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Prop. 101 a pre-emptive strike on universal health care

At a debate sponsored by a Phoenix chapter of The Federalist Society, four physicians speak about the pros and cons of Prop. 101, the Medical Choice for Arizona Initiative. From left, Eric Novack and Jeff Singer support Prop. 101, while Eve Shapiro and Jonathan Weisbuch oppose it.

Health care reform has been discussed in American politics for decades, but now the topic is addressed routinely at the state level. The trend for localized reform has two Phoenix physicians concerned that the right of patients to make their own health care choices will be forgotten somewhere in the midst of the legislative debates on health care reform.
So, doctors Eric Novack and Jeffrey Singer have gone on the offensive by introducing Proposition 101, also known as Medical Choice for Arizona, to constitutionally ensure that any health care reform measure passed in Arizona will not violate a citizen’s right to choose his or her own health care coverage.
But some state physicians and lawmakers say they’re concerned the proposed amendment would alter the legality of the programs offered by AHCCCS, the state’s Medicaid provider.
“Pure and sweet, it is a terribly worded measure, and it clearly has the potential to bankrupt the state of Arizona,” said John Rivers, president and chief executive of the Arizona Hospital Association.
Health care reform took a dramatic turn in 2006 when the Massachusetts Legislature approved a bill that required all residents to purchase health care insurance or face legal penalties. The bill was modeled after the state’s legal requirement for auto insurance and introduced as a practical solution to the state’s 550,000 uninsured citizens.
But Massachusetts is not alone in the implementation of universal-like health care programs. Hawaii and Maine also have instituted similar programs, and in Arizona, Rep. Phil Lopes and other Democratic legislators have attempted to pass a universal health care bill since 2006.
“What got us frightened was Representative Lopes’ bill that would have basically outlawed all private insurance in the state and required all of us to be on state-run system,” Singer said.
The initiative is a pre-emptive measure that guarantees Arizona citizens and legal entities the right to participate in a private health insurance system of their choice without fear of government-imposed penalties or fines.
The initiative disallows handing out penalties to a person or entity for choosing to decline health care coverage, which would make enacting Lopes’ bill impossible.
Singer said Prop. 101 would protect Arizonans from the “inevitable” negative consequences of a universal health care system.
“In the Lopes bill, to give the most extreme case, if that bill were to pass and I wanted to have a procedure done, I would have to wait six months because of all the people that would also want the service,” Singer said.
Singer also said the bill would force citizens to pay for services they may not want or need. He said if only one plan and benefit package is offered, as in the case of the Lopes bill, then the plan would have to be broad enough to cover the specialized needs of all its members, leaving participants with no history of a disease paying for the coverage of that disease.
“In Arizona, we have passed a law that said all insurance has to cover autism,” Singer said. “Well, my children are all grown up and gone, and I am not anticipating that I or my wife will develop autism. But when I buy health insurance I have to buy health insurance that covers autism, whether I want to or not.”
But opponents of Prop. 101 say the potential negatives of the initiative far outweigh any negative effects that would result from the universal health care system Lopes seeks to create.
While the initiative would impose no immediate costs to AHCCCS, based on various interpretations of the ballot language, the possibility remains of a financial impact to the state-run Medicaid program down the road, according to the Joint Legislative Budget Committee’s (JLBC) analysis and a memo released by AHCCCS director Anthony D. Rodgers.
“If you are worried about unintended consequences,” Lopes said, “how about the fact that we run the risk of the initiative getting in the way of programs like AHCCCS? Arizona can’t afford to take a chance on a law with those types of consequences.”
And Eve Shapiro, a Tucson pediatrician, said any unintended consequences from the initiative would be compounded by the fact that a constitutional amendment is nearly impossible to reverse.
“To make a change that is basically permanent when we don’t know what is going to happen in the future, I think, is really dumb,” she said.
According to Rodgers memo, the managed-care model used by the state’s Medicaid provider is at risk by the proposition. Arizona is one of few states that has structured its Medicaid system through a managed-care model, which functions by using a network of private physicians and hospitals to provide care to enrollees.
The language of the initiative bans restrictions to “a person’s freedom of choice of private health care systems or private plans of any type,” which would make AHCCC’s managed-care model illegal if a court were to determine that Prop. 101 applied to the state Medicaid system.
“AHCCCS could be required to offer every AHCCCS eligible person the option of receiving services from any willing provider on a fee-for-service basis,” Rodgers’ memo stated. “The fiscal impact of such an unintended consequence would be astronomical … an increase of $1 billion if AHCCCS converted to fee-for-service.”
The Goldwater Institute has submitted a public records request for the documents that led up to the Rodgers memo. State statute bans the use of tax dollars by a state agency to influence an election. Rodgers’ memo, according to a press release from Yes on Prop. 101, violated the statute by claiming the health choice amendment would have adverse affects on AHCCCS.
Committees supporting Prop. 101 have raised more than $400,000 in donations since January. Key Arizona contributors are the Dawson Companies and the Benjamin Rush League.
No on Prop. 101, which is supported by the Arizona Academy of Family Physicians and the Arizona Academy of Pediatrics, has received only one contribution, $50,000 from SCAN, a California based health care company that contracts with AHCCCS.

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