Arizona Senate race: Martha McSally, Kyrsten Sinema at odds over Affordable Care Act

Stephanie Innes
The Republic | azcentral.com
Republican Martha McSally and Democrat Kyrsten Sinema are in a tight race for Sen. Jeff Flake's seat.

It's an 8-year-old federal law, but the Affordable Care Act remains a big point of contention in Arizona's tight U.S. Senate race between Democrat Kyrsten Sinema and Republican Martha McSally.

Sinema and McSally have found some common ground when it comes to health care: They both agree the system needs fixing, they are both critical of the Affordable Care Act's health-insurance exchanges and they don't think a "Medicare for All" single-payer type of system is the answer.

Aside from that, there are some key distinctions.

McSally opposes abortion rights and Sinema supports them.

And then there was McSally's vote in the U.S. House last year to repeal portions of the law as part of the American Health Care Act, which Sinema voted against.

At that time, McSally called the ACA — dubbed "Obamacare" by Republican critics — an "unmitigated disaster." The bill ended up failing.

READ MORE: McSally, Sinema to debate at 6 p.m. Oct. 15

McSally, a 52-year-old, two-term congresswoman from Tucson, defended her vote Friday in an interview with The Arizona Republic, saying the bill was an improvement on the ACA and that the ads attacking her health-care record on television are "lies."  

The problem is that the model for the ACA's individual health-insurance market has failed, she said.

"I meet people every single day who basically go uncovered under Obamacare," McSally said. "It's important for people to realize that under the Affordable Care Act, you have millions of people with pre-existing conditions who don't have health insurance. They can't afford it. That's really important for people to know." 

McSally added that the system pre-ACA was not working, but that there could have been a better solution with fewer government mandates and more choice and flexibility.

"If we could have been able to start fresh, there would have been a different model of how to do it, and that's what we're kind of trying to move back towards," she said. 

Sinema wants to build on the ACA

Sinema, a 42-year-old, three-term congresswoman from Phoenix, has been critical of the ACA, but also has said its fundamentals were good. She wants to build on the Affordable Care Act by fixing some of its flaws, such as the high cost of some individual plans, and the medical-device tax.

Sinema said in an interview Friday that health care is one of the "core areas" of difference between herself and McSally. And she said it's the No. 1 issue she hears about on the campaign trail.

READ MORE: Obama endorses Sinema for Senate

"I believe we should protect the parts of the existing health-care law that are working well for Arizonans, like protecting people with pre-existing conditions and ensuring Arizonans ages 50 to 64 aren't paying extra just because they are older," Sinema said. 

"Just a really practical approach. Keep the stuff that's good. Fix the stuff that's not good," Sinema said. "These are real differences between Martha and I. Martha voted for repeal and replace."

McSally wants more competition 

Sinema said McSally has not been talking as much about health care because she knows her record is bad for Arizonans.

But McSally says she has been talking about health care, and that she's trying to move it in a direction that provides more flexibility, competition and choice. 

"These are really complicated issues and it's our responsibility to understand them and to be as constructive as we can for those we represent," McSally said. 

The American Health Care Act was a repeal and replace measure that would have taken away key parts of the ACA and cut billions of dollars from the country's Medicaid program. Democrats have criticized McSally's vote as potentially hurting both people with pre-existing conditions and those ages 50 to 64.

"They are resorting to desperate fear tactics," McSally said during a get-out-the-vote rally at the state GOP headquarters last weekend. "I voted to protect people with pre-existing conditions."

She reiterated those sentiments on Friday to The Republic, saying her opponents have "nothing to run on" so they are resorting to fear tactics.

READ MORE: Romney boosts McSally: She 'has fought for American safety'

McSally said she's been working with Democrats to try to stabilize the individual health-insurance marketplace. She wants to see more robust markets with greater flexibility at the state level, she said.

"We need a health-care system where people with pre-existing conditions cannot be denied coverage, cannot be dropped from coverage, and I'm going to tirelessly advocate for that," McSally said. "It's insulting and infuriating when the other side is using lies to gain votes."

Ariz. health-care landscape different

One thing is certain — the health-care landscape in Arizona is far different now than in 2013, before most provisions of the ACA took effect..

Back then, the rate of uninsured people in Arizona was about 19 percent, which was one of the highest levels in the country. The uninsured rate has since been almost halved to 10 percent, says health-policy expert Dr. Daniel Derksen of University of Arizona Health Sciences.

The  percentage of uncompensated care at Arizona hospitals is down post-ACA, and hospital operating margins are up, data from the Arizona Hospital and Healthcare Association shows.

The improved bottom line for hospitals is evident in a local health-care economy that has both new construction projects and health-care-sector job growth. 

READ MORE: More health insurers to enter ACA marketplace

A September Kaiser Family Foundation tracking poll found that half of American adults have a favorable view of the ACA, while 40 percent view it unfavorably (10 percent didn't know), with younger working-age people, women, Democrats and independent voters more likely to have a favorable view of the law than older Americans and Republicans.

Only 15 percent of Republicans reported having a favorable view of the law.

"To completely repeal (the ACA) and replace it with nothing, the damage to health-care coverage and the health-insurance market would be profound and extensive. We are talking millions of persons losing coverage instantly," said James Hodge Jr., a professor of public-health law and ethics at Arizona State University's Sandra Day O'Connor College of Law.

"Repealing the ACA is a very significant, direct threat to health coverage and health access for millions of Americans and hundreds of thousands of Arizonans. But no one in Congress is talking about simply repealing the Affordable Care Act," Hodge said. 

The Republican platforms now are all about "repeal and replace," Hodge said. None of the replacements made it through during the last session of Congress, but that could change, depending on the results of the midterms.

"To be sure, it's yet to be proven that the replacements are better than the existing version," Hodge said.

McSally's 2017 vote scrutinized

After casting her vote for the American Health Care Act, McSally issued a statement saying the legislation preserved protections for people with pre-existing conditions.

But Derksen, the UA health-policy expert, said the American Health Care Act had the potential to harm Americans by cutting billions of dollars from Medicaid, which is a government health-insurance program for low-income people that currently covers one in every four Arizonans.

"Consumer protections are things people want to see stay," Derksen said. "The fact is that under the American Health Care Act of 2017, millions of Americans would have lost their health insurance."

READ MORE: Why McSally and Sinema seem so scripted

More recently, the Trump administration has been working to chip away key provisions of the ACA through measures such as approving work requirements for people on Medicaid, which in Arizona is called the Arizona Health Care Cost Containment System, or AHCCCS.

The AHCCCS program has applied to the federal government to add work requirements and a decision is pending.

Former Massachusetts Gov. Mitt Romney hugs Martha McSally during a rally at the Falls Event Center in Gilbert, October 12, 2018.

Individual penalties going away in 2019

Another aspect of the ACA that's changing is the individual mandate that charged penalties to people for not having health insurance. Those penalties go away in 2019 and could disrupt the risk pool and threaten the individual insurance marketplace.

"I do have concerns about what happens with health care next," Sinema said. "We don't have a Congress that's working very effectively together to solve these problems. The House of Representatives tried to repeal an existing law without replacing it with workable options."

McSally said she's committed to "bipartisan solutions" to problems in health care, including the spiraling cost of care.

READ MORE: Senate poll: Sinema has edge over McSally

Derksen of the University of Arizona says he's heard "hyper-partisan rhetoric" on both sides of the health-care issue during this election season and believes the campaigns would be better served sticking to facts, rather than partisan politics. The rhetoric creates a "fog of confusion," he said.

"It is kind of a new phenomenon that we are so partisan. I don't think we do well as a country when we lurch from one extreme to the other," he said. "I think it's particularly important that people are educated about the issues and understand where the candidates stand."

Kyrsten Sinema greets volunteers and supporters on Oct. 3, 2018, at a Democratic field office in Glendale.

Expert: Voters want answers, not attacks

Voters are concerned about spiraling drug costs, losing coverage and potential cuts to Medicaid and Medicare, among other health-care issues, Derksen said.

That's why they want answers, not attacks, he said.

MORE: Arizona health premiums likely to drop in 2019 after years of increases

As a non-profit hospital, Tucson Medical Center cannot endorse any particular candidate. But the hospital has launched a campaign called "Vote for the Health of It" that urges voters to cut through the rhetoric and consider candidates' positions on access to care and  pre-existing conditions, in addition to factors that create healthy communities such as economic development and job growth.

“Without getting caught up in the political rhetoric, we see on the front line the impact that the actions of our elected officials have on the people we serve, " said Julia Strange, Tucson Medical Center's vice president of community benefit.

"We ask that people vote as if their health depends on it. ... Because in so many ways and you may least expect it, it does.” 

Arizona PBS, in partnership with The Arizona Republic and azcentral.com, is hosting the only live television debate between McSally and Sinema on Monday at 6 p.m.