Key Points:

• 25% of Medicaid recipients in Arizona could lose coverage

• Rural areas would be hard hit

• State favors work requirement with exceptions

Democratic Gov. Katie Hobbs brought nearly a dozen hospital officials to the Capitol on May 29 as part of a public relations effort to stop cuts to Medicaid approved by the Republican-controlled U.S. House.

The executive and others each predicted dire results if the measure is approved in the current form by the Senate and, ultimately, signed by President Trump. These included layoffs and possible closure of some rural facilities.

And Hobbs predicted that up to a quarter of the nearly 2 million Arizonans currently enrolled in the Arizona Health Care Cost Containment System, the state’s Medicaid plan, could lose coverage.

The governor acknowledged that at least part of that — perhaps 200,000 — would be due solely to new requirements for able-bodied individuals to work or be engaged in community service for at least 80 hours a month. There are only limited exceptions, like for pregnant women.

Hobbs said there’s nothing wrong with a work requirement. In fact, AHCCCS has submitted its own proposal to the federal Center for Medicare and Medicaid Services.

The governor, however, said what the House has approved is far stricter than the plan the state is offering which has nearly two dozen exceptions.

The event, organized by Hobbs, was billed as a “roundtable” for hospital officials to detail how they will be affected. But it also was designed to get as much publicity as possible, with reporters invited to sit in to hear their concerns.

Some of the stories focused on dollars.

Todd LaPorte, CEO of HonorHealth, figured his network of hospitals in the Phoenix area would lose about $600 million a year out of a “topline” budget of $4 billion.

“We view health care as basic infrastructure to a vibrant business in the state,” he said.

But Dave Cheney, CEO of Northern Arizona Healthcare, said the situation goes beyond lost revenues for rural operations like his.

“I’m not sure how many rural hospitals would survive,” he said.

And Neal Jensen, CEO of Cobre Valley Regional Medical Center, said the effects on facilities like his in Globe could be dire. He said that pregnant women who now come to his hospital would otherwise have to drive 90 minutes to the Phoenix metro area.

“I think about the mothers we would have probably lost last year if we didn’t have a hospital,” Jensen said.

At the center of all of this is the federal legislation that Democrats say will cut Medicaid funding and result in fewer people with coverage but that Republicans contend simply tightens up enrollment restrictions and cuts what they say is waste, fraud and abuse in the program. And central to that is whether those who are getting free health care should be required to work.

Under the GOP plan, there would be exceptions not just for pregnant women but also for certain others, including those with serious or complex medical issues, parents who are caregivers to a dependent child, and those participating in drug or alcohol treatment programs. There also are some special circumstances for short-term hardships like those in a federally declared disaster area or living in a county with a high unemployment rate.

“If you are able to work, and you refuse to do so, you are defrauding the system,” House Speaker Mike Johnson said this past Sunday on Face the Nation. “You are cheating the system. And no one in the country believes that’s right.”

Hobbs said she has no problem with the concept — at least on paper.

“People who can work should work,” she said. “There’s no disagreement there.”

It’s when it comes to the details that the governor contends the Republican-controlled House has gone too far.

“There’s also a lot of evidence that very stringent work requirements don’t work,” Hobbs said, citing what she called “failed experiments in Georgia and Arkansas.”

In the latter case, the Urban Institute said their examination of the program found that the state’s work requirement reduced the number of adults with health insurance coverage — but had no effect on employment.

Hobbs also said the costs of administering such a program are “extraordinary and won’t actually end up saving a lot of money.”

“It will just cause people to fall off the health care that they need,” she said, having the “ripple effect” that was cited by the hospital executives.

And LaPorte said that the work requirement is being put out front by proponents of the measure “to justify what is a whole portfolio of things that, at the end of the day, net, are going to be a disastrous impact on our industry.”

Among those other things are requirements for people to prove every six months they remain eligible for coverage, twice as often as now required. And even those who are applying for a first time would have to show they have met the work requirement for at least one month before applying.

“This will just cause people to lose care because of administrative red tape,” she said.

There also are provisions that would curtail federal funding for services to those earning above the federal poverty level as well as impose cost-sharing requirements.

And the governor said she is particularly worried that the U.S. Senate, also in Republican hands, may approve “more drastic cuts.”

Hobbs said the state has submitted its own plan to impose work requirements for those on AHCCCS.

It does have many of the same exceptions as the federal bill like for pregnant women, caregivers and those who are being treated for substance abuse disorder.

But there are others that Arizona wants to exempt.

The state would not impose a work requirement on those who are at least 56; the federal bill covers everyone through age 64. Also exempt would be the homeless, domestic violence victims, full-time trade school, college or graduate students, veterans regardless of their discharge status, and anyone who has been incarcerated within the past six months.