Affordable Care Act Affordable Care Act|Stock Photo

Enrollment in the Affordable Care Act is on the decline in Arizona and nationally, due to what experts say is a series of “mini-devastations” that have plagued the ACA since Donald Trump took office.

The latest enrollment numbers show approximately 8.3 million Americans enrolled in the ACA. In Arizona, 153,020 residents have healthcare plans through either HealthCare.gov or CuidadoDeSalud.gov, a 5% drop from 2019. Overall, enrollment has dropped 25% since it peaked in 2015.

“There have been so many mini-devastations to the ACA,” Arizona State University Clinical Assistant Swapna Reddy told the Arizona Republic. “And yet people are still enrolling. What it has shown is reflective of the resiliency of the law, to be perfectly honest. It shows people need comprehensive health coverage.”

The “mini-devastating” level of attacks on the ACA began as soon as it was signed into law. Former Gov. Jan Brewer attempted to convene a special session of the state legislature in March 2010 to sue the federal government over the national healthcare law. She failed, but other elected officials continued to escalate attacks on the ACA. 

As of now, Arizona remains part of the lawsuit to repeal the ACA thanks to Republican lawmaker support.

Sen. Martha McSally has been a vocal opponent of the Affordable Care Act since she first ran for Congress in 2012.

“We need to repeal Obamacare and replace it with initiatives that truly bring the cost down and do not add to our suffocating debt,” McSally said in a candidate questionnaire

McSally has kept the same stance on the ACA since her appointment to the U.S. Senate in 2018. After infamously telling Sean Hannity that she was getting her “ass kicked” prior to losing an election to Sen. Kyrsten Sinema, McSally doubled down on her opposition to the ACA. She split with Sinema on overturning the Trump administration’s controversial healthcare rule that allows states to ignore certain aspects of the ACA.

Despite opposition from McSally and other Republicans, enrollment in the ACA seems to have leveled out. Seema Verma, administrator for the Centers for Medicare & Medicaid Services, said the recent enrollment statistics “represent remarkably stable enrollment.”

But data from Arizona’s insurance market shows more fluctuation than resiliency. In addition to the state’s enrollment decline, insurance providers participating in the state’s health exchange has varied widely over the years. After peaking at 11 providers in 2015, the number of insurance providers on the state’s public exchange tanked to only two providers in 2017. That number bounced back in 2019, when five insurers signed up with Arizona’s ACA.

The drop in enrollment is largely due to changes made by the Trump Administration. These changes include “junk” insurance plans, reducing the number of days participants can enroll, slashing $26 million from the ACA marketing fund, and repealing the individual mandate penalty.

Data from the Census Health Bureau shows that, while ACA numbers are stable, uninsurance rates are still high. An estimated 2.8 million people in the US are currently uninsured. Arizona ranks 39th in the highest number of uninsured, with nearly 11% of the state’s population left without insurance in 2019.