The threatened repeal of the Affordable Care Act could have a big impact on the health of Arizona’s children in the midst of a pandemic, the Children’s Action Alliance concluded in a report last week.

Arizona has joined 17 other states and the Trump administration in a lawsuit asking the U.S. Supreme Court to declare the Affordable Care Act unconstitutional. The court will likely decide the case after the election.

However, the Children’s Action Alliance released a report suggesting such a repeal could cost 363,000 Arizona residents their health care coverage and perhaps cost 2.8 million Arizonans affordable coverage for pre-existing conditions.

The pandemic has dramatically increased the potential impact of a repeal of the ACA, according to the report prepared by the Arizona State University College of Health Solutions. Before the pandemic, some 297,000 Arizonans received coverage through the ACA, which includes both buying mostly subsidized health plans directly as well as an expansion of the Arizona Health Care Cost Containment System from 100% of a poverty-level wage to 138% of a poverty-level wage.

Before the pandemic, about 34% of Gila County residents relied on AHCCCS for their health care. Many others got coverage through the ACA’s insurance marketplace, which subsidized premiums for people making up to 400% of a poverty-level wage.

The pandemic boosted the state’s unemployment rate from about 4% to about 16%. The rate has since fallen to about 10%, but is on the rise again. A deadlocked Congress last week failed to extend the enhanced unemployment benefit provisions of the original CARES Act, which could mean many more people will have a hard time getting health care.

About 27 million Americans lost their jobs during the pandemic, which means many also lost their health care coverage.

Moreover, the ACA requires coverage of preexisting conditions with no extra charge, as well as coverage of many preventive medical services like birth control and treatment for substance abuse and mental health problems. Republican alternative bills would have required coverage of pre-existing conditions, but without a limitation on higher premiums to make the coverage affordable.

The Children’s Action Alliance said the loss of the Affordable Care Act would represent a major setback to children’s health statewide.

Studies show having medical coverage makes it much more likely children will receive preventive care and vaccines and have fewer unmet health needs. Children with health care coverage also miss fewer days of school and earn more money as adults.

The pandemic has further underscored the huge gaps in the nation’s health care system, with low-income people without coverage suffering far more effects. Health officials have already warned that the pandemic had resulted in a worrisome decline in childhood vaccinations for other diseases, like measles, mumps and rubella. Doctors also worry Arizona will still be coping with COVID-19 in the fall when the flu season will ramp up once again.

All that underscores the need to prevent a fresh rise in the ranks of the uninsured, which the ACA had reduced by 50%. The act proved especially helpful for Native American and minority children, with those communities facing a far greater risk of infection and serious illness than whites as a result of the pandemic.

The Children’s Action Alliance tallied up the benefits to children of the health care insurance expansion, including:

  • 3,400 foster children gained coverage.
  • 41,000 low-income children whose parents didn’t qualify for AHCCCS have gained coverage.
  • 64,000 low-income children gained coverage through the expansion of AHCCCS.

The issue has become increasingly important in many political campaigns, with the ACA now broadly popular with the public.

For instance, incumbent Republican Sen. Martha McSally does not oppose the lawsuit seeking repeal. She says she supports coverage of pre-existing conditions and voted for a Republican-backed bill that would require coverage. However, the bill would have let insurance companies charge far higher rates for someone based on prior health conditions.

Her Democratic opponent — former astronaut Mark Kelly — has said he supports the Affordable Care Act. He favors the addition of a “public option,” which would be a government operated health plan that would compete with private plans on the ACA insurance exchanges. He also favors restoring money that allowed the ACA insurance exchanges to market themselves and provide advisers to guide consumers through the process.

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