Arizonans voted overwhelmingly, under two Republican governors, to extend Medicaid coverage to childless adults up to 100 percent of the poverty level. These are people with cancer, trauma injuries, heart attacks and strokes, serious mental illness, and the routine but important health care needs for which we lucky ones just make an appointment with our doctor.
To balance the budget, enrollment in that program was frozen in 2011 under an agreement with the U.S. Centers for Medicare and Medicaid Services (CMS). The doors to care closed for 150,000 of our fellow citizens in need.
Now we’re faced with the prospect of nearly 60,000 Arizonans being booted from that program at the end of the year when the state’s agreement with CMS expires—even patients undergoing chemotherapy and other life-saving procedures. One patient, a young woman with an autoimmune disorder, told a recent House hearing that she would go blind without her treatments.
Sitting back and doing nothing really isn’t a feasible option and, without federal assistance, preserving their coverage would drain the general fund of about $1.4 billion in 2015.
Instead, Governor Brewer has introduced a bill that would honor the will of voters and not only restore Medicaid coverage for those at or below 100 percent of the poverty level but increase it to 133 percent, covering 57,000 more people. Because CMS will pick up 90 percent of the costs instead of the traditional two-to-one match, Arizona would receive $8 billion through 2018. The state’s share would be covered by an assessment on hospitals, drawing still more federal money. If this plan is rejected, it would actually cost Arizona more to cover fewer people. Thumbing our nose at federal money that our neighbor states are more than willing to accept rather than bleed their general funds would be fiscal malpractice.
Those billions pouring into our economy— Arizona taxpayer dollars, may I remind you—would relieve the strain on our health care providers and our crowded emergency rooms, where all of us share shrinking resources with the uninsured. Hospitals have seen the costs of uncompensated care nearly double since 2011, resulting in layoffs and hiring freezes. Economists estimate that the expansion would create tens of thousands of new jobs.
For these sound financial reasons, business leaders in every sector of the state’s economy support the governor’s plan. It is not an endorsement of Obamacare, as the rhetoric claims, but a modest expansion of the Medicaid program—which, incidentally, was created in 1965 when the president was age 4. A vigorous critic of the health law who sought its repeal, Gov. Brewer is at the forefront of GOP governors who, with that fight over, now see a realistic, practical outcome for their states in expanding Medicaid. In addition to the respect for human life that the governor shares with millions of Arizonans, she says, “At its core, this issue is truly a matter of dollars and cents.”
Those who oppose the governor’s plan must ask: What would voters make of a decision to spurn federal money and pay for Medicaid out of the general fund, draining resources for education, infrastructure and other pressing needs? Or worse, a decision to abandon the program and deny coverage to hundreds of thousands of Arizonans?
A decision to support a nationally respected governor, who has never lost an election and has led her party to statewide victory even after proposing a sales tax increase, is not only good for Arizona but clearly makes political sense.
Opponents of the governor’s plan claim the government might one day withdraw its matching funds and stick Arizona with the entire cost of caring for additional thousands of Medicaid recipients. But while federal matching rates rose temporarily during the last recession, they have never been reduced in Medicaid’s 57-year history. The governor’s bill even includes a “circuit breaker.” Arizona would roll back its expansion if federal support falls through. As in the past, when the state faced difficult times, the governor and Legislature have not been afraid to scale back programs.
Critics say the governor’s plan will contribute to the federal deficit. But the federal debt and Medicaid coverage for Arizonans are two different issues. There needs to be a comprehensive, national solution to the country’s debt problem. Depriving Arizonans of Medicaid coverage would not help with the federal debt and would only hurt Arizonans—while other states gladly take the money we forfeit. However, providing health care for hundreds of thousands of Arizonans when they need it, so they don’t wait until they’re really sick and flood the ERs, or develop serious conditions, will result in huge savings.
And those who say the governor’s plan amounts to “a government takeover of Arizona’s health care system” ignore the state’s proud history in implementing the very opposite. As the coalition backing the governor’s plan reminds us, our state’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), is a nationally recognized example of “limited government, where care is managed by private health plans and provided by private physicians and hospitals,” the same providers many of us turn to for our care. AHCCCS has drawn praise for its efficient, cost-effective management of health care services through private sector partnerships and limited government interference.
Bottom line: There is no Plan B. Critics of the governor’s plan have offered no alternative—let alone a vision—for providing care for hundreds of thousands of our citizens in need. An uninformed, out-of-touch minority must not be allowed to dismantle the great model that compassionate Arizonans have time and again called on us to preserve.
— Reginald Ballantyne is senior corporate officer, Vanguard Health Systems and a past chairman of the American Hospital Association.