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Brewer and Campbell would give up local control of Arizona health care

Bill Sandry

Gov. Jan Brewer’s federal government expansion plan, spearheaded by Sen. John McComish’s amendment to SB1492, denies our ability to decide what health care we want to provide our citizens and how much to pay.

It automatically increases our administration costs by at least 37 percent (for federal administration), plus additionally mandated expenses over which we have no control but we pay for one way or another. If we accept the federal funding contract to expand Medicaid, we give up the control of our health care and we’ll be forced to fund what health care is left. The federal contract goes both ways. The federal government can approve and deny what health care we can provide.

In NFIB vs. Sebilius, the majority opinion by Chief Justice Roberts made it clear that the federal government can’t coerce a state to join a federal program, but when a state does join it is accepting federally transferred funds for our compliance with the federal contract terms. It does not matter what state laws are passed because when we accept federal money the terms and conditions of the federal contract control. They made the offer and we accepted.

The Sebilius Court made it clear: “Under the Spending Clause the federal government may condition a grant of funds requiring states to ‘taking certain actions that Congress could not require them to take. . . .’We have repeatedly characterized . . . Spending Clause legislation as much in the nature of a contract.’” The Court held that “Congress cannot make the states engage in unconstitutionally prohibited activities, particularly through coercion, but if the states enter into an agreement to accept federal funding, they will have entered into the binding contract with the terms and conditions the federal government imposed in exchange for the federal funding.” This is the law! The federal contract controls and enables them to unilaterally change the terms any time it wants, including elimination of federal funding – leaving us with another unfunded federal mandate the IRS will be in charge of enforcing. Governor Brewer recently demonstrated we lose control to the feds when she confessed that we must pass the federal Medicaid expansion because if we don’t do what the federal government wants us to do, the feds will pull the funding for 60,000 Arizonans.

I explained this Supreme Court precedent to Representative Chad Campbell in the hearing held by Representative Kavanagh.

Approximately 30 people testified about how they will be adversely affected if they loose their health care. I asked Representative Campbell how he was going to provide health care services to them when he gives up our state authority for what services we can provide and which services we must deny under a federal contract that compels us to pay the bill. Mr. Campbell offered no answer. He did not know how our state will provide health care to these people once he has given up Arizona’s constitutional jurisdiction.

The federal government has announced it will be denying Obama care based on federal financial constraints. The administration has already made it clear that people will be denied health care for pre-existing conditions based on cost and “your value” to society, including the most common pre-existing condition, old age. If you’re over 70 don’t expect any neurological surgery care and if you’re over 75, doctors have been telling patients they will not be able to get hip replacements. You will get “comfort care.”

The $1.6 billion we are supposed to save annually is a canard. It will cost us at least $2.2 billion to get our own $1.6 billion back. The federal government takes at least a 37% cut off the top to tax, process and allocate our own money on the condition we comply with their terms of what services we should provide or deny our citizens. As Robert Robb (columnist for The Arizona Republic) said, we are just “getting the money from a different pocket.”

However it comes from the same pair of pants. He’s right, and it will cost us $600 million annually to go from one pocket to another so the feds can tell us what we can or can’t do. These health care federal allocations are supposed to be allocated on a pro-rata basis. Therefore, we are not loosing money by turning down the expansion that the federal government doesn’t have the money to fund anyway; we are saving at least 37% and retain the right to self-determination.

Why would any responsible legislator, or governor, participate in otherwise “unconstitutionally prohibited activities” to willingly abdicate their responsibilities and ability to provide services for our citizens; especially to an overbearing set of unelected and unaccountable federal agencies like Sarah Hall Ingram and the IRS? The feds are not even promising to provide funding past year two.

According to all reputable economists they will not have the funding beyond then to provide the health care services we want to provide our citizens. Expansion of federal Medicaid guarantees we will not be able to take care of our citizens as we see fit and at a lower cost.

- Bill Sandry is a long-time Mesa resident who practiced in corporate and regulatory compliance law and has been active in legislative issues.

3 comments

  1. Dear Bill,

    I find your article rather confusing. Sounds like another “the sky is falling” slam on the Governor’s Medicaid expansion proposal. If this proposal is so awful, why are notable GOP legislators – including the current Senate Majority Leader, and Sen. Steve Pierce and Carolyn Allen (former state lawmaker and current VP of the Grand Canyon Institute) – resoundingly in favor of it?

    Simply stated, approval of the Gov’s proposal will infuse 1.6 billion dollars of federal funding into our Medicaid program, at no net cost to Arizona – enabling our state to extend coverage to an estimated 300,000 needy Arizonans, many of whom were dropped from coverage due to the 2010 austerity cut-backs. According to projections by the Grand Canyon Institute this infusion of funds will bring an additional 21,000 jobs to our state, many in the high paying health care sector. The additional funding will also alleviate the heavy cost burden associated with uncompensated care that currently plagues safety net hospital throughout the state. Also, you fail to acknowledge the “circuit breaker” provision of the Governor’s proposal that will enable Arizona to withdraw at any time the federal funding share dips below 80 percent.

    Again, I cannot understand why anyone who is truly concerned with the welfare of Arizonans would be so adamantly opposed to this bill. I strongly urge all readers to urge their Representatives to vote “yes” on this proposal.

    Sincerely,

    John Newport, PhD
    Former Senior Health Services Policy Research Associate, UCLA School of Public Health
    Columnist, The Tucson Citizen (Healing Tucson and Our Nation)

  2. John,
    More notable GOP legislators oppose Obrewercare than support it.

    I do not understand why your side wants to sell out the poor because that is what you are doing. The poor deserve a relationship with their doctor and Obrewercare forces a doctor to ask a bureaucrat for permission to treat a patient. This is morally disgusting.

    All your side talks about is how much money you are going to get. When did it become our State representatives number one job to obtain federal money. He states “The $1.6 billion we are supposed to save annually is a canard. It will cost us at least $2.2 billion to get our own $1.6 billion back. ” It is all a ruse John. There isn’t any money and we will not be getting any money!

  3. Bill – you are correct. ANY contract with the Federal Government by a State without very clear funding guarantees is a bad deal. How many times must we fall for the same lie?

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