ARI SHAPIRO, HOST:
Obamacare has made a difference to kids in Arizona. It's helped that state pay for its Children's Health Insurance Program, which Arizona had put on hold a few years ago. Now some worry that a repeal of the law could undo Arizona's progress. Will Stone of KJZZ reports.
WILL STONE, BYLINE: Like any college student, Vanessa Ramirez never expected chemo would be part of her busy school schedule.
VANESSA RAMIREZ: I don't have any history of cancer in my family. So it wasn't something that I was on the lookout for.
STONE: Ramirez was diagnosed with ovarian cancer when she was 23. She's healthy now, and so are her children.
RAMIREZ: But there's also emergencies that happen. You know, I have two young kids who are running around. They're rambunctious. I have a daughter that loves to climb trees.
STONE: Overcoming her illness at such a young age, Ramirez doesn't take health care for granted. And the Affordable Care Act has given her that security. She bought insurance through healthcare.gov even with her pre-existing condition. And her children got covered, too.
RAMIREZ: I want them to be able to have health insurance and doctors to monitor them in case something unfortunate comes up.
STONE: Ramirez's kids are covered through the federal Children's Health Program, which is for working families who don't qualify for Medicaid. Here, it's called KidsCare. And until last year, Arizona was the only state without an active program. Lawmakers froze enrollment back in 2010. But Obamacare helped revive it by fully funding it, says Dana Wolfe Naimark with the advocacy group Children's Action Alliance.
DANA WOLFE NAIMARK: A lot of people don't realize that a repeal of the Affordable Care Act could wipe out KidsCare that we just got back.
STONE: The legislature here reopened it because of that federal funding for Arizona and a handful of other states. Now Naimark worries if the law is repealed...
NAIMARK: It would be up to the state legislature - whether they could invest state dollars to keep it going or whether the coverage would go away.
STONE: Arizona is one of the Republican-led states that expanded Medicaid under the ACA but only after fierce infighting about growing federal influence. The same was true for restarting KidsCare. Naomi Lopez Bauman is with the conservative Goldwater Institute, which is suing the state to stop Medicaid expansion. She spoke via Skype.
NAOMI LOPEZ BAUMAN: Whenever you take a look at some of these top-down Washington approaches, you really do lard up these insurance policies with a lot of benefits that individuals and families really would not go out and buy on their own.
STONE: One of the proposals favored by Republican leadership is giving states a fixed amount of money called a block grant and letting them have more say in who and what they cover, says Bauman.
BAUMAN: How do you make it easier and better for individuals and families to get the coverage and care that best meet their own needs and preferences?
STONE: But other conservatives say changing how these programs are funded could backfire. Heather Carter is a Republican state representative who voted for Medicaid expansion and KidsCare.
HEATHER CARTER: What I hope does not happen is that decisions are made nationally that actually penalize us for being efficient and effective.
STONE: Carter says Medicaid in Arizona is already one of the lowest-cost programs in the country. So a block grant could actually shortchange the state, especially because it's growing fast and has a large share of people living around the poverty line. And with less federal money...
CARTER: We will have to make very difficult decisions in Arizona on who will and who will not receive coverage.
STONE: It could cost Arizona hundreds of millions of dollars to keep everyone covered like they are now. And even Democrats like Senate Minority Leader Katie Hobbs say it's not realistic.
KATIE HOBBS: I don't see anyone in the state coming forward and saying, oh, we'll cover this 'cause we don't have the money to do it.
STONE: Repeal without an equivalent replacement could put nearly 700,000 Arizonans' coverage at risk. And more than a quarter of those could be children. For NPR News, I'm Will Stone in Phoenix.
SHAPIRO: And this story is part of a partnership with NPR, KJZZ and Kaiser Health News.