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Nearly 2.8 million Arizonans who live with pre-existing medical conditions receive protections under the Affordable Care Act (ACA), but those protections are at risk of being gutted due to an ongoing lawsuit from Arizona and 19 other Republican-led states.

The lawsuit, filed in 2018, marks just the latest attempt by Republicans, including Arizona’s own Sen. Martha McSally (R-AZ), to repeal the healthcare law in its entirety.

The suit has since earned the support of the Trump administration and has made its way to the U.S. Court of Appeals for the 5th Circuit, which is expected to make a decision in the next few weeks.

Consequences of ACA Repeal

Should the court rule that the ACA is unconstitutional, it could lead to the repeal of the law, leaving Arizonans who suffer from pre-existing conditions, such as asthma, diabetes and cancer, without patient protections.

Such a ruling would once again allow insurance companies to deny these individuals coverage. That includes more than 386,000 children, according to FamiliesUSA, a nonprofit, nonpartisan advocacy group for healthcare consumers.

McSally’s record on healthcare

While the lawsuit is still working its way through the courts, Republicans’ ongoing attacks on the ACA have Arizonans worried and skeptical of McSally, according to an August 2019 poll from Public Policy Polling (PPP).

A plurality of respondents, 45%, said they did not believe Sen. McSally could be trusted on the issue of health care. This is particularly notable because 39% of respondents identified as Republican, while only 35% identified as Democrat, and 26% as Independent. 

This lack of faith in McSally may have something to do with her record on the issue.

McSally voted for a full repeal of the ACA in 2015, which would have meant the loss of protections for people with pre-existing conditions. 

She also voted to repeal and replace the law in 2017, infamously telling her colleagues they needed to get the “f-cking thing” done. The bill she voted for, the American Health Care Act (AHCA), would have weakened protections for people with pre-existing conditions, according to health experts. 

Despite her record on the issue, during her 2018 campaign for U.S. Senate, McSally misleadingly stated that she was “leading the fight” to “force insurance companies to cover pre-existing conditions.”

Politifact, a non-partisan website focused on fact checking journalism, rated her claim as “mostly false.” 

McSally’s record on healthcare dogged her during her campaign, and may have played a role in her loss to now-U.S. Sen. Kyrsten Sinema (D-AZ), as an October 2018 poll from PPP found that 58% of voters said healthcare was the “most important” or a “very important” issue for them. 

Following McSally’s loss, interim U.S. Sen. Jon Kyl (R-AZ), who had been appointed to fill the seat left vacant by the death of John McCain, announced his resignation. Arizona Gov. Doug Ducey (R-AZ) then appointed McSally to the seat. 

McSally is up for re-election in 2020 and her record on healthcare may once again take center stage. 

Healthcare matters to Arizona voters

Eighty-four percent of respondents to PPP’s August 2019 poll said healthcare was a “top” or “important” priority to them.

The outcome of the ongoing lawsuit could also factor into McSally’s re-election campaign, as 65% of respondents said they found it either “extremely concerning” or “very concerning” that the Trump administration is pushing a repeal of the ACA without a plan to replace it. 

Another 40% said they were extremely worried that they or someone they care about could lose healthcare coverage because of a pre-existing condition if the ACA is repealed. 

What’s next

If the U.S. Court of Appeals for the 5th Circuit upholds the ACA and rules against the Republican-led states, those with pre-existing conditions would, at least for now, still be protected under the ACA. 

If the court strikes down the ACA as unconstitutional, the case would likely be appealed and find its way to the Supreme Court in 2020.

It would then be up to the highest court in the land to decide the fate of nearly 2.8 million Arizonans who live with pre-existing medical conditions.