Marina Wena for years has endured failing kidneys and diabetes, barely able to walk two steps in a row and going to the emergency room only when the pain, dizziness and nausea become too much too bear.
That changed this month thanks to the health insurance she received through the Patient Protection and Affordable Care Act, nicknamed "Obamacare." Her monthly premium is covered by the law's subsidies for low-income people, and she received dialysis treatment for the first time that wasn't in an emergency room to assist her kidneys.
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Wena, 54, could walk hundreds of feet a few days later at an event in Springdale held by the Arkansas Coalition of Marshallese and Hispanic Women's Organization of Arkansas to help others sign up for insurance.
"She says she's very excited," said Lucy Capelle, Wena's friend and director of the Marshallese coalition, who translated questions for Wena and typically paid the $15,000 bills for those emergency room visits. Marshall Islanders can travel and work in the United States without visas but aren't eligible for Medicaid.
Wena's also worried, given promises from Republican leaders to repeal Obamacare and enact an unspecified replacement. Like other Northwest Arkansans who have insurance through the law or help others sign up, she can only watch and wait.
"Only the Lord" knows what will happen, Wena said.
The 2010 health act expanded Medicaid eligibility and established insurance marketplaces to help people shop for a variety of plans, among its many changes. Open enrollment in Arkansas and other states' markets ends Jan. 31.
Roughly 22 million more Americans have some coverage because of the law, according to the nonpartisan Congressional Budget Office, which predicts and tracks legislation's budget impact. Arkansas' uninsured rate fell by more than half between 2013 and 2015, according to the polling organization Gallup.
The Republican Party has opposed the law. Republicans point to its several new taxes and fees on manufacturers and high-income earners and note it hasn't prevented significant increases in monthly premiums and deductibles. President Donald Trump repeatedly called Obamacare "a disaster" during his campaign, and his administration said it plans to throw it out as soon as possible.
Support for the law across the country has surged to its highest level ever, and enrollment has reached record levels, according to polling and reports by NBC News, The Wall Street Journal and other media.
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More than 300,000 Arkansans were signed up at the end of December for Arkansas Works, which uses Medicaid money from Obamacare to help buy private insurance for people or families with incomes near the federal poverty level. That's more than 50,000 over what the state expected. Another 71,000 were enrolled in regular marketplace plans, up from less than 60,000 in October, before open enrollment began.
Republicans have promised to replace the law in such a way its beneficiaries don't lose their coverage, but it remains unclear how they will do so. Trump last week promised "insurance for everybody," going even beyond the scope of Obamacare, but he and other officials later backtracked.
He and House Speaker Paul Ryan, R-Wis., have suggested turning Medicaid money into block grants to the states or directly subsidizing a high-risk pool of people with severe and expensive health needs. Arkansas Gov. Asa Hutchinson has supported the block grant proposal, though critics have said it could herald steep cuts in Medicaid spending.
"Give us the Medicaid dollars that we're receiving now; we can manage it," Hutchinson told reporters in Washington last week.
Repealing Obamacare without a replacement will strip millions of people of their insurance and could cause average monthly premiums to double in the next decade while also increasing federal spending by tens of billions of dollars, according to recent analyses from the Congressional Budget Office.
The uncertainty and risk has led to mixed feelings for Deja Glover, case manager for Fayetteville's 7 Hills Homeless Center. Glover refers new clients without insurance to the state Department of Human Services or advocates at Washington Regional Medical Center who help them sign up in the state's health insurance marketplace or for Arkansas Works.
"I can't say that I'm super excited about telling people to sign up because I don't want to waste their time," Glover said.
The coverage is essential for treating diabetes or other health concerns common among homeless people, she added. If Obamacare goes away without something to take its place, "this would be a catastrophe for our clients."
The Marshallese coalition is trying to sign people up while Obamacare lasts, said Rumina Lakmis, who has helped hundreds of families get coverage in the past two years.
One of the people she helped is Yoshie Elcar, who's on disability because of cataracts and other eye problems. He got insurance in the marketplace a year ago and immediately scheduled surgery for his left eye. The other eye should come early this year.
"It's a new life -- I can see the color, I can see everything," Elcar said with a laugh, adding he's looking forward to going back to work, maybe as a school cafeteria worker or janitor. But, he added, if Obamacare goes away, "I don't know what I'm going to do."
Not all uninsured feel an urgency to sign up. Washington Regional's advocates said they hadn't seen a faster pace of uninsured people seeking coverage. Rather than worry about the law's fate, most of those patients are focused on more mundane concerns about the cost of plans and fines for not having coverage, Eunice Wood, vice president of the medical center's revenue cycle services, wrote in an email.
"It has been significantly slower for me over this enrollment period than the previous two," wrote Trace Henley, a certified application counselor, noting people can sign up for Arkansas Works year-round.
Spokesmen at Mercy Northwest Arkansas and Northwest Health didn't return phone messages requesting comment.
NW News on 01/23/2017