Gov. Jan Brewer apparently won’t say until January whether Arizona should expand the state’s Medicaid program under the federal health care overhaul — a decision that could present legislators with a white-hot political issue.
That’s the word from Brewer administration officials who briefed reporters on Thursday about funding and policy considerations being weighed by the governor, her staff and agency officials.
Officials in Arizona and other states are waiting for federal officials to answer numerous questions about states’ options regarding the Medicaid expansion, and Brewer administration officials said her policy choice would be part of the budget proposal she submits to the Legislature at the start of 2013 session in January.
“It becomes part of what’s available in terms of resources in the budget discussion,” said Tom Betlach, director of the state’s Medicaid program and a former state budget director.
Though Brewer could propose a course for the state to take on the Medicaid expansion, the Legislature also would have a big say on the issue because expanding the program would require additional state funding along with possible changes in state laws.
The health care overhaul included requiring states to expand their Medicaid programs to make more low-income people eligible. But the Supreme Court’s June decision upholding most of the overhaul overturned the provision making the Medicaid expansion mandatory for states.
While some Republican governors have already taken firm stands against implementing the Medicaid expansion or any other part of the overhaul, Brewer is taking a more deliberate approach for now as her state and others press federal officials for more information on implementation and funding.
Many majority Republicans in Arizona also have staked out firm positions against implementing any part of the overhaul, while Democrats are pressing for full implementation. Hospitals also want the state to go at least part way so they can get compensated for more care that they must provide regardless of patients’ ability to pay.
A key question for Brewer’s administration is whether Arizona would get additional federal dollars provided by the overhaul even if it implements only part of the Medicaid eligibility expansion. One possible option for the state is to only increase its program to the eligibility levels previously in place before the state implemented a partial enrollment freeze and made cutbacks due to budget troubles that have eased since then, officials said.
State officials think their federal counterparts have discretion under the health care law to provide the extra funding even if a state doesn’t go the full-expansion route, said Monica Coury, a deputy to Betlach. “It’s a policy decision for them.”
While Brewer is not expected to tip her hand on the Medicaid expansion issue until January, the state must by mid-November tell Washington its choice on another health care overhaul issue.
That’s whether Arizona will create and run a so-called “exchange” — an online marketplace for health care coverage — or let the federal government provide that service.
There’s also an option of having a hybrid “partnership” arrangement, but there will be an exchange no matter what because it is mandated by the overhaul and the only question is who designs and runs it, said Don Hughes, Brewer’s health policy adviser.
Hughes said Brewer hasn’t made a decision on the exchange issue but he said she wants to impose as few regulations and reporting requirements on insurers as possible “and not turn the exchange into a second de-facto regulator of the insurance industry,” Hughes said.