For years, says Corinne Bobbie, shopping in Arizona for a health plan for her little girl went like this:
鈥溾�楽orry, we鈥檙e not covering that kid,鈥欌�� Bobbie recalls insurers telling her. 鈥溾�楽he鈥檚 a liability.鈥欌��
On the day I visited the family at their home in a suburb north of Phoenix, 8-year-old Sophia bounced on a trampoline in the backyard. It鈥檚 difficult to tell she has a complex congenital heart condition and has undergone multiple surgeries.
鈥淪he鈥檚 a kid whose clock is ticking every day,鈥� her mother said, 鈥渂ut she goes to school, she rides horses. She does everything a regular kid can do, with a certain level of limitation.鈥�
In the early years of Sophia鈥檚 life, the child鈥檚 preexisting condition kept Bobbie and her husband, who runs a sandwich shop, on a constant quest for health coverage for Sophia. Her premiums alone were so expensive that the rest of the family often did without health insurance. The little girl鈥檚 medical bills were still huge, and the family racked up debt and lost their car and home.
Then the Affordable Care Act, also known as Obamacare, came along. In 2013, the Bobbies bought good health insurance for Sophia on Arizona鈥檚 exchange, for coverage to start the next year.
鈥淔or the first time in her life, we had a choice,鈥� Sophia鈥檚 mom said. 鈥淚 didn鈥檛 know what do. My head was spinning.鈥�
Arizona鈥檚 federally run marketplace was a success early on. There were lots of insurers and multiple plans that consumers could choose from, including many policies with low premiums. But that didn鈥檛 last. This past year, when the couple tried to add coverage for themselves and their son, they couldn鈥檛 afford it.
鈥淚t鈥檚 more disappointing to be so in favor of something, but to have such animosity toward it at the same time,鈥� Corinne Bobbie said. 鈥淚鈥檓 angry about it. Why can鈥檛 I have insurance, too?鈥�
The family faced 鈥� there was only one insurer to choose from in Maricopa County, where they live. The networks were narrow, meaning insurers didn鈥檛 offer a lot of doctors and facilities in their plans. Furthermore, the Bobbies were looking at hundreds of dollars more in premiums and a $6,000 deductible for each person on the policy.
On one hand, the ACA had finally guaranteed that someone like Sophia Bobbie 鈥� with her preexisting medical condition 鈥� could apply for insurance and switch policies without risk of being turned down. And yet the plans on the marketplace were unaffordable for the rest of the family.
The Bobbies are the kind of consumers who should be the target audience for Republicans intent on repealing the Affordable Care Act. But, so far, Corinne Bobbie is far from sold on the alternative the GOP is proposing: the American Health Care Act.
鈥淚t鈥檚 a bunch of garbage,鈥� she said. And about the lawmakers who passed it: 鈥淭hey could be the heroes. And instead it just became this nonsense.鈥�
Opponents of the effort to repeal Obamacare are tapping into this unease, running that accuse Republican moderates like , who represents Tucson, of voting for 鈥渁 disastrous health care repeal bill.鈥�
鈥淭hey are trying to put her in league with the extreme, hardcore Republicans in Congress,鈥� said GOP consultant , who is a partner at Molera Alvarez.
Democrats think McSally and , R-Ariz. 鈥� who are both up for re-election 鈥� are vulnerable. The politicians have a fine line to walk.
鈥淚t鈥檚 a balancing act between being aggressive in wanting to repeal Obamacare,鈥� Molera said, 鈥渨ith the fact that there are a lot of components of it that people like.鈥�
Those components include protections for preexisting conditions and Medicaid expansion, which has covered more than 400,000 people in Arizona alone.
The replacement bill would scale back that expansion, and the proposed curtailment in Arizona, including .
The major cuts to Medicaid, however, probably won鈥檛 survive in the Senate version, and Molera says that could actually help Flake.
鈥淗e doesn鈥檛 have to take that extreme position in order to get out of a Republican primary,鈥� Molera said, 鈥渁nd then that affords him the opportunity to be more of a centrist running against the Democrats.鈥�
Among Republican incumbents in Arizona, Flake is likely in the toughest race, but Democrats are even at Republicans in safer districts like conservative , who represents Scottsdale and is a member of the House鈥檚 conservative .
Schweikert says he voted for the GOP health plan in order to give states flexibility to transform Medicaid 鈥� through block grants, for example 鈥� even though that means less federal money for the state.
He admits his decision makes some in Arizona鈥檚 health care industry nervous.
鈥淭hey are concerned because they are quite comfortable with the current Medicaid model instead of a model that would provide a lot more choices,鈥� Schweikert said.
The state鈥檚 health care industry has warned that the GOP bill would result in more people showing up in the emergency room without insurance coverage, leaving hospitals 鈥� and, ultimately, consumers 鈥� to pick up the tab.
Schweikert also claims the bill will help salvage the state鈥檚 marketplace, which, he says, is 鈥渋mploding.鈥�
鈥淲e can lower the price so much for that 50 percent that鈥檚 healthy, that they鈥檒l start to participate in the system, because that鈥檚 the only way the math works,鈥� Schweikert said, adding that the ACA鈥檚 penalty system is not getting enough young people to join.
About 20 percent of people who signed up for Arizona鈥檚 marketplace are between , according to the Kaiser Family Foundation.聽(Kaiser Health News is an editorially independent program of the foundation.)
The GOP bill is expected to bring down the cost of some premiums, but prices would rise significantly for those who are older or have preexisting conditions, to the Congressional Budget Office.
Schweikert also predicts that, as configured right now, the insurance marketplace will not survive for much longer, given the exodus of insurers in recent years.
鈥淭oday, you鈥檙e lucky we have one,鈥� he said, 鈥渁nd tomorrow, you may have zero.鈥�
But , who oversees enrollment for the Arizona Alliance for Community Health Centers, disagrees that the state鈥檚 insurance exchange is in crisis.
鈥淲e believe that the two insurance companies that are covering Arizona will be back next year with the same footprint,鈥� Gjersvig said.
He also doesn鈥檛 expect Arizona to see the same dramatic rate hikes it saw last year, calling that an adjustment for underpricing in previous years.
But with the current uncertainty about what is in store for the health care law, insurers are having a tough time planning for the future.
Gjersvig said the biggest unknown is whether the Trump administration will withhold key payments known as ; these payments to insurers help subsidize coverage for low-income people. If insurers lose those, Gjersvig said, the insurance premiums for consumers will go up.
All this uncertainty is also a problem for Corinne Bobbie.
She said the debate over the ACA has become a political game in which her family and others have been forgotten. Her overriding fear: 鈥淲e are potentially in a position where this time next year, nobody in this house will have insurance,鈥� Bobbie said. 鈥淚f that happens, it鈥檚 going to be ugly. It鈥檚 going to be real ugly.鈥�
And the political fortunes of elected officials in Arizona and across the nation may well depend on voters like her family getting the care they need.
This story is part of a partnership that includes , and Kaiser Health News.