Authors: Francisco I. Pedraza, Roxanna Figueroa, Nathalya Galvez, Marcel Glover
Introduction
There are 72 countries in the world that provide universal healthcare to their citizens, not all
of which are economically developed and industrialized countries. Unlike the U.S., none of those
countries conditions the provision of healthcare on employment. The U.S. healthcare system is a
complex mix of public and private providers, insurers, and government programs, producing wide
variation in access, affordability, and health outcomes across states. Arizona, like many states,
faces persistent challenges in balancing cost, coverage, and quality of care — challenges that are
intensified by federal policy instability, public health disinvestment, and immigration enforcement
strategies that deter healthcare utilization.
This policy brief examines how recent federal actions, including the expiration of Affordable Care
Act (ACA) subsidies, the rollback of evidence-based vaccination guidance, and expanded immigration
enforcement are reshaping healthcare access and public health conditions nationwide, with
consequences for Arizona and neighboring states. Using comparative analysis with California, Nevada,
and New Mexico, this brief evaluates health outcomes, coverage trends, and system performance to
identify disparities, assess policy gaps, and highlight best practices. It concludes with targeted,
evidence-based policy recommendations to stabilize healthcare coverage, strengthen public health
infrastructure, and protect access to care for immigrant and mixed-status communities, advancing a
more equitable and sustainable healthcare system in Arizona.
Federal Instability Affecting Healthcare Access in the U.S.
The federal government shut down during President Trump’s second administration and lasted 43 days
(1 October – 12 November 2025). The shutdown coincided with administrative disruptions to Medicare,
Medicaid, and Veterans Affairs (VA) health benefits. However, the overall impact on beneficiaries was
limited because these programs are largely pre-funded. In contrast, the expiration of Affordable Care Act
(ACA) subsidies has produced far more severe and direct consequences for healthcare access, with health
insurance premiums projected to rise by more than 30 percent in some states in 2026.
ACA subsidies are federal tax credits designed to reduce monthly health insurance premiums for
individuals and families purchasing coverage through the ACA marketplaces. Although a House bill passed
in January 2026 seeks to retroactively extend these subsidies, the interruption itself has already pushed
many individuals into a “subsidy cliff,” where modest income changes result in the sudden loss of
financial assistance. State-level stopgaps exist in some places but are uneven and often insufficient.
The Comeback of Measles: Public Health at Risk
Measles became a nationally notifiable disease in the United States in 1912, and a vaccine was introduced
in 1963. Prior to widespread vaccination, nearly all children contracted measles by the age of 15. The
introduction and expansion of routine immunization led to a dramatic decline in cases—by 2000, the
disease was declared eliminated in the United States. Since elimination, most measles cases have been
linked to unvaccinated travelers or communities with low vaccination coverage. However, recent years have
seen a troubling resurgence of measles cases, reflecting declining vaccine uptake and growing vaccine
hesitancy.
In January 2026, the Department of Health and Human Services announced that the CDC would reduce the
number of vaccines recommended for all children from 17 to 11, moving several vaccines to a "shared
clinical decision-making" category. Public health experts have raised serious concerns about the
consequences of weakening routine recommendations and have emphasized that evidence-based guidance
and investment in immunization infrastructure are essential to prevent outbreaks.
Immigration Enforcement — Undermining Public Health
Recent immigration enforcement measures have intensified deportation efforts, expanded local law enforcement
involvement, increased detention capacity, and rescinded protected-area directives. Evidence shows that
exclusionary immigration policies and policies that connect healthcare settings to enforcement discourage
individuals from seeking necessary medical care, even when services are legally available.
In February 2026, the Arizona Legislature introduced SB-1051, which would have required hospitals to collect
and report patients’ citizenship status. If enacted, such requirements would likely deter undocumented and
mixed-status families from seeking care. (Governor Katie Hobbs vetoed the bill in late February.) These
chilling effects jeopardize preventive care and exacerbate health inequities — particularly among families
and children.
Health Outcomes in Arizona vs. Neighboring States
Key indicators (selected):
- Life Expectancy — Arizona: 75; California: 78.3; Nevada: 75.1; New Mexico: 73 (CDC, 2024)
- Infant Mortality — Arizona: 6.17 per 1,000 live births (CDC, 2022)
- Diabetes prevalence — Arizona: 11.3% (BRFSS, 2022)
- Suicide rate per 100,000 — Arizona: 20.6; California: 10.4; Nevada: 21; New Mexico: 24.7 (CDC, 2022)
- Uninsured rate — Arizona: 12% (KFF, 2023)
Disparities persist for American Indian/Alaska Native (AIAN) and Hispanic populations across many indicators.
Healthcare Spending & Programs
Total Medicaid & CHIP expenditures (selected): Arizona: $22.9B; California: $135B; Nevada: $5.9B; New Mexico: $8.6B.
Arizona’s per-capita health spending is lower than California’s and generally aligns with neighboring states; however,
gaps exist in mental health and rural health investments.
Overview of Federal & State Programs
Medicare (seniors & eligible disabled), VA health services, ACA marketplace plans, Medicaid/AHCCCS and KidsCare
are central to Arizona’s coverage landscape. Eligibility rules and immigration-status restrictions continue to limit
access for some populations.
Conclusion & Policy Considerations
Key findings: Arizona lags behind California but is similar to Nevada and New Mexico on some measures; mental health and rural access remain critical gaps; Medicaid expansion narrowed uninsured rates but affordability gaps persist.
Top policy recommendations
- Permanently extend and expand ACA subsidies to remove “subsidy cliffs.”
- Create automatic stabilizers to protect ACA subsidies & Medicaid during federal disruptions (e.g., shutdowns).
- Restore and codify evidence-based vaccine schedules and protect them from political interference.
- Increase federal & state investment in immunization infrastructure and community-based vaccination.
- Prohibit hospitals from collecting or sharing patients’ citizenship/immigration status except where strictly required.
- Invest in community-based care models, expand mental health funding, and improve Medicaid outreach.
Contributors
Student authors and contributors: Nathalya Galvez (Policy Data Analyst), Marcel Glover (Research Analyst),
Erica Marie Maglalang (Director of Marketing), Dianna Gallardo (Research Analyst) and others. This project was
produced by ASU’s Center for Latina/os & American Politics Research (CLAPR) and Community Pulse.
References & Sources
Selected sources used in the brief: CDC; Arizona Department of Health Services; Kaiser Family Foundation; PBS;
Health Affairs; Harvard Kennedy School; ASU CLAPR internal research. For the full reference list see the original PDF.
