions across the country may end up with only one insurer available, especially in rural areas. She says Congress will need to pass some fixes to the law in 2017.

  • CAROLINE PEARSON, Avalere Health:

    Improvements to risk adjustment and potentially other programs to help stabilize the market, and then some very creative solutions to figure out, how do we actually get younger, healthier people, middle-income people into the exchanges? How do we make these plans that they want to buy, that they think are valuable?


    Despite the problems with the law, those who need insurance coverage like Jo are doing better because of it. After years without seeing a doctor, Jo was able to get a checkup, which led to her cancer diagnosis and treatment.

    Studies suggest that because of the law, patients are more likely to have a regular doctor and get preventive health care, including vaccines and cancer screenings. And they're less likely to postpone treatment because they can't afford it.

  • JO:

    I got a primary care doctor, which I hadn't had a primary care doctor for a decade. And from the primary care, it just went from there, the tests and the mammograms and the ultrasounds and the MRIs and all that stuff.


    Jo felt so strongly about being one of the 20 million people who've gained coverage since President Obama signed the health law, she wrote a letter to the White House.

  • JO:

    But then I got this in the mail. "Thank you for writing." He was encouraged to hear about people who had benefited from the Affordable Care Act, signed Barack Obama.


    She said, without the law's consumer protections that require insurers to cover people with preexisting conditions, she would be bankrupt or dead.

    But Trump volunteer Diana Brest thinks the law has caused more harm than good and supports Trump's vow to repeal it. At 66 and on Medicare, she blames the law for driving up premiums for others.


    Some people said it was going to help, but I knew right away it wasn't. I spoke to Donald Trump about that two rallies ago. And he indicated that he was going to address those that are having problems with insurance. And I know, knowing Donald Trump, that he will address it.


    But the debate over the health law has often ignored a group that has seen widespread improvements from Obamacare, low-income adults, like 45-year-old Alfred Mendoza of Phoenix, who are now eligible for Medicaid.

    More people have gained coverage in this way than in all of the exchanges combined. A new study suggests that people living in the 31 states that expanded Medicaid, like Arizona, were more likely to report being in better health.


    My gastroenterologist, she advised me to go ahead and get the C.T. scan. So, we got the C.T. scan.


    Mendoza, a truck driver who suffered a head injury from a crash, went years without health insurance. Now, with Medicaid, he's finally getting treated.


    I don't have the funds, the means to pay for a C.T. scan, for an MRI. It's a lot of money. But to go see a specialist, you know, that's a lot of money. So, for me, it's a 10.


    A flood of new Medicaid patients have been arriving at community clinics around Arizona with a backlog of untreated conditions, like high blood pressure and uncontrolled diabetes. Medical providers say getting this population healthier will take time, but they're making progress.

    Back in Phoenix, at Carly's Bistro, the next question will be how much any of this will weigh on a divided electorate as voters head to the polls. Early voting in Arizona begins October 12.

    For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney.