TEMPE, Ariz. — Just weeks before the presidential election, Josephine has spent nearly every morning worrying as she drives to her breast cancer treatments, waits for her doctor and comes back home.
At 61, Josephine, who asked that her last name not be used because she has been under the protection of a restraining order, has much riding on this election. Once uninsured after being laid off from her job, she was recently diagnosed with breast cancer and has been able to get subsidized health coverage through the Affordable Care Act. The pro-Hillary Clinton signs on her parched lawn show which candidate she trusts to keep her covered.
In these final weeks of campaigning, Clinton, a Democrat, is pressing hard into once reliable Republican territory, especially in Arizona where recent polls show her close to tying Donald Trump. At stake in the election is President Barack Obama’s signature domestic achievement.
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.This KHN story also ran on PBS NewsHour. It can be republished for free (details).
Meanwhile, Trump has vowed to “repeal and replace Obamacare so quickly.” He has suggested smaller measures, like allowing health insurance to be sold across state lines and tax deductions for monthly premiums. Health policy experts widely agree that these approaches would cover far fewer people than the Affordable Care Act and result in a rise in the uninsurance rate, which reached a record low of 9.1 percent in 2015.
But in Arizona, Republican opposition to the Affordable Care Act has been fueled by volatility in the state’s health insurance market set up by the law.
When the marketplace for individual insurance coverage in Arizona first opened, eight companies vied for consumers in various parts of the state. After three years of low enrollment and higher-than-expected medical claims, only one insurer remains in about half the counties and many Arizonans are facing steep premium increases.
“A lot of people that are just getting worn down,” said Michael Malasnik, a Phoenix-based insurance broker. He says he’s already getting calls for the upcoming enrollment period with clients expressing “frustration and anger.”
The drop in competition isn’t just in Arizona, said Caroline Pearson, a senior vice president for policy and strategy at Avalere Health, a strategic advisory firm located in Washington, D.C.
More than a third of regions across the country may end up with only one insurer available, especially in rural areas, and Pearson said a remedy would require congressional changes to the law in 2017.
“We’re going to need a combination of changes” to the health law’s risk mitigation programs and other changes to help stabilize the market, Pearson said. And, she added, the program will need “some very creative solutions to figure out, how we actually get younger, healthier people, middle-income people, into the exchanges.”
The exodus has raised questions for Mesa resident Leah Sondergeld about adequate access to medical care, the potential for price gouging and the durability of the ACA marketplace.
Sondergeld and her husband are self-employed, and the family 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 gonna do?” she said. “With one of the doctors, during that first transition with UnitedHealthcare, she was four days without medications. I had to watch her have seizures.”
Now on the right medications, Kate Sondergeld, age 25, is back at the University of Arizona in Tucson after a long medical leave. But finding the best prescription 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,” she said. “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 pre-existing condition.
Her mother 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,” said Leah. “Just, tell Blue Cross Blue Shield, ‘Hey, guess what? You’re gonna keep this person.’”
Despite the problems with the law, those like Josephine who need insurance coverage are doing better because of it. After years without seeing a doctor, she was able to get a check-up which led to her cancer diagnosis and treatment. She said without the law’s consumer protections that require insurers to cover people with pre-existing conditions, she would be bankrupt or dead.
“I got a primary care doctor, which I hadn’t had a primary care doctor for a decade,” she said. “And from the primary care, it just went from there. The tests and the mammograms and the ultrasounds and the MRIs.”
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.
But Trump volunteer Diana Brest, of Phoenix, thinks the law has caused more harm than good and supports her candidate’s vow to repeal it. At 66 and on Medicare, she blames the law for driving up premiums for others.
“Obamacare, some people said it was going to help, but I knew right away it wasn’t!” she said. “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 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 states that expanded Medicaid were more likely to report being in better health. Arizona is one of the 31 states that expanded Medicaid.
Alfred Mendoza, a 45-year old 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 to pay for a CT scan, an MRI,” he said. “It’s a lot of money to go see a specialist.” He added, that Obamacare has “been working out great, to the point where I feel safe with my health.”
Nancy Johnson, CEO of the bustling El Rio Community Health Center in Tucson, which sees 100,000 people annually, says newly insured Medicaid patients have been arriving with untreated conditions, like high blood pressure and diabetes.
“There’s a lot of catch up to do, whether it’s around primary and secondary prevention, or whether we’re identifying people who do need ongoing chronic care management that we know will save the health care system in the long run over time,” said Johnson.
PBS NewsHour producer Jason Kane contributed to this report.
With major insurers retreating from the federal health law’s marketplaces, California’s insurance commissioner said he supports a public option at the state level that could bolster competition and potentially serve as a test for the controversial idea nationwide.
“I think we should strongly consider a public option in California,” Insurance Commissioner Dave Jones said in a recent interview with California Healthline. “It will require a lot of careful thought and work, but I think it’s something that ought to be on the table because we continue to see this consolidation in an already consolidated health insurance market.”
Nationally, President Barack Obama and other prominent Democrats have revived the idea of the public option in response to insurers such as Aetna Inc. and UnitedHealth Group Inc. pulling back from the individual insurance market and many consumers facing double-digit rate hikes.
The notion of a publicly run health plan competing against private insurers in government exchanges was hotly debated but ultimately dropped from the Affordable Care Act when it passed in 2010.
Health insurers have long opposed the idea, and other critics fear it would lead to a full government-run system.
Most of the discussion surrounding a public option, however, has focused on a nationwide plan, not one emanating from a state. In July, Democratic presidential nominee Hillary Clinton said she would “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan.”
Jones offered few specifics on what a public option might look like in the Golden State.
“I don’t want to begin to prejudge it,” said Jones, an elected Democrat serving his second term as head of the state Department of Insurance, one of two insurance regulators in California. “I don’t know whether you would start in certain areas of the state and expand from there. I think there would be significant reservations about the state running it. There would be a wide variety of governance models you could come up with.”
Politically, the proposal may gain more traction in Sacramento than Washington with Democrats firmly in control of the state Legislature and many lawmakers eager to go beyond the boundaries of the federal health law. Depending on what form it took, a public option would require state legislation, some type of federal approval and some source of funding.Use Our Content This story can be republished for free (details).
The idea of a California-style public option drew mixed reaction. Some consumer groups say they welcome another run at the public option after a disappointing outcome in 2010.
“We’re certainly very interested,” said Anthony Wright, executive director of Health Access California. “This is something we advocated for in its most ambitious form during the debate over health reform and there are elements of the proposal that could be adapted for California.”
Some health-policy experts questioned whether the proposal would backfire, ultimately reducing competition.
“I don’t know what would compel other insurers to stay in the market, so the public option could quickly become the only option,” said Katherine Hempstead, who directs the Robert Wood Johnson Foundation’s work on health insurance coverage. “I think that is only a clear win when the alternative is nothing.”
State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, said a public option could make sense in some underserved areas. But he said it may not address the problem of large health systems dictating high prices, and it could interfere with the progress made by the Covered California insurance exchange.
Covered California said 7.4 percent of its 1.4 million enrollees will only have two health plans to choose from for 2017. The state’s biggest markets of Los Angeles, San Francisco and Orange County all feature six to seven insurers.
“I don’t know if a public option will create a lower price [for] the consumer,” Hernandez said. “Covered California has done a good job of keeping rates fairly stable and it has enough plans.”
Health insurers agreed. “Covered California has arguably one of the strongest and most stable exchanges in the country. There is robust consumer choice so we don’t think we need to mess with something that isn’t broken,” said Nicole Evans, a spokeswoman for the California Association of Health Plans, a trade group.
For years, Jones has criticized the lack of competition in Covered California, and more recently he has opposed the mergers proposed by industry giants Anthem Inc. and Aetna Inc., saying they’re anticompetitive.
Anthem wants to acquire Cigna, while Aetna is trying to merge with Humana, but the U.S. Justice Department has sued to block both deals.
Covered California has fared better than many states in terms of insurer competition. Eleven health plans are participating in the state-run exchange for 2017, but UnitedHealth is dropping out after just one year in California’s individual market.
Consumer advocates had hoped UnitedHealth would become a strong rival to the state’s four largest insurers. Anthem, Blue Shield of California, Kaiser Permanente and Health Net (now a unit of Centene) account for 90 percent of the state’s exchange enrollment.
After modest 4 percent rate increases in 2015 and 2016, Covered California premiums are set to climb by 13.2 percent on average next year.
Jones said he anticipates that critics will cite the failure of numerous co-ops across the country as evidence a public option won’t work. But he said that criticism is unjustified because the Republican-led Congress eliminated crucial funding that many of the co-ops were depending on.
The co-ops are nonprofit insurers backed with federal loans and designed as an alternative to commercial health plans.
Earlier this year we reflected on Hispanic Heritage Month with a post by my colleague Francisco Macias. He and I have explored the origins of the month in previous years’ posts. You can read this year’s Presidential Proclamation online too. Once you know all about it, how will you commemorate this month? It begins each year on September 15 and runs to October 15, so you have some time to think about it. One method is to take a look at the new arrivals to the collection. With the anniversaries of the independence of several Latin American countries recently behind us (Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Mexico, Chile and Belize) and the celebration of Día de la Raza to look forward to on October 12, I pulled several of our newest titles (i.e., the last two years) that you’ll find here on the shelf at the Law Library. This list is representative, not exhaustive. Enjoy!Brazil
KHD2817.C348 2016 The CAM-CCBC Arbitration Rules 2012 : a commentary.
KHD2698.B37 2016 Barroso, Luís Roberto. O controle de constitucionalidade no direito brasileiro : exposição sistemática da doutrina e análise crítica da jurisprudência.
KHD5443.F394 2016 Fayet Júnior, Ney. Do crime continuado.
KHD4603.C86 2016 Cunha, Leonardo José Carneiro da. A Fazenda Pública em juízo.
KHD3230.B67 2016 Bordalo, Rodrigo. Os órgãos colegiados no direito administrativo brasileiro.
KHD4680.H54 2016 Higuchi, Hiromi. Imposto de renda das empresas : interpretação e prática, atualizado até 10-01-2016.
KHD1241.G66 2016 Gomes, Josiane Araújo. Contratos de planos de saúde : a busca judicial pelo equilíbrio de interesses entre os usuários e as operadoras de planos de saúde.
KHD3421.M33 Machado, Paulo Affonso Leme Direito ambiental brasileiro.
K1315.L49 2016 Lezcano Navarro, José Maria. Piercing the corporate veil in Latin American jurisprudence: a comparison with the Anglo-American method.
KGF327.H35 2016 Hall, Frederic, 1825-1898. The laws of Mexico : a compliation and treatise relating to real property, mines, water rights, personal rights, contracts, and inheritances.
KGF335.C65 V45 2016 Velasco San Martín, Cristos. Cyber law in Mexico.
KG595.L44 2016 Legislative institutions and lawmaking in Latin America.
K460.F54 2016 Figueroa, Dante. El derecho natural en una perspectiva comparada.
KHF3739.R63 2015 Rodríguez Grez, Pablo. Derecho del consumidor: estudio critico.
KHF3702.A67 S46 2015 Seminario de Profesoras de Derecho Constitucional (4th : 2014 : Chile) La constitución económica.
KHF3015.A944 2015 Aliaga Medina, Vicente. Acto administrativo e información pública: los criterios del Consejo para la Transparencia.
KHH1954.R63 2103 Rodríguez Mesa, Rafael. Sistema general de riesgos laborales : ley 1562 de 2012, reforma al sistema general de riesgos laborales decreto 723 de 2013.
KHH567.D66 2016 Domínguez Giraldo, Luis Alberto. Los alimentos: (juicio oral), (norma sustantiva, procedimientos, práctica forense).
KHH3240.R53 2016 Riascos Gomez, Libardo Orlando. El acto administrative.
KHH1011.P56 2016 Pinzón Muñoz, Carlos Enrique. La reparación directa: aspectos procesales y probatorios.
KHH2914 1991.C675 2016 Constitución y democracia en movimiento.
KHH3053.R4895 2016 Reyes González, Guillermo Francisco. Los mecanismos de participación ciudadana y las consultas populares en Colombia.
KGB5924.B87 2015 Burgos Mata, Álvaro. El Uniforme penitenciario y su posible implementación en Costa Rica.
KGB5936.B874 2015 Burgos Mata, Álvaro. La polución delictiva: prevención y represión del delito en materia penal juvenil en Costa Rica.
KGB5831.A96 2015 Amador Badilla, Gary. La audiencia preliminar en el proceso penal.
KGB2914 1949.H47 2015 Costa Rica. Constitución política de la República de Costa Rica: actualizada 2015 comentada y con citas de jurisprudencia.
KGC4804 2015 El Salvador, enacting jurisdiction. Recopilación de leyes en materia de integración económica y aduanal.
KGD5510.E836 2016 Escobar Cárdenas, Fredy Enrique. Compilaciones de derecho penal: parte especial.
KGD409.B73 2016 Brañas, Alfonso. Manual de Derecho Civil: libros I, II y III.
KGD263.M86 2015 Muñoz, Nery Roberto. La forma notarial en el negocio jurídico: escrituras públicas.
KGD5819.E83 2015 Escobar Cárdenas, Fredy Enrique. El derecho procesal penal en Guatemala.
ΚΖΑ1146.C7 R66 2015 Romero Pérez, Xiomara Lorena Diferendo fronterizo entre Nicaragua y Colombia: consecuencias políticas para el estado colombiano.
KGG404.31904.A52 2015 Nicaragua. Código Civil de la República de Nicaragua: incluye reformas de la Ley No 870 “Código de Familia” : publicado en la Gaceta Diario Oficial no 190 del día 8 de octubre de 2014.
KGG3070.A312006 A4 2015 Nicaragua. Ley no. 606: texto de Ley no. 606, “Ley Orgánica del Poder Legislativo de la República de Nicaragua” : con sus reformas incorporadas.
KGG5414 2015 Nicaragua. Compendio de leyes penales de la República de Nicaragua.