Homeless in Arizona

You know the $1 billion plus government welfare program for Jerry Colangelo and his professional sports. You know the Phoenix Suns and the Arizona Diamondbacks.

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Surprise Medicaid plan draws tepid GOP reaction

By Mary K. Reinhart The Republic | azcentral.com Mon Jan 14, 2013 11:45 PM

Gov. Jan Brewer waded into choppy political waters Monday with her decision to push for Medicaid expansion, but she offered a financial strategy that could improve the odds that reluctant Republican lawmakers will go along.

Brewer, bucking GOP legislative leadership in a reversal of her long-held opposition to federal health-care reform, said in her annual State of the State speech that Arizona can no longer afford not to extend health-care coverage to tens of thousands of uninsured.

Concerned about billions of dollars in losses to the health-care industry from budget cuts and forgoing future federal funding, the governor said the benefits of expanding the Arizona Health Care Cost Containment System, the state’s version of Medicaid, far outweigh the costs.

“With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctors’ offices and emergency rooms,” Brewer said. “Weigh the evidence and do the math.”

The governor’s plan would bring the state an additional $7.9 billion in federal funds over three years and insure 250,000 more low-income Arizonans, in addition to restoring coverage for roughly 50,000 people who lost health care because of budget cuts. The federal law boosts funding for states that expand Medicaid to anyone earning up to 133 percent of the federal-poverty level, which is $14,856 for an individual.

GOP legislative leaders, who generally oppose expansion, were skeptical and cautious in their reaction to Brewer’s announcement, which came as a surprise to many.

Several Democrats, however, jumped to their feet and applauded when Brewer announced her plan. Health-care executives and advocates also were thrilled, but bracing for a legislative battle ahead from GOP opponents who say taxpayers can’t afford it and that it’s government overreach.

Brewer needs to corral enough support to get the proposal through both chambers and onto her desk.

Some key Republicans said they were pleased.

“This sure does sound like a win-win for our economy,” said Rep. Heather Carter, R-Cave Creek, the House Health Committee chair. “And it’s also the right thing to do.”

The governor proposes that the state’s share of Medicaid expansion, $154 million, be paid through fees assessed on Arizona hospitals, or “bed taxes,” that hospitals would pay to the state in exchange for a greater amount of federal reimbursement. [So we are not going to lose billions in Federal money, it's going to cost us $154 million in taxes]

To guard against future cost increases, Brewer said she would build a “circuit breaker” into AHCCCS, so that if Congress reduces federal subsidies below current levels, the expanded coverage would be rolled back. [Yea, sure. There ain't no such thing as a "temporary tax". And the "circuit breaker" mumbo jumbo is just a way of saying it's a temporary tax that won't go up]

“I won’t allow ‘Obamacare’ to become a bait and switch,” she said.

Hospitals floated a statewide bed-tax proposal two years ago to avoid AHCCCS cuts, but it fell flat. In December, the Phoenix City Council passed a provider assessment on 11 local hospitals that’s expected to generate $130 million in additional federal funding for uninsured and underinsured patients. That tax is due to expire in January 2014, when the Medicaid expansion takes hold, and Brewer’s plan would take the provider assessment statewide.

“This doesn’t mean it’s free money, of course,” Brewer said. “We know there is no such thing. But Arizona’s Medicaid program, AHCCCS, is not the problem. It is, in fact, part of the solution as the nationally recognized gold standard for cost-effective, managed care in this country.” [Wow and that's coming from a person who claims to be a conservative Republican??? Cost-effective government medical care always turns out to be an oxymoron]

Brewer had previously joined 25 states to push for repeal of the federal health-care overhaul and rejected a state-run health exchange, an online insurance marketplace and another pillar of President Barack Obama’s health-care law.

But she was lobbied hard in recent weeks to support Medicaid expansion by a coalition of hospital CEOs and business leaders, represented by former Brewer adviser and state budget director Peter Burns. [I suspect that also includes lots of bribes, oops, I mean campaign contributions]

Burns and the Arizona Health Care Coalition last month presented a detailed proposal for Medicaid expansion, complete with the number of uninsured patients for each legislative district.

Brewer’s plan, and her reasoning, is similar to that plan: The health-care system is an important economic driver; voters already approved Medicaid expansion in 2000; AHCCCS is a national model; and hospitals are being “pushed to the brink” by costs for the uninsured.

Lawmakers will need to approve any expansion as part of the budget process, and most Republican lawmakers gave it a tepid response.

Senate President Andy Biggs, R-Gilbert, said he expected Brewer to broach the issue, but not so firmly.

“I was surprised by her level of commitment to it,” he said. “But I really want to know what’s in her plan.”

Brewer’s office released those details after her speech, in a budget document that offers more insight into how the governor reached her decision.

Rep. John Kavanagh, R-Fountain Hills, and the chairman of the House Appropriations Committee, called expansion a threat to the state’s fiscal stability in an op-ed piece submitted over the weekend to The Arizona Republic.

“I intend to vigorously oppose any effort to grow this unsound program in the hopes of avoiding the derailment of Arizona’s recovering economy,” he wrote.

On Monday, Kavanagh said Brewer’s call for a tax paid by health-care providers could complicate the discussion. Such a tax would shift dollars from middle- and upper-income areas to poverty areas, since many Medicaid patients come from poorer neighborhoods, he said.

House Speaker Andy Tobin, R-Paulden, said if the governor has found a way to pay for Medicaid expansion without imperiling the state’s balanced budget, he is ready to talk about it.

To help balance the budget, Brewer and lawmakers in 2011 froze the voter-approved program for childless adults, eliminated coverage for people with catastrophic medical bills and capped the KidsCare program for children of the working poor. More than 150,000 Arizonans have since lost health insurance.

Some Arizona hospitals have since seen their budgets for uncompensated care quadruple. In 2011, Maricopa Integrated Health System, which runs Maricopa Medical Center, spent $120 million in charity care and uncovered AHCCCS expenses.

“We knew that she has a soft spot for health care and behavioral health,” said Betsey Bayless, CEO of MIHS. “We have a lot of citizens in need of health care who are not being served right now.”

Republic reporter Mary Jo Pitzl contributed to this article.

Jan Brewer pushes socialized medical care in Arizona

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Brewer begins Medicaid push, seeks support to extend coverage for 300,000

By Mary K. Reinhart The Republic | azcentral.com Wed Jan 16, 2013 10:47 PM

Gov. Jan Brewer launched her campaign to expand Medicaid on Wednesday, appearing at Maricopa County’s safety-net hospital with health-care and business leaders to tout a federal law she once hoped to repeal.

The governor said she struggled with her decision to support broadening the health-care program for the poor under the Obama administration’s overhaul but is convinced it is the right thing to do and that Republican lawmakers in the state Legislature will go along.

“I believe truly that when we look at the Legislature and the makeup of that body, that ... they want to do what’s right for Arizona,” said Brewer, who revealed her decision in her State of the State address Monday. “And there is no way you can look at this issue and say this is not the right thing for Arizona at this time.”

Chamber of Commerce officials and hospital CEOs from across the state took turns at the lectern, while dozens more supporters, state officials and Brewer advisers filled the seats in a Maricopa Medical Center auditorium. They praised Brewer’s decision and said Medicaid expansion and the federal funds that come with it are key to the state’s economic vitality, the health-care industry’s viability and the well-being of Arizonans.

Brewer’s plan, if she can get reluctant Republican legislative leaders to go along, would extend health coverage to roughly 300,000 uninsured Arizonans by 2016. The federal law boosts funding for states that expand Medicaid to anyone earning up to 133 percent of the federal poverty level, which is $14,856 for an individual.

To protect the state budget, the governor’s plan would pay for the state’s share of Medicaid through hospital assessments, or “bed taxes,” that would in turn draw down more federal funding. Similar assessments are in place in more than 30 states. The proposal would automatically roll back the expansion, and drop the newly insured from the rolls, if a future Congress reduces federal subsidies.

In 2010, Brewer and lawmakers froze enrollment in two Medicaid programs and eliminated a third to help balance state budgets. That took an estimated $2billion out of the state’s health-care economy, eliminated coverage for more than 150,000 people and left hospitals and clinics to pay for a growing number of uninsured patients.

Judy Rich, president and CEO of Tucson Medical Center, said the hospital’s charity care for unpaid medical bills has tripled in the past 18 months, and expanding Medicaid would significantly reduce those costs.

Hospital officials said they continue to treat more uninsured patients through the emergency department, the most expensive health-care setting, after their illnesses have become dire.

“They wait and they get sicker and sicker,” said Pat Walz, CEO of Yuma Regional Medical Center. “Let me assure you, treating high blood pressure in the emergency room doesn’t get you well.”

Brewer has been a longtime opponent of federal health-care reform, joining 25 other states in a lawsuit against it and rejecting a state-run health exchange, the online marketplace for individuals and small businesses to find health care.

Glenn Hamer, CEO of the Arizona Chamber of Commerce, said the business community wasn’t crazy about the new federal law either. But he said the influx of federal spending will offset the so-called hidden health-care tax passed on to consumers and businesses in higher insurance premiums.

“This is a tough decision,” Hamer said. “But we stand here united as a business community across the state to make sure that we get this policy done.”

The chamber and hospital officials will help Brewer lobby recalcitrant lawmakers to support the plan. House and Senate leaders, most of whom oppose expansion, said they want to see more details. Brewer releases her fiscal 2014 budget plan Friday.

“I did not make this decision in a vacuum,” Brewer said. “I am committed. And I have faith that the Legislature will move in that direction.”

Opposition also will come from the conservative Goldwater Institute and conservative political-advocacy group Americans for Prosperity, whose Arizona director, Tom Jenney, said studies show patients are sometimes better off with no health coverage than with Medicaid because of coverage limits and shoddy care.

Jenney said Medicaid proponents have inflated the amount of care provided to the uninsured to boost support for expansion.

Opting out of expansion would eliminate coverage for about 50,000 childless adults who remain on the program Brewer and lawmakers capped. Preliminary numbers show that, after the first full year of Medicaid expansion, that program would be returned to about 200,000 people, just short of its maximum enrollment before the freeze.

Medicaid expansion also could have a significant impact on the state’s 30-year-old class-action lawsuit involving the seriously mentally ill.

Arizona lawmakers reduced funding, then restored part of it, for people with severe mental illness who earned too much to qualify for Medicaid or who were frozen out under the budget cuts. Budget analysts believe the majority of those people would become insured if Brewer’s plan wins approval.