Arizona Gov. Doug Ducey wants able-bodied Arizonans on the state’s Medicaid program for the poor to pay into health savings accounts and be charged co-pays for some services, but those proposals and others he’s touting got a tough reception at the first meeting where the public was allowed to weigh in.
Health care providers and patients said the governor’s proposals would likely end up costing the state more money by discouraging people from getting treatment until they are far sicker. And their blunt assessment will be passed on to the Centers for Medicare and Medicaid Services, which must approve a waiver to allow them to go into force.
The most concerning proposals to those who attended the first of five planned public hearing were the co-pays and mandatory premiums Ducey wants the able-bodied to pay and a five-year cap on enrollment.
“Our office has tried (co-pays) and they really just don’t work. The effect they have is people just don’t come,” said Dr. Tim Jordan, a Phoenix pediatrician who specializes in developmental disabilities. “The short-term effect is you’ll save money because people just won’t participate in the program. And it seems like the purpose of this is to get people not to participate.”
Jordan’s comments were echoed by several speakers at a meeting organized by the Arizona Health Care Cost Containment System, the state’s Medicaid plan.
But Ducey is set on what he calls a modernization of the health care insurance plan for poor Arizonans. In additional to “strategic co-pays” for some services limited to 3 percent of a recipient’s income, his plan uses the 2 percent of income premium to fund an account an insured person can use to pay for non-covered services. Patients can tap the account once they meet “wellness” steps and keep unused cash when they move off the program.
Only about 350,000 people out of 1.7 million now on the plan would be affected. The elderly, disabled and those caring for young children would be exempt.
“These are able-bodied adults and we want to put them in a position so that they can move outside of Medicaid into private insurance,” Ducey said earlier this month. “And we want to reward good behavior and wellness behaviors and that’s what this program does.”
Those incentives include a request to put in place a mandatory work-search program for the unemployed, and a portable savings account to help them with added expenses they’ll face in the private market once they move off the program.
“They’re going to continue to have Medicaid but the idea is to put them in a position where we think the best social program we can provide for them is a job,” Ducey said. “So we want, once they transition from Medicaid into the workforce, (they) will have the right habits and incentives to do that.”
Co-pays and premiums, however, have been shown in studies to keep people from getting care and to actually drive up the ultimate cost because of delays in seeking treatment, said Dee Mahan, Medicaid program director for Families USA, a nonpartisan group that pushes for increased access to health care.
“What ends up happening is a lot of times people can’t make those payments – when you’re very, very low income 2 percent is a lot – and that means people drop coverage or they don’t sign up for the program,” Mahan said. “And that ends up driving up health care costs because they don’t get the care they need.
A single person who earns just below the Medicaid cutoff of 138 percent of the federal poverty level, about $16,000 a year, would pay about $26 a month in premiums into their health savings account.
Other parts of the Republican governor’s plan include a request to require people to either be actively looking for work or enrolled in a job training program. A requirement that he requested for a maximum of five years of eligibility is part of legislation he signed into law this year.
Many of the governor’s proposals — especially the work requirement and the five-year rule, are likely to have a tough time being approved.
“That’s contrary to the structure of the Medicaid program and I don’t believe CMS has the authority to do that,” Mahan said.
A Republican lawmaker who was at the meeting said many of her constituents back such proposals, and she does as well.
“There’s a perception out there whether it’s true or not from people that are the taxpayers that their needs to be some personal accountability,” said Sen. Debbie Lesko, R-Peoria. “And I think that’s why the governor proposed what he did – because he wants to move people out of government assistance and into careers so that they can help themselves.”