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Unintended health care consequences of Prop. 101

Proposition 101, the so-called Freedom of Choice in Healthcare Act, is a vague and poorly written proposition that will decrease health care choices and increase health care costs for Arizona residents. 
Arizona’s pediatricians want families to know that we oppose the measure that could cost our state’s taxpayers billions of dollars, increase private health insurance premiums and threaten our ability to provide a cost-effective medical home for some of Arizona’s most vulnerable children. 
Health care law experts have advised the medical community that Proposition 101 can be interpreted to prohibit the Arizona Medicaid program (Arizona Health Care Cost Containment System) from using a medical home/managed care model. This approach allows AHCCCS to control the cost of providing health care for the poor by contracting with private health plans that require the enrollees to pick a qualified, licensed provider for their medical home. Our AHCCCS managed-care program is a nationally recognized model for the delivery of high-quality, cost-effective health care. The program has been shown to decrease health care costs by providing continuity of care, limiting use of emergency rooms and encouraging preventive care.
Indeed, health care researchers have estimated that abandoning this model will increase the cost of providing health care for Medicaid families by $1 billion per year.  In addition, a shift from our current managed-care model to a fee-for-service model could result in the loss of our federal waiver. Without this waiver, the state would lose an additional $1 billion in federal matching dollars. Thus, Prop. 101 could cost Arizona taxpayers approximately $2 billion annually. 
Prop. 101 also could prevent private health insurance plans from effectively managing the cost of the plans they provide their enrollees.  Higher costs will force employers to drop insurance benefits and/or raise employee premiums, co-pays and deductibles in order to remain profitable. Fewer families will be able to afford coverage, and these uninsured families will rely on our already-overcrowded emergency departments for care and they will forego vital preventive health services that could keep them out of emergency rooms. Increased numbers of uninsured hurts our economy by increasing enrollment in taxpayer-supported public health plans and cost-shifting by the health care industry, which must make up for the cost of providing care for the uninsured by passing these costs on to everyone else. 
Supporters of Prop. 101 argue that they did not intend for this initiative to have such far-reaching adverse effects on our health care system. However, intentions don’t matter; we will have to live with the court’s interpretation of the proposition and its application. Whatever the courts decide, Arizona families will be forced to pay for the consequences. 
Prop. 101 may be an excellent economic stimulus program for health care lawyers, but for the rest of us it’s an economic nightmare that we should oppose.
— Mary Ellen Rimsza is a pediatrician in Scottsdale, chairwoman of the Legislative Committee for the Arizona Chapter of the American Academy of Pediatrics and professor of pediatrics at the University of Arizona College of Medicine.

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