AILSA CHANG, HOST:
I'm Ailsa Chang in Phoenix, Ariz., where I've been talking with a lot of voters about the midterm elections. We came to Arizona for reasons we're exploring throughout today's show. First, it's a state where tight races are going to be decided by the voters in the middle, the moderates, the independents. And their minds are on health care, which is nothing new. Health care has been a top issue for the past several elections. But the fight used to sound more like this.
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BARACK OBAMA: It's working despite countless attempts to repeal, undermine, defund and defame this law.
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MICHELE BACHMANN: Let's repeal this failure before it literally kills women, kills children, kills senior citizens.
CHANG: But in 2018, the conversation about health care is different. Even though the Affordable Care Act has been weakened by the Trump administration, it is here to stay for now. And during this midterm election, both sides are reckoning with what that means. For Republicans, it's about acknowledging what the ACA got right and for Democrats acknowledging what it got wrong. And what I want to do now is introduce you to two voters who helped both sides get to this point.
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CHANG: Yes, more dogs (laughter).
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CHANG: I traveled to the red rocks of Sedona to meet a man who used to be on one extreme of the Obamacare debate and then ended up on the other, Jeff Jeans, who lives with his wife, two cats and six dogs.
All right, tell me who everyone is right here.
JEFF JEANS: Zoe, Jack, Peewee, Mia, Valentine and Pumpkin.
CHANG: Pumpkin (laughter). Hello.
Seven years ago, Jeans was just about the most fervent conservative you could find - no taxes, no government. As he puts it, the principle he lived by was everybody leave me the heck alone. And when it came to Obamacare, Jeans felt a special loathing.
JEANS: You know, I told my wife we were going to close our business before I complied with this law because as owners of a small business, I would be obligated to provide health insurance. And I'd tell my wife we would close our business before I did that.
CHANG: You would rather shut down then partake in Obamacare.
JEANS: I would have.
CHANG: But in late 2011, his worldview came crashing down. Jeans was on the phone one day, and suddenly his voice disappeared. He thought maybe it was just allergies. He didn't have health insurance, so he waited months before seeing a doctor. And that is when he learned the news. He had been living with stage 3 throat cancer.
And when you heard that, you know, you're thinking you don't have health insurance. What is the first thing that went through your mind when you heard you had cancer?
JEANS: That I was going to die. I mean, what do you think when somebody tells you you've got cancer? That you're going to die.
CHANG: He first tried paying for his cancer treatment with cash, but the hospital wouldn't take on any long-term treatment unless he got health insurance. So his only choice was to sign up for coverage under the Affordable Care Act.
JEANS: Well, it was kind of humorous that my coverage took effect on April 1.
CHANG: (Laughter) April Fool's Day.
JEANS: (Laughter) And we'll just kind of leave it at that (laughter).
CHANG: The joke's on you now.
JEANS: Yeah.
CHANG: To this day, Jeans says Obamacare saved his life.
JEANS: I actually sat in my hospital bed and cried because my perceptions of the health care system, of for-profit health care, of the fact if I got sick, I could show up in the emergency room and get treated were all just so wrong.
CHANG: These days, Jeans is an advocate for the ACA. He appears in commercials and at rallies to champion the law.
JEANS: I'd always wanted to thank President Obama. I'm sorry. I still get emotional about this.
CORINNE BOBBIE: OK.
CHANG: Seven years ago, a mother of two named Corinne Bobbie in Phoenix started at a very different place from Jeff Jeans. Bobbie, an independent, remembers her utter relief the day the ACA marketplace first went live.
BOBBIE: The weight that was lifted when the rollout happened - I cried. And I am not an emotional person. And I went on the marketplace, and I saw that we could - I cried.
CHANG: We met Bobbie right outside her children's school. And to understand just why the ACA was such a godsend to her, you first need to understand something about her daughter.
BOBBIE: So Sophia was born with what's called complex congenital heart disease, or they'll call it - CHD is the acronym. And then she also has another health issue called heterotaxy syndrome, which is less known.
CHANG: In other words, Sophia has several major heart defects. She was also born without a spleen, and some of her organs are in the wrong place.
BOBBIE: They're in the wrong place.
CHANG: All of which means staggering medical bills.
BOBBIE: By the time she was 3, she had already surpassed a million dollars in health care.
CHANG: Bobbie was at home caring for Sophia, and her husband didn't have health insurance through work, so Obamacare gave them hope during a pretty dark time at least for a while. But about three years into ACA coverage, Bobbie says Sophia started having problems getting the health care she needed.
BOBBIE: Her specialists were changing. She wasn't able to get prescriptions that she was totally able to get before. Suddenly they weren't covered. There was more hoops suddenly to jump through. And then by I think, like, the fourth year, we started to notice that providers were pulling out of the marketplace every year. They just started dropping like flies.
CHANG: By 2017, Maricopa County, where Bobbie lives, was down to just one health insurer in its entire marketplace. OK, at this point in our conversation, school lets out, and kids start spilling into the street in front of us. Bobbie waves at Sophia.
Which one is she?
BOBBIE: She is - well, I can't see. She's coming right now. She's got the blue backpack straps.
CHANG: Oh, yeah, I see her. OK.
Sophia is now a willowy 10-year-old with a huge smile gliding home on a hot pink scooter.
SOPHIA BOBBIE: I really hate walking.
CHANG: Why? Why is walking so bad?
SOPHIA: It just hurts my legs.
CHANG: But riding a scooter could be really risky now because remember how Maricopa County had only one insurer left on its exchange? Well, turns out the hospital had always treated Sophia terminated its contract with that one insurer. And Bobbie decided staying with those doctors was important, so she canceled the family's plan under the ACA, which means the Bobbies don't have any health insurance right now.
Well, I'm thinking, what happens when some emergency happens...
BOBBIE: Right.
CHANG: ...With Sophia?
BOBBIE: Exactly. So...
CHANG: Really, no, what is your answer to that right now?
BOBBIE: What is - it's - it literally - what I say is, OK, we'll cross that bridge if we come to it. Like, I don't have a backup plan right now.
CHANG: How does that feel?
BOBBIE: It's terrifying. It's absolutely terrifying.
CHANG: Bobbie's hoping this will be temporary. She will have more options for coverage during the next open enrollment period in November. But when she thinks about how hopeful she was when Democrats rolled out the ACA, she says what she didn't see at the time were all the pockmarks underneath the makeup.
When you hear Democrats cheering about it, applauding themselves for passing it, is there something a little bit impatient that...
BOBBIE: Yes.
CHANG: ...Wells up inside of you?
BOBBIE: I think impatience is an excellent way to describe it. I'm like, it's - I'm impatient because I'm waiting and waiting and waiting and waiting.
CHANG: Waiting for what?
BOBBIE: For some sort of change, some sort of champion maybe.
CHANG: Some fix.
BOBBIE: Some - a fix would be amazing.
CHANG: Corinne Bobbie says she doesn't know exactly what that fix should be, but she knows she wants to see Republicans and Democrats working together to come up with some compromise. And she says this is the single most important issue for her in this entire midterm election.
And for more on how health care is playing out in Arizona's races, we are now joined by KJZZ's Will Stone, who covers health care. Hey there, Will.
WILL STONE, BYLINE: Hi, Ailsa.
CHANG: So, you know, we've seen a lot of issue ads about health care throughout the state, including one that Jeff Jeans starred in. But what are candidates actually saying about health care on the campaign trail?
STONE: Democrats are certainly framing it as a choice between two very different visions of health care and another referendum on the Affordable Care Act. The voters can expect the GOP to do what they tried to do last year, repeal the health care law. And this narrative is kind of forcing Republicans to take what I call a more defensive posture. It's very much on display in our tight Senate race between...
CHANG: Democrats have been the defensive ones for the past eight years, but you think it's Republicans now.
STONE: That seems to be what's happening right now. I mean, if you just look at the race between Democrat Kyrsten Sinema - she's using that line of attack against her Republican opponent, Martha McSally. And, you know, in response, McSally's had to kind of soften, moderate her stance on the issue, saying we cannot go back to where we were before the ACA, that we need to fix the law and protect people with pre-existing conditions. And so for me, I think it shows that to win a statewide race in Arizona, which before the ACA had one of the highest uninsured rates in the country, Republicans like McSally need to reassure voters that they support certain key provisions of the health care law...
CHANG: Right.
STONE: ...And it's not just a full repeal.
CHANG: So you don't get the sense that the mantra repeal and replace resonates anymore in this state.
STONE: Not so much. And you can see that, you know, in the political races. And a lot of the concern revolves around Medicaid. Arizona expanded Medicaid under the ACA, and we had a lot of people who needed coverage, so there was a big rush to join the program. That was at risk under the GOP bill. And people in Arizona like the state's Medicaid program. Republicans, moderates like the program. It functions well. So no one wanted to see that damaged or cut. And as for those who shop for insurance plans on the marketplace, they say they want more options, cheaper plans, lower deductibles, but they do not want to see a full overhaul.
CHANG: Yeah, on more options, you know, we heard Corinne Bobbie say that she was hoping to have more choices in terms of health insurance during the next open enrollment season that starts next month. What does it look like? I mean, does it look like there will be more options for this state?
STONE: It's looking remarkably better. The market has stabilized. It's rebounded. Health experts I talked to say there'll be more options. And it's really one of the more resilient examples in the country of a marketplace that's working.
CHANG: That's KJZZ's Will Stone. Thank you very much, Will.
STONE: Thank you.
(SOUNDBITE OF LITTLE PEOPLE'S "MAKEMEBETTER") Transcript provided by NPR, Copyright NPR.