nogales arizona two thousand miles away healthcare debate washington president donald trump threats let obamacare collapse sow confusion fate dampen 2018 enrollment expectations uncertainty arizona echo interview across country show even though able repeal former president barack obama signature healthcare law republican effort undermine gain traction confuse quite often rhetoric say rosemary dixon yavapai county arizona undergo kidney transplant 2015 insurance affordable care act know widely obamacare plan sign next year worry could lose medical benefit credit save life first nine months presidency donald trump repeatedly claim obamacare dead vow let law implode republican lawmakers try pass legislation multiple time year repeal replace national health program even congress fail vote repeal last week trump claim without evidence republicans vote still know republicans vow keep try succeed consumers increasingly hesitant sign accord reuters interview half dozen enrollment group well industry experts people look get insurance next year maria losoya amaury gama see firsthand nogales dusty city 20,000 people border mexico charge help americans navigate healthcare options take newly tailor pitch local spanish radio obamacare alive well government program official gama say radio last month refer status obamacare losoya gama work arizona center rural health visit community health clinics bring message hundreds consumers encourage get coverage personal health crisis strike part uphill battle navigators say face enrollment 2018 begin nov. 1. nonpartisan congressional budget office say four million few people sign obamacare private insurance previously forecast due trump administration policies still total enrollment expect reach 11 million 2018 10 million 2017 cbo say see confusion cause know affordable care act law land say maggie norris bend navigator program director westside family healthcare delaware say work get hard without warn trump administration august cut federal grant 40 percent 100 navigator group slash obamacare advertise 90 percent cut sign-up period half president also threaten cut billions dollars insurance subsidies low-income consumers prompt insurers pull score u.s. counties 2018 hike monthly premium price follow trump 's impact energy environment healthcare immigration economy trump effect www.reuters.com/trump-effect arizona center rural health employ six full- part-time navigators say help enroll 1,402 people either individual health plan medicaid program poor disable last year navigator group say often main information source group like immigrant rural communities learn need health insurance use benefit two people julia husband miguel request last name use plan re-enroll next year question whether benefit could take away act congress administration fact insurance contract 2018 bind change make obamacare would take effect late years sit hospital bed tucson arizona days learn diverticulitis inflammation digestive tract julia recount losoya help enroll miguel private health plan subsidize federal government miguel lose employer-sponsored coverage heart attack two years ago force quit work live day day say miguel take obamacare away suppose year arizona center rural health budget cut 14 percent force scale back enrollment efforts epilepsy foundation florida suspend activity learn two weeks late grant worth 1.7 million last year cut million michigan arab community center economic social service access state second-largest navigator group say grant cut 36 percent explanation state large navigator enroll michigan receive 90 percent cut trump administration say navigator group ineffective 78 percent fail meet enrollment goals last year sign 81,426 people less one percent total enrollment cut advertise say people already know obamacare enrollment administration would instead rely digital media email text message inform consumers short sign-up period former obama administration officials dispute number say reflect scope navigators work capture everyone help sign provide data group impact navigators say year work include convince skeptical benefit big focus redirect clients say law law repeal safe coverage say madiha tariq deputy director community health research access obamacare sign-up challenge prove law dead