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Increase in Health Act Premiums May Affect Arizona Vote

Kathy Hornbach, 60, a breast cancer survivor in the Tucson area, learned Blue Cross would no longer cover people in her age group.Credit...Caitlin O'Hara for The New York Times

PHOENIX — Arizona was shaping up to be one of the more unlikely battlegrounds of the 2016 campaign when a political bombshell appeared to explode last week: The Obama administration revealed that the cost of midlevel plans on the Affordable Care Act’s health insurance marketplace here would increase next year by 116 percent on average.

Senator John McCain, running for re-election against the headwind of Donald J. Trump, took the bad news as a gift, highlighting it in a new television ad that begins, “When you open up your health insurance bill and find your premiums are doubling, remember that McCain strongly opposes Obamacare.” Other Republican candidates here also seized on the rate increases, counting on the issue to buoy them with Election Day imminent and Mr. Trump losing ground in the Republican-dominated state.

But as with everything related to the Affordable Care Act, it is complicated. The rate increases had been predicted for months as insurer after insurer announced plans to drop out of the marketplace here. Very few Arizonans are directly affected. Voting has already begun, and the political environment has been largely fixed for months, defined by deep divisions over immigration, Hillary Clinton’s emails and Mr. Trump’s fitness for office.

The rate increases, in fact, are unlikely to be a deciding factor.

Leslie Rycroft of Scottsdale, who works in human resources, is paying $1,100 a month this year for a United Healthcare plan that has a $13,000 deductible for her family of four. Their income was a little too high to qualify for a subsidy, she said. When she looked at her options on HealthCare.gov last week, she said she was “absolutely horrified” to see only one insurer, Health Net, offering plans that started at $2,200 a month. “It’s beyond ridiculous,” she said. “All of a sudden you are paying $26,000 a year,” Ms. Rycroft said, “just for catastrophic health insurance.”

Still, Ms. Rycroft, 59, said she had already cast her vote for Hillary Clinton. A registered Republican, she finds Mr. Trump “abhorrent,” she said. She did split her ticket and voted for Mr. McCain instead of his Democratic opponent, Representative Ann Kirkpatrick, because of his national security experience, she said.

Shortly after Ms. Rycroft learned about her rate increase, she got a reprieve in the form of a job offer. Her new job will provide insurance starting in January.

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Dante Fierros of Tempe, who owns a small manufacturing business, considers the Affordable Care Act an example of government overreach.Credit...Caitlin O'Hara for The New York Times

On Monday, the Obama administration confirmed what many Arizonans had already suspected, publishing premiums for policies offered under the Affordable Care Act that revealed that Arizona faces the biggest average rate increase in the country. The news was even worse in Phoenix, the nation’s sixth-largest city, where the price of a midlevel plan will increase by 145 percent on average.

Insurers rushed into the Phoenix market in the early years of the Affordable Care Act, offering some of the lowest prices in the country. But many younger, healthier people failed to enroll, and sick people flocked to the Arizona exchange, taking advantage of the law’s prohibition on denying coverage for pre-existing medical conditions. It now appears that many insurers severely underpriced their premiums, and they are now making up for that error by either jacking up rates or simply leaving the marketplace.

The fourth open enrollment for Affordable Care Act plans starts Tuesday, and in Phoenix and its suburbs, only one insurer, Health Net, a subsidiary of Centene, is offering plans for next year, compared with eight this year.

Many customers, particularly those with lower incomes, will not be affected by the price increase; the subsidies that the law provides to help pay premiums will cover most or all of it. Seventy-four percent of Arizonans with marketplace plans got subsidies this year, and the percentage is expected to grow next year.

But for those whose incomes are too high to qualify for premium subsidies — people who earn more than 400 percent of the federal poverty level, or $97,200 for a family of four — the price increases will be excruciating.

“When things flare up around Obamacare, it tends to motivate Republicans,” said Glenn Hamer, president and chief executive of the Arizona Chamber of Commerce and Industry. “I would say with 100 percent certainty that this is going to help Republicans. How much? Who knows?”

Most Arizonans have health insurance through their jobs. About 180,000, or less than 3 percent of the population, had insurance through the Affordable Care Act marketplace as of March, the most recent data the federal government has released. Others — it is unclear how many, because the state says it does not keep track — buy essentially the same plans outside HealthCare.gov, going directly to insurers. They cannot receive subsidies but will be affected by the rate increases.

Dante Fierros of Tempe, who owns a small manufacturing business, blames the health law for the rising cost of insuring his 30 employees, although the connection, if any, is unclear. Like many of the law’s opponents, he also considers it an example of government overreach. The turbulence in the Affordable Care Act marketplace here only solidified his support for Mr. Trump. “I think it will help him,” Mr. Fierros said of the rate hikes. “It’s kind of late, though.”

Hostility toward the health law is considerable here, but not overwhelming. A poll conducted this month by The Arizona Republic, the Morrison Institute for Public Policy and Cronkite News found that voters here remain divided on the Affordable Care Act, with 53 percent opposing and 40 percent supporting it. That is somewhat more negative than the national view, according to the latest Kaiser Family Foundation tracking poll, which found 45 percent of Americans opposing the law and 45 percent supporting it.

Mr. McCain has made the health law’s troubles a centerpiece of his re-election campaign, attacking it for months now in ads and on the stump. It is a particularly potent issue with the Republican base, whose support he has sought to solidify after many voted for his primary opponent. He has hammered Ms. Kirkpatrick for voting for the law in 2010 and calling it her “proudest moment” in Congress, a claim she stood by in a debate on Oct. 10. Like Mrs. Clinton, Ms. Kirkpatrick — whom polls show trailing far behind Mr. McCain, a four-term incumbent and his party’s presidential nominee in 2008 — says the law needs to be fixed, not repealed.

Allen Gjersvig, who helps oversee Affordable Care Act enrollment efforts around the state, said he had been running the numbers and finding many plan holders might even spend less on premiums next year because subsidies were jumping along with rates.

“What the headline or social media or your neighbor says may not be your reality,” said Mr. Gjersvig, the director of navigator and enrollment services for the Arizona Association of Community Health Centers.

He added, however, that people in Maricopa County, which includes Phoenix, Scottsdale and Tempe, would have a narrower network of hospitals to choose from next year. The same goes for Pima County, home of Tucson, where Blue Cross Blue Shield of Arizona is selling only “catastrophic” plans through the marketplace next year, and only to people younger than 30. For everyone else, the only insurer will be Health Net.

Kathy Hornbach, 60, a breast cancer survivor in the Tucson area, was certain the rate increases and insurer exits would not affect her, as she receives a generous subsidy and had heard Blue Cross Blue Shield, her current insurer, was staying in the marketplace in her county. Then she looked on HealthCare.gov.

“Disaster!” she wrote in an email, after learning Blue Cross would no longer cover people in her age group and her only option was a plan from Health Net. “I know nothing about this company, they know nothing about this market, I have no idea how restricted their plan is, and there is no information available for me to review.”

On a brighter note, her monthly premium, now $195 after her subsidy, will drop to $79 while her subsidy more than doubles. Ms. Hornbach, while shaken, is a self-described liberal Democrat who will still vote for Mrs. Clinton.

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A version of this article appears in print on  , Section A, Page 21 of the New York edition with the headline: Increase in Health Act Premiums May Affect the Voting in Arizona. Order Reprints | Today’s Paper | Subscribe

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