I’ve been an Emergency Physician in Arizona now for nearly two decades.  The Affordable Care Act (ACA), along with the Emergency Medical Treatment and Labor Act (EMTALA) have been the two most important laws that have affected my practice during that time, and both have been immensely positive for patients.

EMTALA says we can’t turn anyone away, regardless of their ability to pay.  What it doesn’t say is that they can’t get a bill at the end of that – and that might be a crippling bill that could threaten their financial security.

Before the ACA about ⅓ of adults living in the US had no health insurance. Children were often moved off their parents’ insurance as soon as they went to college if they moved out of the house – even into a dormitory. And of course the worst was the dreaded “pre-existing conditions” exclusions – which meant basically anyone who had any healthcare conditions and had a job change or any other reason they needed to switch insurance carriers might find, for example, that their diabetes care – nor anything related to it – was covered by their new plan.

The ACA changed all of that – and more. It abolished the pre-existing conditions exclusions. It allowed children to stay on their parents’ plan until age 26.  And it reduced the number of uninsured to under 10%, which made it far less financially worrisome for people who needed to be admitted to the hospital .

Despite being the constant target of political demonization and sabotage from Republicans for nearly a decade and a half, the Affordable Care Act has been a success. Now, new numbers from Kaiser Family Foundation (KFF), a leading health care nonprofit that focuses on policy research and polling, show more people than ever are purchasing quality, affordable health insurance that gives people peace of mind knowing they can see a doctor when they get sick.

To date, more than 348,055 Arizonans have health insurance because of the ACA. In 2014, Arizona was one of the first Republican-led states to accept the Medicaid expansion of ACA, extending coverage to those up to 138% of the federal poverty level.  The acceptance of the Medicaid expansion quelled a crisis of the state’s own making when the Jan Brewer administration introduced deep budget cuts that forced many people off of AHCCCS (Arizona’s Medicaid program), and flooded the state’s Emergency Departments with patients who not only were cut off from their primary care providers, but were made sicker by delays in care and lack of access to life-saving medications.  

Since that time, ACA and the Medicaid expansion have been an enormous benefit to Arizona.  In fact, ACA coverage in Arizona has more than doubled thanks to the efforts of the Biden-Harris administration who has worked to protect and expand the ACA. 

But now, all this progress is once again under threat.  Institutional memory can be short, and it seems many people have forgotten about the crisis induced the last time GOP state lawmakers attempted to curtail insurance coverage for Arizona residents. Cutting budgets and cutting healthcare doesn’t make patients healthier – it does the opposite.  When Brewer’s administration pushed people off of Medicaid, chronic conditions like heart failure and depression stopped being managed in the outpatient setting, and patients couldn’t get access to medications or healthcare providers.  It was not infrequent during that time to have previously stable cardiac patients come in with acute heart failure, or depressed patients, deprived of medication, arrive in our ED’s with suicidal thoughts.

Acceptance of the Medicaid expansion reversed this trend, restoring access to physicians and ensuring people got their medications, so most problems remained outpatient problems, and preventable hospital admissions were sharply curtailed.

The Biden-Harris administration have taken this even further.  The Inflation Reduction Act reduced or eliminated out-of-pocket premiums for millions of people by expanding tax credits through 2025. Lowering premiums allows more families than ever before to enroll in the coverage they need to stay healthy – 80% can find coverage through the Marketplace for $10 or less. This means the average family in Arizona will save $475 each month and can put that money toward other essentials like putting food on the table and a roof over their heads.

Despite its record success, MAGA Republicans can’t quit their attempts to repeal the ACA. Since he first reignited his promise to “terminate” the ACA in November, Trump has repeated his public attacks at least seven times. 

The stakes for American health care could not be higher and we must take these threats seriously. Millions, including hundreds of thousands of Arizonans, depend on the ACA for critical health care coverage.

Arizonans don’t want to go back to 2014, when ⅓ of them were uninsured, and of the insured many were afraid of losing their jobs and losing coverage, or changing jobs and losing coverage for what would be considered pre-existing medical conditions.  Our own state’s history showed us both the folly of trying to cut back on healthcare coverage and thinking it will save the state money, the danger to our citizens who can no longer have access to the care they need for their medical issues, and the immense strain to already overcrowded Emergency Departments across the state who can neither close nor turn anyone away – even if means we’re not getting paid for the care we deliver.

The Affordable Care Act and the Medicaid Expansion saved Arizona, and greatly improved the health of its residents.  The new Biden-Harris provisions under the Inflation Reduction Act take us even further in terms of providing equity in coverage.  It’s good for the health of our patients, our communities, and our state.

Larry DeLuca is an Emergency Medical doctor in Tucson.