More than two thousand miles away from the healthcare debate in Washington, President Donald Trump's threats to let Obamacare collapse are sowing confusion about its fate and dampening 2018 enrollment expectations.
The uncertainty here in Arizona, echoed in interviews across the country, shows that even though they have not been able to repeal former President Barack Obama's signature healthcare law, the Republican effort to undermine it is gaining traction.
"What's confusing quite often for me is the rhetoric," said Rosemary Dixon of Yavapai County, Arizona, who underwent a kidney transplant in 2015 and has insurance through the Affordable Care Act, known widely as Obamacare.
She plans to sign up for next year, but worries that she could lose medical benefits that she credits with saving her life.
Over the first nine months of his presidency, Donald Trump has repeatedly claimed Obamacare is "dead" and vowed to let the law "implode." Republican lawmakers have tried to pass legislation multiple times this year to repeal and replace the national health program.
Even after Congress failed to vote on a repeal last week, Trump claimed - without evidence - that Republicans had the votes to still do it.
Knowing Republicans have vowed to keep trying until they succeed, consumers are increasingly hesitant to sign up, according to Reuters interviews with half a dozen enrollment groups, as well as industry experts and people looking to get insurance next year.
Maria Losoya and Amaury Gama are seeing this firsthand here in Nogales, a dusty city of 20,000 people on the border of Mexico. Charged with helping Americans navigate their healthcare options, they are taking a newly tailored pitch to local Spanish radio: Obamacare is alive and well.
"When we have a government program, it's official," Gama said on the radio last month, referring to the status of Obamacare.
Losoya and Gama, who both work for the Arizona Center for Rural Health, have been visiting community health clinics and bringing their message to hundreds of consumers, encouraging them to get coverage before a personal health crisis strikes.