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Dying man an example of why state should expand AHCCCS coverage

Dave was a homeless guy. Some blamed him for the bad choices he must have made. Some were a bit more sympathetic. A few got close enough to him to realize how little it would take to get Dave to a much better position in life — off the street, working, and even serving as a superb role model for others similarly in desperate need of a few small breaks.

The story of how Dave climbed his way out of homelessness would probably be billed as a “feel good story of the year” by movie critics if Hollywood got around to making a movie about him. Most everyone loves to hear about a guy who gets dealt a bad hand in the game of life, but then overcomes unimaginable odds and lands back on his feet, committed to helping others who have faced similar obstacles.

Unfortunately, though, the bad breaks just kept coming for Dave.

First, he lost his access to health care. Although Dave had been enrolled in AHCCCS (Arizona Health Care Cost Containment System) while he was homeless, he lost his coverage because he had landed a part- time job and because of funding cuts to AHCCCS. Although Dave was working, there was no way his meager earnings would enable him to replace his AHCCCS coverage. And without that coverage, Dave was simply no match for the next bad break to come his way.

Dave knew for about a year something was wrong with him. Friends kept telling him to see a doctor, but he couldn’t afford to without insurance. This spring, he finally was taken to the emergency room when he couldn’t breathe and was in excruciating pain. Dave was admitted to the hospital where he was diagnosed with Stage IV metastatic cancer involving brain, bone and lungs. His doctor fought valiantly to keep him in the hospital for just a little longer so he could at least start Dave on radiation to shrink the brain tumor and get him on pain control medication. But, without insurance Dave wouldn’t have access to medication or any type of treatment regimen. A hospital social worker applied to AHCCCS for Dave, but he was denied coverage. (A later application, this one clearly referencing Dave’s terminal condition, was finally successful in securing hospice care for him.) If Arizona elects not to participate in the expansion of Medicaid, a coverage gap will be created for hundreds of thousands of Arizonans who won’t earn enough to qualify for the insurance subsidies scheduled to begin in 2014, but still won’t qualify for coverage under our existing Medicaid (AHCCCS) program. Thousands of people like Dave will fall in that gap.

The federal Affordable Care Act greatly reduces the costs for states to expand Medicaid. The federal government will initially bear 100 percent of the costs of this expansion. The level of cost reimbursement will be gradually reduced, but even after the phased-in reduction period the federal government will still bear at least 85 percent of the costs.

Arizona’s leaders are faced with a choice — an economic choice and a political choice, but a moral choice as well.

While Dave is dying of cancer, we feel good about keeping taxes low.

We can afford to be more neighborly. And expanding AHCCCS is by far the most effective and efficient way for Arizonans to be more neighborly.

— D. Kent Olson, member, Desert Southwest Conference Board of Church and Society, United Methodist Church; Sonia Burns, health ministry leader, Tempe First United Methodist Church, contributed to this commentary.

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