IRT AirSumo, Arizona?  Drove through Arizona once.  Okay, as a State you folks have some major challenges.  All the issues you identify are under ACA.  The Republican legislation to improve America's healthcare system has only passed the House.  The legislation must pass the Senate and signed by President Trump.  The ACA was not developed on the template of Massachusetts and then Gov. Romney.  But, as you say it was State based as Hawaii.  And, Hawaii had the best medical care system in the Country and now must be corrected and redone.  We advocated for a State waiver when ACA was first proposed and the State never applied and today suffer under ACA.