The electorate wants to hear ideas on resolving major problems that affect them and their families. We have a pandemic that is not over and many are still sick. Arizona education is in peril, and our pay scale is one of the lowest in the United States. This summer has been one of the hottest on record, and yes, climate change is real. Thousands of Arizonans have lost their jobs due to Covid-19 and are in dire need of financial assistance.
The upcoming Supreme Court hearing on the Affordable Care Act, and the thought of losing health care coverage, is a frightening reality. These are the concerns of the people. Candidates, when you want votes, stick to viable solutions, forget the name calling, and put the people before power and party. Why not start today by showing voters you have respect, empathy, and ideas to bring the state together. Voters are looking to you for answers, so remember that together we will stand and flourish while the continued divisiveness is beneficial to no one.
It has become increasingly difficult over the last few years to watch and listen to some of our elected officials and observe their policy positions, political activities and behavior. This decade will prove critical for the future of our country and our state as we decide whether to remain the global economic leader we’ve been for nearly a century or whether we’ll abandon the better angels of our nature. While it can be argued that the majority of the elected exhibit, to varying degrees, great support of and passion for our democracy, the landscape has changed and offering best wishes and thanks to those working on our behalf is dissipating.
That said, we do have reason to bank on hope and also recognize that there are those elected to office who are working in a constructive and positive manner to a large extent behind the scenes.
There is no better example of hard work yielding results than the benefits now available to Arizonans as the Affordable Care Act (ACA) enrollment period begins. The ACA passed Congress a decade ago, providing protections for people with pre-existing conditions, closing a “donut hole” in Medicare Part D that made prescription drugs unaffordable for seniors, and expanded Medicaid coverage to nearly half a million Arizonans.
Yet, the COVID-19 pandemic proved to any doubters that every one of us needs access to quality affordable health care coverage. Thanks to the American Rescue Plan passed by Arizona’s two United States senators, Mark Kelly and Kyrsten Sinema, and signed into law by President Joe Biden in March of this year, health care coverage is now more affordable than ever before.
The American Rescue Plan expanded eligibility for subsidies to all Arizona households, meaning that no Arizonan will be forced to spend more than 8.5 percent of their annual income on health premiums with ACA plans. This also allows Arizona households making up to 150 percent of the federal poverty line not being crushed by premiums. For an Arizona family of four, there will be coverage for all households with $39,000 or less in annual income. This is already in addition to Arizona households of all shapes and sizes realizing monthly premium savings.
ACA subsidies are also assisting small business owners address one of their biggest challenges – the cost of providing quality health insurance benefitting their hardworking employees. Simply put, the ACA is working for Arizonans.
By way of example, Senator Kelly’s continued leadership on behalf of Arizonans has been essential. And as a leader on key health care priorities in the Senate, he is making sure that everyone has access to affordable coverage – from veterans and their families during the vaccine rollout to Arizonans receiving care at community health centers benefiting from federal aid.
The Affordable Care Act, the signature piece of legislation of President Obama’s Administration, was purposefully sabotaged throughout the Trump Administration, but we now have elected officials in office who are dedicated to decreasing costs. It is important to note that the health care arena (including physicians, nurses, hospitals, outpatient facilities, community health centers, the medical device sector, insurance sector, pharmaceutical sector, Medicare, Medicaid, veterans’ health, etc.) represents one-sixth of our entire economy.
Members of the United State Senate have an assortment of issues with which to deal and each senator must choose from among many competing issues. Kudos to our two senators for voting to assure passage of the American Rescue Plan and a special thanks to Senator Kelly for his leadership on key health care priorities. What a contrast to some of the “entertaining” conduct of some of the others in Congress.
Reginald “Reg” M. Ballantyne III is former chairman of the American Hospital Association and commissioner of The Joint Commission on Accreditation of Healthcare Organizations.
Arizona Attorney General Mark Brnovich announced Thursday he’s running for U.S. Senate, becoming the third major candidate seeking the Republican nomination to take on Democrat Mark Kelly.
Brnovich, who is in his second term as the state’s top law-enforcement officer, is the best-known GOP candidate and the only one with political experience.
In a video announcement, Brnovich described himself as the son of immigrants who fled communism in Yugoslavia. He says he used his post as attorney general to take on “crony capitalists” and government overreach, while promoting religious liberty, border security and election integrity.
“We need an Arizona conservative in Washington who stands up for us and our values,” Brnovich said in the video. “Someone who’s been tested. Someone who won’t go run and hide at the first sign of trouble.”
Brnovich has drawn the ire of former President Donald Trump, which could become a major liability in a crowded GOP primary. Trump has repeatedly called Brnovich “lackluster” and said he’s “nowhere to be found” in support of the audit of Maricopa County election results by state Senate Republicans.
Trump and many of his most loyal supporters have latched onto discredited allegations of widespread election fraud in Arizona and elsewhere, which they claim cost him his re-election. Brnovich, Gov. Doug Ducey and Secretary of State Katie Hobbs certified Arizona’s election results showing a narrow victory for Democrat Joe Biden.
“Our Country needs Attorney General Mark Brnovich, who has done little so far on Voter Integrity and the 2020 Presidential Election Scam, to step it up,” Trump wrote in a statement earlier this month.
Brnovich downplayed the presidential feud, saying he can’t worry about what anyone else does.
“I want this race to be about me, what I believe in and what I stand for,” Brnovich said in a brief interview. “The media focuses so much on the things that no one can control. They don’t want to focus on what I stand for, what I believe and the record I have.”
Solar energy entrepreneur Jim Lamon and retired Air Force Maj. Gen. Michael “Mick” McGuire, both political newcomers, have also announced plans to seek the GOP nomination. U.S. Rep. Andy Biggs has said he’s considering a run but has not announced a decision. Blake Masters, who has worked closely with billionaire Peter Thiel, also may run.
Kelly, a retired astronaut, won a special election last year to finish the late John McCain’s Senate term. He is now running for a full six-year term. The race is one of the most high-profile contests in 2022 and will help determine which party controls the U.S. Senate.
As attorney general, Brnovich has picked a number of high-profile fights, including suing the Arizona Board of Regents — which is typically his client — over plans to build a hotel at Arizona State University. He’s also asked the U.S. Supreme Court to invalidate part of the Voting Rights Act in a high-stakes case filed by the Democratic National Committee; a decision is expected in the coming weeks.
Democrats immediately signaled that they would highlight his support for a lawsuit seeking to invalidate the Affordable Care Act, the health care law known as “Obamacare.” Democrats effectively used opposition to the law against Republicans in 2018 and 2020.
Before he was elected attorney general in 2014, Brnovich was a federal prosecutor and head of the state Gaming Department, which regulates gambling.
Health care is one of the most complex issues of our times. For the LGBTQ+ community as for all Arizonans, lowering costs, increasing access, and expanding coverage is of paramount importance. That is why the myriad proposals that seek to undermine our current health care system under the Affordable Care Act has many members of the Greater Phoenix Gay & Lesbian Chamber of Commerce so concerned.
While the intentions behind proposals such as Medicare for All or the public option may be good, the impact that these government-controlled programs would have on access, quality, and affordability would be detrimental. This is especially true for rural Arizonans, with one study indicating that even the introduction of a public option could put more than 1,000 rural hospitals nationwide at a “high risk of closure.” For communities already suffering from lack of access, this would be devastating.
Access to care is vital for both the LGBTQ+ community as well as in the broader fight against AIDS and HIV. To ensure patients have linkage to the vital services and treatments they need, we must have a robust, talented health care workforce. Yet Medicare for All would threaten the future of that workforce. According to another study, the reimbursement cuts associated with that proposal could result in 90 percent of hospitals nationwide running consistent deficits, which would increase the risk of hospital closures even further, cutting off access for at-risk patients.
There is no question that lawmakers at every level of government need to work together to pass meaningful reforms that lower costs and increase access to care. However, government-controlled proposals like Medicare for All and the public option are not the right fit and could only worsen access issues for the LGBTQ+ community and all Arizonans.
By Deanna Jordan, Executive Director, Greater Phoenix Gay & Lesbian Chamber of Commerce.
And at this point, that road might as well be paved with gold.
With just over two weeks to go before the election, incumbent Republican Sen. J.D. Mesnard, Democratic challenger Ajlan Kurdoglu and outside groups have already spent a combined $1.7 million, most of that from deep-pocketed national Democratic organizations intent on flipping the Arizona Legislature.
In LD17, registered Republicans still outnumber Democrats by about 9,500. But Democrats have made significant gains in the district in the past four years – about 10,000 new Democrats registered between 2016 and 2020, compared to just under 4,000 new Republicans.
Independent voters who supported Mesnard and Republican Rep. Jeff Weninger when they defeated Pawlik in 2016 clearly broke for her in 2018. A general suburban shift from the Republican Party caused by distaste for President Donald Trump, and an influx of transplants drawn to the Southeast Valley by a booming tech sector have made the district a reachable goal for Democrats.
“LD17, just like our state is changing,” Kurdoglu said. “Our priorities are changing. Frankly, the only thing that is not changing is the stale approach of our current state senator.”
In Kurdoglu, who party leaders recruited to run against Mesnard, Democrats found a fresh-faced, enthusiastic candidate who draws on his own experience as a Turkish immigrant to describe the American dream he found in Arizona and how he wants to make that dream a reality for would-be constituents.
This is Kurdoglu’s first campaign, against a formidable incumbent who has spent almost his entire adult life drafting state policy. Mesnard is counting on his decade of experience in state office to be a selling point for voters during an unprecedented health and economic crisis.
“You have someone in office now, whether you agree with him on every issue or not, who knows the stuff, who has the experience,” Mesnard said. “We can’t afford the learning curve of someone brand new, who’s never served in any capacity in public service, and is now going to step into one of the biggest challenges of our lifetime.”
Mesnard, 40, showed up at the Senate almost two decades ago for a research internship and has basically never left the Capitol since, going on to spend eight years as a Senate Republican policy adviser before he resigned to run for an open seat in the House in 2010.
He served eight years in the House, the final two as speaker, before winning a Senate seat in 2018. His roots in the Senate basement showed in the 27-page blueprint he drew up as his campaign for speaker, and in the way he spent last summer drawing up an intricate property tax cut plan that looked like it would move forward before COVID-19 wrecked the state’s budget plans.
Mesnard’s tenure as House speaker was marked by a #MeToo-era reckoning that led him to launch an investigation into several representatives and ultimately lead the call to expel then-Rep. Don Shooter, R-Yuma — a historic vote Mesnard now features in some campaign ads. He also presided over the chamber during 2018’s massive “Red for Ed” protests, and ended up carrying legislation to raise teacher salaries by 20% over three years.
The main story of his two years in the Senate, meanwhile, has been perpetual conflict with Senate President Karen Fann, R-Prescott. Fann narrowly beat Mesnard for the Senate presidency in 2018. Relations between the two have remained frosty, as Mesnard and other conservative lawmakers were stymied in their attempts to pass a different tax cut package in 2019 and prevent the Legislature from adjourning this year. In 2019, he was the sole Republican to vote against the state’s budget because he disliked the tax cut package it contained.
This year, Mesnard also sponsored and passed the bill that has become one of the biggest triggers of attack ads against Republican incumbents – a bill supported by 89 of Arizona’s 90 lawmakers that states that insurance companies in the state cannot deny coverage to people with pre-existing conditions if the Supreme Court rules the Affordable Care Act is unconstitutional.
The new state law lacks the interlocking protections of the Affordable Care Act that were designed to prevent insurance companies from charging patients with pre-existing conditions more or refusing to pay for medical care they need, leading Democratic PACs to use the bill to hammer vulnerable Republican incumbents as bad for health care.
Independent liberal organizations have spent nearly $1 million to attack Mesnard, while GOP organizations have spent just about $400,000 to help him. More than $500,000 of the anti-Mesnard spending appeared in the past week, on top of about $160,000 spent the previous week.
“Pouring in $160,000 in a single week into a legislative race, even a state Senate race, that is a lot of money,” Mesnard said. “You’ve never seen anything like that before. So that can make a difference, mostly by bringing up my negatives and tearing me down. It’s not really helping the other guy so much as it’s just hurting me.”
Even hardcore Republicans in the district have been targeted by push polls suggesting Mesnard is part of a crime syndicate and wants to forcibly sterilize transgender people. (The sterilization charge stems from the involvement of one of his employers, the conservative legal outfit Alliance Defending Freedom, in a European human rights case over whether countries could require transgender people who wished to change the sex designations on their birth certificates to first undergo sexual reassignment surgery; Mesnard said he still doesn’t know what crime syndicate he allegedly belongs to and that charge has not been repeated in other attacks.)
A million dollars goes a long way in a district with about 150,000 voters, and voters and candidates have been inundated with internet ads. Mesnard, a self-described Trekkie who keeps a Star Trek channel on streaming in the background while he works from home, said nearly every commercial break now brings at least one ad bashing him.
He said he remains optimistic about his chances of returning to the Senate.
“I think it could go either way, but I feel like on the whole, I have more working in my favor than against me,” Mesnard said. “I feel like I’m gonna win and we’re working hard, but I also acknowledge that I don’t know how much they’re gonna spend to get through this race. I mean, they seem to have unlimited funds.”
Kurdoglu, likewise, said he is confident that he’ll be sworn into the Senate in January.
Republican independent expenditure groups, led by a political action committee affiliated with Gov. Doug Ducey, have worked to paint Kurdoglu and other Democrats running this cycle as too far-left for Arizona.
“I brush it off,” he said. “My life story is out there. What I want to do is out there. I explain everything as much as I can.”
Around the same time Mesnard was starting a legislative internship, Kurdoglu arrived in Glendale to begin master’s courses at the Thunderbird School of Global Management. He fell in love with the state and decided to stay, eventually starting retail furniture stores and becoming a naturalized citizen.
Those early years as an immigrant building a life and business from scratch left Kurdoglu with an unfailing sense of optimism, leaving him confident that he and fellow Democrats will be able to pass legislation to improve health care and education in the state with bipartisan support and a signature from Republican Gov. Doug Ducey.
“I’m sure if we really put partisan politics, gamesmanship as they call it, aside, and we put our heads together, we can find a way to make that happen,” he said. “Come on, this is the United States of America, the biggest country on Earth, so we should be able to solve these problems.”
Attorney General Mark Brnovich found himself defending the decisions he made to challenge various federal laws, challenges that his Democrat foe said Wednesday worked against the interests of average Arizonans.
During a televised debate on KAET-TV, January Contreras lashed out at Brnovich for working to overturn a decision by the Obama administration to put about a million acres of federal land near the Grand Canyon off limits to mining. Federal appellate judges did not agree with him.
Brnovich has had no better luck in joining with other Republican attorneys general to overturn the Affordable Care Act and its mandate to provide coverage for pre-existing conditions.
And Brnovich also sided with Americans for Prosperity in challenging a California law that would require the organization, part of the Koch brothers network, to disclose its donors.
All that, Contreras charged, showed that Brnovich during his four years as attorney general was more interested in pursuing cases that helped special interests than those that help average Arizonans.
Brnovich said that Contreras, a former assistant attorney general under Democrat Janet Napolitano, would follow her own political agenda if she was in charge of the office.
His prime example is the challenge his office filed against the Maricopa community colleges over the decision to charge resident tuition to “dreamers.”
“I would not have litigated that case,” Contreras conceded. She said that’s because she believed that they were entitled to in-state tuition if they met other Arizona residency requirements.
Contreras pointed out that those accepted into the Deferred Action for Childhood Arrivals program were entitled by the federal government to not only remain but also to work.
But Brnovich said that ignores the role of the Attorney General’s Office.
He pointed out that Arizonans voted by a 2-1 margin in 2006 to spell out that any person who is not a U.S. citizen or legal resident, or is “without lawful immigration status,” is ineligible to be charged the same tuition as residents at state colleges and universities.
“Even if you don’t like the policy, you have to defend it,” Brnovich said.
“As prosecutors, we enforce the law,” he said. “If you don’t like the law, you run for governor, you run for the Legislature or you run for Congress.”
Ultimately the Arizona Supreme Court sided with Brnovich and concluded that DACA recipients are not entitled to resident tuition.
As to the other cases Brnovich did pursue – and lost – the incumbent defended his decisions.
Take the mining case where he supported a challenge by the National Mining Association to the 2012 decision by the Obama administration to put a 20-year moratorium on new mining claims around the Grand Canyon. The Department of Interior said that would provide the time to study the effects of new mining on the environment, particularly water quality.
“As Arizona’s attorney general, when the federal government and the Obama administration tried to unilaterally remove one million acres of land without any congressional veto, I thought it was important,” Brnovich said. “We want to make sure we have a check on the federal government.”
Contreras said she has no problem with an attorney general seeking to exercise a check on the power of the federal government. But she argued that Brnovich was choosing the wrong issues — and the wrong side.
“You look at the separation of kids and parents at the border,” she said, noting that some attorneys general – but not Brnovich – went to federal court to protect the constitutional rights of those involved.
“What is alarming to me is how often, in the case of the cases I’m talking about, it’s aligning with political donors,” she said.
That question of money and politics spilled into the decision in August by Brnovich to alter the description of Proposition 127, a mandate that utilities use more renewable energy. The Secretary of State’s Office originally wrote the description. Brnovich added language that some considered to be unfair and uneven.
Contreras charged that Brnovich was influenced by money that Pinnacle West Capital Corp., the parent company of Arizona Public Service, has given to the Republican Attorneys General Association; RAGA, in turn, helped Brnovich get elected in 2014 and is spending money on his reelection campaign.
Brnovich responded that California billionaire Tom Steyer, who is financing the Prop 127 campaign, is now funding a $3.6 million media campaign urging Arizonans to turn him out of office. He called such out-of-state influence to help Contreras win the race “improper.”
“I think it’s funny coming from you when you have Arizona in a California courtroom defending the secrecy of donors to the Koch brothers network,” Contreras responded.
In that case, Americans for Prosperity sought to overturn a California law that requires certain nonprofit corporations to submit on a confidential basis a report of their large donors to that state’s attorney general as part of enforcing its laws governing tax-exempt groups. While Arizona was not affected — and Arizona has no similar laws – Brnovich submitted an amicus brief urging the 9th Circuit Court of Appeals to rule that California had no “legitimate governmental interest” in such a mandate.
The federal appellate court concluded otherwise.
After the debate, Brnovich defended his decision to intercede on behalf of Americans for Prosperity. He said forcing release of the names of donors amounts to “trying to intimidate people who are exercising their First Amendment rights.”
Brnovich said even if he did take positions on these cases that does not reflect the vast majority of how his office has operated.
“My opponent wants to point out one or two or three cases,” he said.
“We have almost 500 lawyers in our office,” Brnovich continued. “What we do touches people’s lives every day.”
Senator Martha McSally has flooded the airways with advertisements stating she will protect our health care. Instead, she just voted to confirm Judge Amy Coney Barrett, who is against the Affordable Care Act, to the U.S. Supreme Court. Justice Barrett will be given the opportunity, in a few weeks, to destroy this law that benefits millions. McSally has just turned her back on the citizens of Arizona, who have counted on the ACA for their survival.
If you were going to vote for Senator McSally, you might want to think about some very frightening facts. The Supreme Court is now, not moderate, but extremely conservative with Heritage Foundation and Federalist Society members who want to change laws that safeguard everyone. It is unconscionable that while more than 55% of adults favor the ACA, 60% believe in science, climate change, and our environment along with 66% who want a woman’s right to choose remain law, the Supreme Court is now prepared to dismantle each of these laws. Think about the control these justices have over your life and their blatant lack of empathy for women, their ignorance regarding science, and their vengeful obsession to get rid of the ACA.
A California union is funding a measure in a bid to convince Arizona voters to force hospitals here to pay their workers more.
An initiative drive being launched Monday would mandate that everyone working at a hospital get an immediate 5 percent pay hike if the measure is approved by voters in 2020. There then would be successive 5 percent pay increases for the following three years.
Rodd McLeod, spokesman for what’s being dubbed the Healthcare Rising Arizona campaign, said that would apply at all levels, including medical staff, nurses, social workers, orderlies and even custodians. And with a prior voter-approved state law already mandating a $12 an hour minimum wage beginning in January, that would put the base salary for hospital workers after the fourth year at $14.59.
McLeod said it is in the public interest to raise hospital wages, even if it does raise costs for hospitals and, potentially, by extension for patients who do not have insurance.
Higher wages are just part of what is being promoted by the campaign financed by the Service Employees International Union. The initiative, if it makes the ballot and is approved, also would:
put provisions directly into Arizona law to ensure patients can get coverage for prior existing conditions; impose new infection control protocols for Arizona hospitals; institute a more comprehensive law than now exists to protect patients from “surprise” medical bills.
A spokesman for the Arizona Hospital and Healthcare Association declined to comment.
This isn’t the first ballot foray by the California branch of the union.
But McLeod said the fact that this is being proposed and financed by an out-of-state organization − one with a history of doing battle with hospitals − should not deter Arizonans from supporting it.
“We have a health care system that costs a lot of money and doesn’t deliver results that are as good as they could be,” he said.
McLeod said the measure, if enacted, will improve patient protections, saying that 99,000 people a year get “serious infections” in hospitals.
Then there’s that issue of surprise billing, with patients admitted to hospitals after checking their insurance coverage, undergoing a procedure and only later finding out that someone on the medical team, like an anesthesiologist, isn’t on hospital staff, isn’t part of the insurer’s “in-network” providers, and doesn’t accept what the insurer is willing to pay.
A new law that took effect earlier this year addresses that in part by setting up a procedure for patients and doctors to have disputes resolved. But McLeod said that still doesn’t prevent the surprise bills in the first place, and only covers disputes of more than $1,000.
Potentially more significant would be language prohibiting insurers from denying coverage for patients with prior existing conditions.
McLeod noted that Arizona Attorney General Mark Brnovich is among those trying to get federal courts to kill the Affordable Care Act. If successful that lawsuit also would wipe out the requirement to cover preexisting conditions, as Congress has yet to enact a replacement if the litigation is successful.
But a key part is the issue of salaries for workers at all levels, at least those below management.
“Arizona has among the highest turnover rates for hospital workers in the country,” McLeod said. “You have one in five leaving for jobs in other states or leaving for other professions because the salaries are so low.”
That, he said, results in worker shortages which, in turn, affects patients.
“I sat in the emergency room waiting for a long time because there’s not enough people to handle the work,” McLeod said.
He said the initiative is at least related in part to the fact that there are fewer and fewer people in unions who can engage in collective bargaining on issues like salaries and working conditions.
“I think there’s a real desire to use creative problem solving to figure out how to improve people’s standard of living and the quality of health care,” McLeod said.
The California-based United Healthcare Workers West branch of the SEIU is no stranger to the ballot process here.
This is the same group that sought in 2016 to cap the pay of hospital executives at no more than what the president of the United States is paid, or $450,000 a year. But after gathering what it claimed was more than 281,000 signatures − far more than needed − the union decided to scrap the effort in the face of challenges to the validity of many of those signatures.
Then last year the same organization sought to cap the amount dialysis centers can charge patients at no more than 15 percent above their costs, with a requirement for refunds if profits exceeded that amount. They scrapped that effort, with a union spokesman saying it was instead focusing on similar measures in California and Ohio.
Ian Danley is fighting for his life for the third time in four years, and yet he has decided to take on another fight – health care for the hundreds of thousands of Arizonans covered through the Affordable Care Act.
The 36-year-old father of two, who found out two weeks ago that he’s facing cancer again, said he’s not one to back down from a fight.
“I can sit and get scared and hunker down and feel sorry for myself, or I can fight. And I’m kind of a fighter,” said Danley, who has worked on Democratic campaigns and now runs One Arizona, an advocacy group aimed at getting more people to vote and increasing civic engagement.
He took both battles to social media in a series of frank and personal tweets as the debate in the U.S. Senate heated up over the Better Care Reconciliation Act, the Republican plan to repeal and replace the Affordable Care Act.
“I’m calling you from my chemo chair to protect AZ health care. Vote No!” Danley tweeted to U.S. Senators Jeff Flake and John McCain on July 14, complete with a photo of him with an IV in his arm.
While Congress continues to debate health care, expect to see more social media posts from Danley calling on elected officials to vote against repealing the ACA.
As someone who has worked in politics, he gets that it’s politically difficult for Flake and McCain right now. But he hopes his personal story will resonate with the men and get them to vote against repealing the Affordable Care Act.
McCain and Danley both were actually at Mayo Clinic on July 14 at the same time. McCain was recovering from brain surgery he underwent at the hospital to remove a blood clot. McCain announced July 19 doctors diagnosed him with brain cancer.
Danley was also at Mayo’s campus, starting up treatment for the third time to fight anaplastic large cell lymphoma, a rare blood cancer.
He was first misdiagnosed in 2013 with Hodgkin’s lymphoma and got treated, then the cancer came back after about a year. The second time, he was managing the campaign for Democratic superintendent of public instruction candidate David Garcia when he felt a lump. He knew it was cancer again. He went through a stem cell transplant and spent a month at Mayo Clinic recovering.
He thought he was fine. He started posting old pictures of his previous treatments to social media as a warning call to the state’s elected officials. Then, during a routine scan two weeks ago, doctors found a small lump.
His current course of treatment will last 54 weeks, with infusions of a more targeted chemo drug every three weeks during that time.
He has insurance coverage through his employer, but he’s still worried about what could happen. Repealing the Affordable Care Act entirely could make coverage requirements for pre-existing conditions, like his cancer, disappear. Essential health benefits, like cancer treatment, could be weakened.
If lifetime limits are allowed to come back, something prohibited under Obamacare, he’s already gotten $1.2 million worth of treatment over the past few years. He’s only had to pay less than $5,000 out of pocket.
It’s unclear what the path is for Republicans. A 2015 plan to repeal the Affordable Care Act, vetoed by President Obama, would have kept protections for things like pre-existing conditions in place while ending Medicaid expansion and subsidies.
McCain said in a statement July 17 that one of Obamacare’s central problems was partisanship, as the ACA passed without any Republican votes.
“As this law continues to crumble in Arizona and states across the country, we must not repeat the original mistakes that led to Obamacare’s failure,” McCain said.
“The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care,” he said.
Flake’s office said July 18 that he supports repealing Obamacare without a replacement, just as he did in 2015.
But in a statement last week, while the Republican plan was still alive, Flake said his vote on any health care plan would balance fiscal sustainability with ensuring people with coverage don’t have the rug pulled out from under them.
Danley tried to appeal to Flake’s sense of family in his tweets after he saw how Flake spoke of his father, Dean Flake, when he died at age 85 on June 27.
“I want to live so I can have a relationship with my son Tyler like you had with your dad. Give me that chance,” Danley tweeted on July 10.
Danley’s son is 4 years old. He said he believes his treatment will work, if it continues to be covered.
“And if I don’t make it, (my kids are) not going to remember me. I’m just going to be this guy in a photo they’re going to tell stories about,” he said.
He said he knows Flake is a good man. And he understands that Flake is in a tough spot politically – if he doesn’t vote to repeal Obamacare, his Republican primary challenger will go after him. If he does, his Democratic challenger will.
“It’s a risky move either way. So do the right thing and let the chips fall where they may. And you can look your kids in the face, look yourself in the face, and say, I walked with integrity,” Danley said.
Arizona Gov. Doug Ducey says he still has hopes for congressional passage of the latest Republican effort to repeal former President Barack Obama’s health care law, despite Sen. John McCain’s announcement that he won’t vote for the bill.
A Ducey tweet reacting to McCain’s announcement Friday doesn’t mention McCain but says the governor still supports the bill and encourages others to do the same.
Ducey also asserts that “51 votes are still possible,” a reference to the number of “yes” votes needed for Senate approval.
Ducey had come out in favor of the bill Monday.
He says the legislation’s block grant approach “is far superior to anything Washington,. D.C. has proposed on health care policy in recent memory, because it shifts dollars and decisions back to the states.”
Gov. Doug Ducey endorsed the concept of the Trump and Republican tax cuts Monday even though he conceded he has little idea of what’s in the plan.
And some of what he does know is in there he does not like.
But the governor said he wants action on tax cuts — and wants it by the end of the year.
“The time for excuses is over,” he told a small audience at a rally organized by the Job Creators Network, a business advocacy organization that is traveling around the country by bus and scheduling similar events.
“It is time right now to make our tax code simpler and fairer,” Ducey continued.
“We can’t wait til next year,” he said. “We shouldn’t even wait til next month.”
But the governor, questioned by reporters after the event, quickly backed away from any suggestion that he supports — or even likes — what emerged from the president and Republican congressional leadership.
“Today is not an endorsement of the plan,” he said.
“It’s an endorsement of the idea that it’s time for Congress to act on tax reform and tax cuts,” the governor said. “I want to understand the details of the full plan.”
Overall, the governor said he supports closing “loopholes” in the tax code.
“That’s what’s going to happen when they pass this bill in Congress at the end of this year,” Ducey said.
Still, Ducey said he’s already found things to dislike in closing some of those “loopholes.”
For example, one of the deductions that would disappear is the $250 available for teachers who use their own money to buy classroom supplies.
Unlike a credit, that’s not an actual dollar-for-dollar loss. But for a teacher making up to $37,950 who is in the 15 percent tax bracket, that translates to $37.50; those earning more than that — up to $91,900 — are in the 25 percent tax bracket, where the loss of the deduction equals $62.50.
That would cut into the 1 percent across-the-board increase in teacher pay approved by state lawmakers earlier this year which, for the average teacher, computes out to about $455 a year, before federal and state taxes.
“I don’t want to see anything to hurt our teachers,” the governor said when asked about that provision in the federal plan.
“I want to see it help our teachers,” he continued. “But I want to understand the details of the full plan.”
That’s not all that Ducey has found troubling.
“I have concern for things like elimination of the adoption credit,” he said. That one-time credit of up to $13,570 is an actual dollar-for-dollar decrease in federal taxes for parents who adopt from foster care and in other situations.
But Ducey, who was adopted by his stepfather and who has promoted adoptions, even by same-sex couples, said he also has been told that few people actually use the credit.
“That’s why we want to understand what’s in the plan across the board before we’re commenting on the specifics,” the governor said.
So when will Ducey weigh in?
“We’ll have some specific comments on how we think this affects Arizona and how it can benefit small businessmen and women of Arizona so that they have more money in their pocket,” he said.
Ducey bristled when he was asked if his professed lack of knowledge of the plan, released last week, is a way for him to avoid taking a position.
“No, it’s not a way to avoid the issue,” he responded.
“I ran on a better tax system, a simpler, fairer, flatter tax system,” Ducey continued. “And we have that in Arizona today.
But pushed for specifics of that “simpler, fairer, flatter tax system,” the governor conceded that there have not been significant changes in the tax code since he took office in January 2015.
The number of tax brackets remains the same. Instead, what’s changed is that the bracket break points and the standard deductions have been indexed for inflation.
“We’ve reduced taxes moderately each of the years that I’ve been governor,” he said. Ducey said there’s a good reason that there hasn’t been more significant tax reform at the state level.
“We did come in to a billion-dollar deficit,” the governor said. “We had to balance the budget.”
And Ducey said some of the state’s revenues were put into additional funding for K-12 education above and beyond inflation.
The governor did give his endorsement to one thing GOP leaders are considering adding to the plan: repeal of the “individual mandate” tax in the federal Affordable Care Act for those who do not have insurance, whether from the government, employers or purchased outright.
“We have over 150,000 Arizonans who paid an average of $450 each under this tax,” he said, with 40 percent of them making less than $25,000 a year.
“That’s taking $70 million from hardworking Arizona families and sending it to Washington with no return on this investment,” Ducey said. “That’s $70 million that could be used to put food on the table, buy clothing, pay the mortgage or rent, or any other bills.”
Monday’s event drew about two dozen supporters, including a handful of Republican legislators, along with an equal number of protesters holding signs decrying the tax plan as relief only for the wealthy and corporations.
Gov. Doug Ducey wants Congress to adopt limits on what jurors can award to medical malpractice victims, a cap that Arizona voters have previously rejected multiple times.
Ducey told Capitol Media Services that limit on damages should be part of anything that becomes a replacement of the Affordable Care Act. He said some of the high cost of health care in Arizona can be blamed on high malpractice insurance premiums and awards to patients in lawsuits.
The governor’s comments came as the U.S. Senate killed the last-ditch effort by Republican leaders to repeal what has become known as “Obamacare.” It was John McCain, the state’s senior senator, who cast the deciding vote on the “skinny repeal” plan which would have annulled the Affordable Care Act now with a promise to come up with something else later.
Ducey press aid Daniel Scarpinato said Friday his boss is “disappointed” that Congress has essentially thrown up its hands and “will be taking a recess without repealing Obamacare.”
“The problems with Obamacare and the health insurance markets are real and continue, especially in Arizona,” he said. But the governor would not comment on the fact that it was McCain, as the deciding vote, who killed the repeal.
Ducey, however, still believes that the Affordable Care Act can be repealed and replaced.
Potentially more significant, the governor already has ideas on what needs to be in what comes next. And a key provision of that is what has been dubbed “tort reform.”
In essence, Ducey wants federal law to set limits on non-economic damages in malpractice cases. That category covers everything from the pain and suffering of patients — or survivors — to punitive damages that can be awarded when juries conclude a doctor’s actions were so egregious as to impose a financial punishment and send a message to others.
Ducey acknowledged that what he wants would overrule two provisions in the Arizona Constitution that date to the first days of statehood.
One, in the Declaration of Rights — the state’s version of the Bill of Rights — says “no law shall be enacted in this state limiting the amount of damages to be recovered for causing the death or injury of any person.” And another section says “the right of action to recover damages for injuries shall never be abrogated, and the amount recovered shall not be subject to any statutory limitation.”
Proponents asked voters for outright repeal in 1986 and 1990. And four years later they sought to amend those same provisions, albeit to allow for “no-fault” auto insurance.
All three were defeated, leaving the legislature powerless to impose caps.
But the congressional action Ducey wants would override what voters here have rejected. That’s because the constitutional provisions are limits on the power of state government: They offer no protections against changes in federal law.
The governor defended the idea, saying he sees it as “allowing justice when there is wrongdoing, but not pushing doctors out of the marketplace, not making it so burdensome to practice medicine,” he said.
“We’ve certainly seen our (health care) costs rise in Arizona and in America,” Ducey said. “And I think part of it is how expensive the liability (insurance) and litigation has become.”
Ducey said Arizona should look to other states. One of those often cited is Texas where there is a $250,000 cap on non-economic damages for all doctors and other individual health care providers.
The idea of a federal override of the Arizona Constitution drew fire from David Diamond, president of Arizona Attorneys for Justice, a group composed of attorneys who represent plaintiffs in civil lawsuits. He said it would be wrong for Congress to impose its will.
“Arizona voters have three times voted down efforts to amend their constitution to allow caps on damages,” he said in a statement.
“This bill would ignore their wishes and impose the very caps they rejected,” he said. “This is overreach by the Big Brother federal government at its worst.”
Ducey said he has no specific language in mind for what he wants to see in limits.
“I want to see when someone is wronged that they are able to access justice,” the governor said. “But I also think we can do a better job so that we’re bringing doctors into the field and not putting them in a position where their premiums are so high they can’t afford to practice anymore.”
It wasn’t a question of tort reform that caused McCain to buck his party.
McCain had, in some ways, been Ducey’s D.C. surrogate in the fight, saying he would not support a measure without changes sought by the governor. And Ducey had demanded several provisions, including ensuring that Arizona is not penalized for having expanded its Medicaid program before most other states, and protecting the federal dollars for that program, at least for the foreseeable future.
On Friday, McCain issued a statement saying said he could not support the “skinny repeal” because it would not have replaced the Affordable Care Act with something that “increases competition, lowers costs and improves care for the American people.” And in a separate statement, he said Republicans should give up on their bid to craft something on their own, saying partisans on both sides of the issue should “stop the political gamesmanship and put the health care needs of the American people first.”
Republican efforts to repeal the Affordable Care Act formally fizzled Tuesday and Gov. Doug Ducey said the state’s senior senator and his desire for “procedure” is at least partly to blame.
Senate Majority Leader Mitch McConnell gave up on his plan to have a vote before the end of the month when he found himself short of the 50 votes needed out of his 52-member Republican caucus. John McCain is among those refusing to go along with a last-ditch draft of a plan crafted by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.
The plan has effectively run out of time as Senate rules allow for this kind of change to be approved by a simple majority only before the end of the federal fiscal year on Sept. 30. With all Democrats opposed, Vice President Mike Pence would provide the tie-breaker if McConnell could get to 50.
Once the new fiscal year starts, it takes at least 60 votes to block any sort of filibuster, effectively eliminating any chance Republicans can pass something on their own.
Speaking to reporters Tuesday, Ducey said he always expected McCain to “make up his own mind” on these kind of issues. But he also took a slap of sorts at the senator who based his objections not so much on what was in the Graham-Cassidy plan — a plan Ducey praised for returning funds and decision-making to states — but the fact that McConnell was trying to fast-track the legislation with minimal hearings which provided no real opportunity for negotiations with or amendments from Democrats.
“I know to the senator (McCain) procedure seems to be of paramount in importance, things like ‘regular order,’ ” Ducey said. That refers to the normal procedure for hearing bills, having them go through committee hearings and providing a chance for debate.
The governor, for his part, said following these procedures “are not as high of a concern for me as a governor.” More to the point, Ducey said that McCain’s refusal to go along because of those procedural concerns, coupled with objections from several other GOP senators, is bad news for Arizonans.
“We’ve got citizens that need a fix now,” the governor said, a need that Ducey said transcends any concerns about time-consuming procedures.
“So to me the result happening sooner rather than later is more important than that,” he said. “And I guess we can go to work with the Senate having a priority on regular order.”
There was no immediate response to the governor’s comments from McCain.
McConnell told reporters that he still has hopes to repeal and replace the law. But he said efforts to craft a plan that could cobble together the necessary votes just ran out of time.
“We aren’t going to be able to do it this week,” he said.
In fact, it is unlikely to happen at all this year. McConnell said Republicans now need to regroup and focus on the other big priority: revamping the tax code.
Some of the GOP foes of Graham-Cassidy had their own concerns.
For example, Sen. Rand Paul, R-Ky., said he was holding out for full repeal of the Affordable Care Act. By contrast, what was being proffered kept many of the taxes to pay for it but instead redistributed the money to the states in the form of block grants.
Sen. Susan Collins, R-Me., however, called the bill “deeply flawed” because of cuts in Medicaid funding and problems she saw in protecting people with prior-existing conditions.
But McCain has made it clear for days that he did not like the process. In fact, in an extensive floor speech the senator cited the failure to follow “regular order” as his reason against voting for the “skinny repeal” proposal that came before the Graham-Cassidy plan.
The state’s hospital industry is gearing up to fight a ballot measure that would require its members give virtually all their employees a 20 percent pay hike over four years.
Greg Ensell, spokesman for the Arizona Hospital and Healthcare Association said wages already are higher than the statewide average, at least when considering everyone employed by hospitals from top executives on down. And he said there is no hard evidence to back claims by supporters of the initiative being financed by a California-based union that the current wage structure is leading to staff shortages or high turnover.
The association also is opposed to another provision of the measure that seeks to impose new oversight about the incidence of hospital-acquired infections.
In a prepared statement, Ann-Marie Alameddin, the group’s president and chief executive officer, said the performance of Arizona hospitals already exceeds the national benchmark in the initiative.
Ensell said his association had no comment on two other provisions of the initiative that do not directly affect its members: ensuring that people with preexisting conditions can get insurance coverage and limits on the ability of insurers to refuse to cover medical conditions because the treatment was provided by an out-of-network physician.
On that latter plan, Marc Osborne who lobbies for Blue Cross and Blue Shield of Arizona said insurers are studying the language but have no immediate reaction. Insurers and doctors did agree to a less comprehensive 2017 law designed to provide a method for patients to appeal.
The last two provisions in particular appear to be issues likely to be popular with voters.
There is national attention to the issue of pre-existing conditions, particularly with Congress debating whether to scrap the Affordable Care Act and its prohibition against denying coverage to those who already are ill and lawsuits. That, in turn, could help build support for what is crafted as a take-it-or-leave-it package.
But campaign spokesman Rodd McLeod said these are not designed to be carrots to get voters to approve the entire plan, saying the four issues are all related.
“It’s designed to deal with the problems of our health care system,” he said. McLeod said it all relates to the kind of care people get in a hospital, how effective the hospital is working, and the ability of patients to pay for that care.
Backers have until July 2 to get the required 237,645 valid signatures on petitions to put the package on the 2020 ballot.
Jenny David, a labor and delivery nurse at St. Joseph’s Hospital in Phoenix, claimed that Arizona has among the highest turnover in hospital staff in the country, “with nearly one in five leaving for jobs in other states, or leaving the profession altogether.”
“Because salaries are so low, hospital worker shortages have real consequences for patients, such as emergency room overcrowding, reduced hospital beds and longer wait times for surgeries,” she said. And the issue, said David, goes beyond the direct medical staff.
“Sometimes we see patients sit in triage for hours because we don’t have a clean room to put them in,” she said.
David acknowledged that the measure, if approved, would mandate 20 percent pay hikes over four years — but only for those working in hospitals.
The salaries of people with similar jobs elsewhere in the private sector, ranging from medical staff at a doctor’s office to custodians in commercial buildings, would be unaffected. But David said that’s no reason to vote against the measure.
“I don’t think it should only apply to us,” she said. “All workers in Arizona should have fair pay.”
But the initiative, David conceded, does not do that.
“We’re focused on health care,” she said.
Ballot organizers did not immediately produce any data backing the claim that staff turnover at Arizona hospitals is higher than the national average.
Ensell also had no state-specific turnover data. But he did have his own figures, at least on salary, saying that in 2018 the average wage of a full-time employee at an Arizona hospital was more than $75,000, versus an average Arizona wage of $49,290. That hospital figure, however, also covers doctors and medical professionals who are staffers, and hospital executives.
Others at a Monday press conference to kick off the initiative drive had their own stories to tell.
Delores Stoeser said her husband died from what she said was methicillin-resistant staphylococcus aureus – MRSA – that he contracted at a hospital.
Fernando Vicino spoke of having to have a valve in his aorta replaced.
“The Affordable Care Act could be repealed or overturned and I would not be able to find insurance at all,” he said.
And Steve Wasson complained about being stuck with high hospital bills for his wife after he said there were multiple tests performed on her without anyone checking with him, explaining their necessity — or, more to the point, telling him ahead of time what it would cost. But the provision on out-of-network billing would not have helped Wasson because he had no insurance at all.
Arizonans won’t be voting in November on a proposal to hike pay of hospital workers and guarantee that those with pre-existing conditions can get affordable health insurance.
In an extensive ruling late Friday, Maricopa County Superior Court Judge Pamela Gates said there are not enough valid signatures on petitions submitted by a California union to put the issue on the ballot. Gates found that some circulators were not legally qualified to circulate the petitions.
In other cases, she said, some of the 332 circulators subpoenaed by foes of the initiative failed to appear in court to be questioned. Gates said the signatures they gathered also cannot be counted.
All that left the backers of the Healthcare Rising measure with fewer than the 237,645 valid signatures needed to qualify for the ballot.
Campaign spokesman Rodd McLeod said there will be an appeal to the state Supreme Court.
The initiative sought to require a 20% pay hike for hospital workers — excluding executives and doctors — over a four year period.
It also proposed a guarantee that people with pre-existing conditions will be able to obtain affordable insurance if the federal Affordable Care Act is repealed. Another provision was designed to protect patients against “surprise” medical bills from doctors and others in hospitals who turn out to be “out of network.”
And it also sought to require hospitals to comply with certain national standards of infection control.
Foes, led by the hospitals and the Arizona Chamber of Commerce and Industry, filed suit. They cited a litany of what they said were flaws in both how signatures were gathered and in the wording of the description of the initiative provided to petition signers.
They also charged that signers were deceived because the names used by the backers of the initiative and of the campaign committee did not disclose that it was being financed by the California-based Service Employees International Union — Union Healthcare Workers West.
Gates acknowledged that virtually all of the $6.7 million raised by June 30 came from the union. But she also said there was not “sufficient credible evidence” to conclude that potential petition signers were defrauded or that anyone was confused or misled because SEIU-UHW was not included in the committee’s name.
But Gates did find other legal problems, even if some of the signatures are restored.
One, she said, goes to the 100-word description which says it will “prohibit insurers from discriminating based on preexisting conditions.”
Gates said the evidence shows that about 60 percent of Arizonans are insured through an employer’s self-funded insurance plan. More to the point, the initiative would apply only to those who purchase individual or group plans. And she said it was misleading not to tell signers that the provision would not aid a majority of Arizonans.
She also said it was misleading to say that the initiative would set “new minimum wages” for workers at private hospitals. Gates said there was evidence that people, confronted with that phrase, would equate it with some bottom-level wage set by federal and state law and not the fact that the raises would be on top of what could be a current $37-an-hour salary paid to an experienced nurse.
Friday’s ruling was cheered by Garrick Taylor, spokesman for the Arizona Chamber. He said it would “have forced tremendous cost increases onto patients and hospitals.”
Two other initiatives have cleared their first legal challenges, one to legalize recreational use of marijuana by adults and another to give judges more discretion in sentencing “nondangerous” offenders.
But a proposal to increase income taxes on the highest income earners to fund K-12 education was found to have a flawed description.
All of those rulings, however, are subject to Supreme Court review.
Two more judges have rejected what they called attempts by Republican lawmakers to taint descriptions given to voters of ballot measures.
Maricopa County Superior Court Judge Sherry Stephens, an appointee of former Gov. Jane Dee Hull, said the explanation of some provisions of the Second Chances initiative approved by the GOP-dominated Legislative Council were “potentially misleading.” And she said some of what the panel put in the description of the crimes that might be affected “reflect a lack of neutrality and impartiality, are argumentative and violate (the law).”
Conversely, Stephens faulted the committee for leaving out some language she said is important for voters.
Meanwhile, Maricopa County Superior Court Judge John Hannah Jr., an appointee of former Gov. Janet Napolitano, made similar findings about how the Legislative Council wanted to explain a measure to voters containing multiple provisions dealing with health care and insurance. And he, too, ordered changes.
These are the second and third judges who have found fault with how the Republicans are — or are not — meeting their legal obligation to craft an explanation of ballot measures that by law “must be fair, neutral, and free from any misleading tendency.”
Earlier in the week Maricopa County Superior Court Judge Randall Warner ruled that several provisions of an explanation of a proposed income tax hike on the most wealthy have a “misleading tendency” and can add “partisan coloring” to what is being told to voters. But the Arizona Supreme Court still has to rule whether the Invest in Education measure itself can go before voters in November.
Arizona law requires the Legislative Council, composed of lawmakers from both parties and both chambers, to come up with language that is supposed to provide a shorthand explanation of what is in each initiative. That explanation is put into brochures which are mailed to homes of all registered voters.
The makeup of the panel is decided by the president of the Senate and the speaker of the House, both Republicans. And they set it up so that GOP members outnumber — and can outvote — Democrats.
The criminal justice measure would give judges more discretion in the sentences they can impose on those convicted of “nondangerous” offenses. It also would allow those already serving time for those offenses to be released after serving just 50 percent of their term, versus the current 85 percent figure that now exists in most cases.
Its text specifically defines ”nondangerous offenses” as anything other than first- and second-degree murder, certain child molestation and dangerous crimes against children, rape, and any offense determined by a judge or jury to be dangerous.
The Legislative Council, however, chose to add some examples of its own to its explanation, including aggravated domestic violence, molesting a child at least 15 years old, conspiracy to commit murder, and abuse of a vulnerable adult. Stephens said that was wrong on two fronts.
First, she said, it doesn’t explain to voters that these offenses actually can be classified as dangerous under the criminal code, depending both on the facts of a particular case and decisions made by prosecutors.
`Without providing that explanation, use of these examples is potentially misleading due to the omission of significant contextual information,” Stephens wrote. And she said that in picking those specific examples the panel was not being impartial and was being “argumentative.”
Stephens said there was nothing wrong with lawmakers putting a warning of sorts into the explanation that the Arizona Constitution prohibits the legislature from repealing what voters have approved and allowing them to make changes only with a three-fourths vote and only if they “further the purpose” of the underlying initiative.
But the judge said they failed to point out there are other ways to rescind or alter voter-approved measures, including either lawmakers sending it back to the ballot or voters themselves seeking a change. So she ruled that information, too, has to be given to voters.
Hannah found identical fault with a measure proposed by Healthcare Rising.
It would provide hospital workers with a 20 percent pay hike over four years, prohibit discrimination by insurers against people with pre-existing health conditions, bar “surprise” medical bills from out-of-network doctors, and impose new infection standards on hospitals.
Here, too, Hannah said lawmakers only partly described how voter-approved measure can be altered.
The judge also faulted legislators for adding what he called “argumentative” and “inaccurate” language.
That additional verbiage sought to tell voters that there already are state and federal laws protecting against discrimination based on pre-existing conditions.
But the federal law is the Affordable Care Act, which Republicans are trying to have voided by the U.S. Supreme Court. And there are questions about whether a state statute enacted earlier this year to fill in if that happens provides as broad a protection as would the initiative.
Two Republican legislators and Attorney General Mark Brnovich are taking the first steps to craft legislation to ensure that Arizonans with pre-existing conditions can still buy health insurance if federal courts strike down the Affordable Care Act.
The move comes even as Republican attorneys general, including Brnovich, actually are working to have the law declared unconstitutional, including the provisions about access to coverage. They contend that Congress lacks the power to mandate that people buy health insurance.
Last December a federal judge in Texas agreed. That sent the case to the 5th Circuit Court of Appeals, which could rule any day.
But the final word is likely to belong to the U.S. Supreme Court. Depending on how quickly they schedule arguments, a ruling could come as early as this spring.
The law, approved by what was at the time a Democrat-controlled Congress, has never been popular among many Republicans.
But Sen. J.D. Mesnard, R-Chandler, said that if the Affordable Care Act disappears, so does the provision requiring insurers to provide coverage for those with preexisting conditions. And he acknowledged that particular part of the statute in particular remains popular.
“I think there’s growing appreciation that we want to make sure that those with pre-existing conditions aren’t now somehow unable to get coverage,” he said.
How that would work and who would pay for it, however, remains to be decided.
“There are obviously going to have to be conversations with a wide assortment of folks, including insurance companies that will obviously be impacted by this,” Mesnard said. And those costs, he said, are likely to be passed on to all people with health insurance, no matter where and how it is purchased.
“I suspect there’ll be a domino effect for all of us to be impacted by this potentially in our premiums,” Mesnard said. “But at the end of the day I think that most people acknowledge that the pre-existing conditions issue has always been a challenge, and one that we have to overcome.”
The wide-ranging 2010 law required employers to provide health insurance for their workers and individuals to obtain their own coverage. It also created insurance exchanges to provide discounted coverage for those who meet income guidelines, expanded Medicaid coverage and eliminated lifetime monetary caps on insurance coverage.
And then there was the prohibition against insurance companies from excluding people for pre-existing conditions.
The Supreme Court upheld the law in 2012, with the majority hanging its hat on the mandate for individuals to purchase insurance, saying that fits within the power of Congress to impose a tax.
But all that fell apart in 2017 when Congress eliminated the financial penalty for failing to have insurance, a move that the current round of challengers eliminated any legal basis for the law. It is that, Mesnard said, that creates the need for a contingency plan if the Supreme Court finds the current version of the law unconstitutional.
“We don’t want to be caught unprepared,” he said.
Mesnard said he believes Arizonans should not have to go back to the days before the Affordable Care Act when they could find themselves unable to purchase insurance.
“From a policy standpoint, I think it’s the right policy to make sure that those with pre-existing conditions can get coverage,” he said. And Mesnard said while there can be debate over other provisions of the law, this issue is “one that most people on both sides of the aisle have rallied behind as an issue we have to tackle.”
None of this would be necessary if there were no lawsuit, one in which Brnovich has joined. But aide Ryan Anderson defended his boss’ decision to join the litigation to challenge the law.
“There is a question here as to whether or not the act, as it stands today is unconstitutional,” he said. Anderson said that is separate from the policy questions of whether there should be mandated coverage for pre-existing conditions and whether more needs to be done to ensure that Americans have better access to health care.
“Those are all very relevant discussions and appropriate discussions,” Anderson said. But what they also are, he said, is irrelevant to the underlying legal question.
“The fact of the matter is, if you believe something is unconstitutional, the ends shouldn’t justify the means,” he said.
“He personally believes that preexisting conditions should be covered by insurance companies,” Anderson said of Brnovich. “But that doesn’t mean the American people should be forced to accept a broader unconstitutional mandate in order to keep the act’s most popular provision.”
Anyway, Anderson said, the lawsuit was already being pursued by others, with a coalition of states led by Texas Attorney General Ken Paxton.
All that, he said, still leaves the question that Brnovich said he is working with Mesnard and Rep. Jeff Weninger, R-Chandler, to address – and soon: What will happen to Arizonans if the entire law is struck down.
“What we’re proposing here is to do a narrow-focused introduction with coverage for pre-existing conditions,” Anderson said.
A court ruling voiding the Affordable Care Act would have effects beyond the issue of pre-existing conditions that this proposal hopes to resolve.
Arizona was one of the states that took of the provision which provided federal dollars to expand health coverage to anyone earning up to 138 percent of the federal poverty level, about $29,400 for a family of three. Prior to that, Arizona law, as approved by voters, included coverage only up to the poverty level.
That added about 400,000 people to the rolls of the Arizona Health Care Cost Containment System, the state’s Medicaid program, bringing the current total to close to 1.9 million. If the Affordable Care Act goes away, so does the federal cash which pays almost the entire cost of the expansion.
Mesnard said it is possible that the Supreme Court could leave the Medicaid expansion piece in place even if the rest of the law is voided.
And if not?
“I’m prepared to consider all options,” he said. And Mesnard said his views won’t be colored by the fact that he voted in 2013 against the proposal by then-Gov. Jan Brewer to expand Medicaid.
“Opposing a new thing is one thing,” he said. “And sort of rolling back something that’s already in place is another.”
Everything is just fine…really? We are speeding around the corner… Seriously? It’s time to let
our guard down…what?
Let’s examine and update. Nationwide more than 61 million Americans have filed jobless claims since March 15, and as our country has passed the grim (actually very grim) milestone of 210,000 confirmed COVID-19 deaths, more than 25 million of our fellow citizens are still struggling with lost income.
At one point, Arizona was the world’s hotspot for the coronavirus outbreak. Over one million in the state lost work and over 500,000 Arizonans are still out of work, struggling to make ends meet on $240 a week. And while it is difficult for some to embrace the truth, more than 5,000
Arizonans, disproportionately the elderly and those with pre-existing conditions, have lost their lives.
Acknowledge it or not, this overview and considerable other information and data underscore a failure of leadership, unless you’re totally dismissive of the truth. We must keep reality in mind as we cast our ballots.
Let’s take COVID relief for instance. The federal government (taxpayer money) in March provided an extra $600 a week for those losing their jobs because of the coronavirus. That kept many, many families afloat as more than one million Arizonans lost their jobs. That also made a palpable difference in Arizona, which infamously claims the second-lowest unemployment payments in the country.
However, “leadership” in the U.S. Senate spent months blocking bills to extend that $600 weekly payment and let it expire at the end of July. But the demand to provide those out of work with more relief has not gone away. It has actually only grown as bills, rents and mortgages come due.
In addition, mayors across the state have been passionately asking for more funding to address budget shortages caused by the pandemic. Fewer people working means that local revenues shrink, which in turn means that school, public safety and public health are placed on the chopping block.
So, what did the president do, himself suffering from COVID? He pulled the plug on negotiations for additional relief. (Maybe he will replug and unplug several more times.) His top aide, Larry Kudlow, said that with so few weeks left on the calendar this year, our government (our taxpayer funds) should turn their attention to confirming a Supreme Court nominee instead. There is a history lesson here. In a not dissimilar situation, the revered Abraham Lincoln chose to postpone the nomination of a Supreme Court justice. The United States Senate should do the same and instead focus on constructing the relief package for the American people. Recent polling suggests that 74% of voters want (and need) more economic relief before even considering the Supreme Court’s future. Evidently President Lincoln’s leadership is a lesson unlearned by some of those we elect (and pay) to look out for the wellbeing of the USA citizenry.
Given the written comments and stance on the constitutionality of the Affordable Care Act (ACA) of the current nominee for the Supreme Court and the reality that the Supreme Court will hear arguments with respect to the ACA repeal lawsuit on November 10, just one week after Election
Day, I believe it is fair to say the timing and the best interest of America’s citizens are worthy of thoughtfulness. That thoughtfulness should be directed to the urgent need of We the People and not a political move which President Lincoln would have had us dismiss.
If it wasn’t for the late Sen. John McCain, the U.S. Senate would have succeeded in repealing the ACA and all of its protections three years ago. McCain knew what it meant to put the interests of constituents before the interests of party. We desperately need that kind of leader now. I remain hopeful.
Reginald “Reg” M. Ballantyne III is former chairman of the American Hospital Association and commissioner of the Joint Commission on Accreditation of Healthcare Organizations.
With the race to 2020 beginning to take shape, presidential candidates are crisscrossing the country, discussing and debating their ideas and policy recommendations, each looking to stand out from the pack by presenting their unique vision for the future of America.
It’s no surprise that health care continues to be one of the top issues for candidates and voters alike. The rising costs of health care here in Arizona and across the country is more than enough reason for it to be at the forefront of any presidential candidate’s platform. It’s most likely a concern for every Arizona family. However, in the dash to attract support, candidates should be careful not to propose policies that could have the unintended consequence of driving costs up or curtailing critical access to care.
Many of the calls to abandon the Affordable Care Act or move toward greater government control of our health care insurance system could do just that. Whether it is former Vice President Joe Biden’s inclusion of a “public option” in his health care proposal or the more extreme calls for Medicare-for-all or single-payer, voters and patient groups should read the fine print when it comes to changes to our current health care system and the impact this could have on Arizona’s patients, particularly those who have started to see an increase in access to care under the expansions and the Affordable Care Act sometimes called “Obama Care,” such as those with pre-existing conditions.
As someone who works with families in crisis after a serious accident, illness, or injury has disrupted life as “normal,” I would be interested in the details of how a shift toward a government-run health care insurance system would impact timely access to the variety of care and specialists Arizonans recovering from brain injury need. One of the most common brain injuries incurred by thousands of Arizona residents each year is a traumatic brain injury sustained in a motor vehicle crash. That injury alone can require a bevy of medical specialists and therapies if one is to enter into the realm of living well after brain injury. Physiatrists, neurologists, neuro-optimologist, and functional endocrinologist all are some of the specialties that enter into the survivor’s and caregiver’s lexicon. There can also be a variety of speech, language, occupational, and physical, therapies needed. While the system is far from perfect or fair, if we enact a government-run health care system, will survivors have the same access to these valuable experts who are so vital in aiding a patient’s recovery?
Whatever the name or moniker — Medicare-for-all, Medicare buy-in, a public option, or single-payer — increasing the government’s role in delivering health care might not be the preferred road to safeguard the leaps forward started by the ACA that have managed to survive the current administration. It’s crucial to make sure we don’t end up with a one-size-fits-all government insurance system that ultimately results in fewer options, diminished access for patients, and a lower quality of care for everyone.
Rather than potentially jeopardizing the quality of and access to care for those who are the most medically vulnerable, our leaders, or prospective leaders, should be focusing on making practical fixes to our current health care system in order to control costs and increase access. There are so many small changes that could make a big difference in the lives of those living with acquired brain injury – or any number of conditions and illnesses.
From expanding Medicaid in the states to increasing health care literacy, reprioritizing education and enrollment to expanding federal subsidies to help more Arizonans get covered – we need to work on expanding what’s working with the ACA and addressing what isn’t. This could be one of the keys to tackling the high cost of health care in our country while expanding access and coverage for more of those who need it. Democrats and Republicans alike should take note.
Carrie Collins-Fadell is the director of the Brain Injury Alliance of Arizona.
The political postcards began landing in swing district voters’ mailboxes nearly as soon as election administrators finished counting primary ballots.
“Arizonans are asking their elected officials to protect coverage for pre-existing conditions and make health care more affordable. But Rep. Blackman is doing the exact opposite,” one said.
“Kate Brophy McGee voted to give insurance companies the power to discriminate against people with pre-existing conditions like cancer or heart disease in Arizona,” another read.
“Anthony Kern can’t be trusted to protect our health,” a third proclaimed in all caps.
The mailers, and subsequent digital ads, are the work of liberal political action committees building on a nationwide 2018 campaign that saw Democrats take the U.S. House in large part because congressional Republicans voted to repeal the Affordable Care Act. Health care matters to voters, and the PACs spending hundreds of thousands of dollars in Arizona know that.
Claims that vulnerable Republicans voted to allow insurance companies to discriminate against people with pre-existing conditions surprised the targets of those claims, because they cite Republican votes on a new law to prohibit insurance companies from denying coverage to people with pre-existing conditions if the Supreme Court strikes down the Affordable Care Act.
The law passed with votes from 89 of the 90 lawmakers, including every legislative Democrat. And health care advocates concluded that it may not be particularly helpful because it didn’t include a group of interlocking protections in the Affordable Care Act that ensure people with pre-existing conditions are not charged more for insurance than others and that their insurance covers treatment for their pre-existing conditions.
But nothing in the new state law hurts people with pre-existing conditions, health care advocates and legislative Democrats who ultimately voted for it decided.
“It’s not doing any harm, but it’s not doing any good,” Will Humble, executive director of the Arizona Public Health Association, concluded in May.
Sen. J.D. Mesnard, R-Chandler, the author of the new law, described it as an attempt to preserve protections for the most vulnerable Arizonans, even as Attorney General Mark Brnovich and 19 other Republican attorneys general push to overturn the federal law that covers pre-existing conditions.
Now, a new digital ad in Mesnard’s district features a woman who describes herself as a military veteran and widow decrying Mesnard’s vote for the bill.
“Mesnard sold us out to the insurance companies, and now we’re in the middle of a pandemic. You’re a disgrace, J.D. Mesnard. A disgrace,” the narrator says into the camera at the end of the 30-second spot.
The digital spot was produced by Forward Majority Action, a liberal PAC that has spent more than $20,000 to attack Mesnard and nearly that much to produce ads supporting his opponent, Ajlan Kurdoglu.
“I’ve never seen such blatant fabrication of votes,” Mesnard said during a debate this week. “I know politics is a dirty business to some, but it is just a lie to say I oppose covering pre-existing conditions. I ran the bill to do it.”
Forward Majority Action is also behind a mailer targeting Sen. Kate Brophy McGee, R-Phoenix, for her vote on the same law. Brophy McGee described it as a ridiculous attack.
Not only is the new state law meant to protect people with pre-existing conditions, Brophy McGee said, it’s moot because the Affordable Care Act is still in effect — and she personally traveled to Washington, D.C., three years ago to lobby then-Sen. John McCain to keep it that way.
McCain’s now-iconic thumbs down vote that blocked an Obamacare repeal followed a meeting with Brophy McGee and a group of Arizona health care providers and business leaders who urged him to maintain the existing federal law.
“Do you remember that ‘no’ vote? I remember that ‘no’ vote,” Brophy McGee said. “So it’s like, excuse me? You’re entitled to your own opinion but not your own set of facts.”
Forward Majority Action stands behind its attack ads and doesn’t see any issues with attacking incumbent Republicans for a vote legislative Democrats also took, communications director Ben Wexler-Waite said.
The new law is significant, Wexler-Waite said, because it comes on the heels of a 2019 law to allow consumers to use short-term insurance policies designed as a way to fill an uninsured gap between jobs or as a bridge between retiring and aging into Medicare for up to 36 months. Those short-term policies, derided as “junk insurance” by critics, are cheaper than regular insurance and cover very little compared to full insurance plans provided by workplaces or sold on the individual marketplace.
Only one Democrat, Sen. Sean Bowie of Phoenix, voted for the 2019 law.
“Arizona Republicans have made this a legislative issue through both their junk insurance bill and this other sham bill that they passed this year,” Wexler-Waite said. “It’s a total sham. They’re saying that they’re protecting people with pre-existing conditions but this bill leaves people with pre-existing conditions exposed to tens of thousands of dollars in medical bills if they need treatment.”
Health care advocates and the Attorney General’s Office disagree on whether this year’s pre-existing condition law would expose patients with pre-existing conditions to price-gouging by insurance companies. The law was written to take effect only if the U.S. Supreme Court overturns the Affordable Care Act.
Oral arguments before the U.S. Supreme Court are scheduled for November 10, one week after the election.
Gov. Doug Ducey officially kicked off his re-election campaign last week, offering up a series of campaign promises in the process.
At a recent campaign event in Tempe, the Republican incumbent promised to increase K-12 education funding above inflation and drive up teacher pay. Ducey also promised to expand career and technical education options and pass his school safety plan to prevent school shootings.
He also pledged to expand law enforcement efforts at the border by instituting 24-hour, seven-day-a-week police coverage in all border counties and promised to reduce recidivism rates by providing more addiction and mental health treatment for inmates.
The governor hasn’t succeeded in cutting income tax rates down to zero, let alone cutting income taxes at all. And some of his other campaign promises may as well have asterisks next to them. But Ducey clearly delivered on some of his other pledges.
He managed to cut taxes every year of his governorship — one of his biggest campaign pledges from four years ago. Another of the major tenets of Ducey’s first gubernatorial campaign was to grow Arizona’s economy by reducing unemployment and increasing the number of jobs in the state. By most measures, he has delivered.
Since Ducey first took office, Arizona’s unemployment rate has dropped from 7.3 percent down to 4.9 percent this spring — the lowest it has been in a decade, according to data from the Bureau of Labor Statistics. Employment jumped from 2.8 million to 3.2 million during the same time period. Of course, when Ducey took office, Arizona was still reeling from economic aftershocks caused by the Great Recession.
“When I entered office, our state was still struggling from the aftermath of the Great Recession,” Ducey said at a recent campaign event. “Leaders before me had made tough decisions to manage through historic economic difficulties. … Today, I’m proud to report that Arizona is on the rise.”
Meanwhile, Ducey’s primary opponent — former Secretary of State Ken Bennett — is already hitting the governor on his record. Bennett’s campaign sent out an email this week highlighting “Ducey’s Broken Campaign Promises” and saying the the governor raised taxes, did nothing to secure the border and caved to the “Red for Ed” movement.
Take what Bennett is saying with a grain of salt because he has proven that he will do whatever it takes to get elected, said Ducey spokesman Patrick Ptak.
In responding to this story, Ptak pointed to a 10-pronged pledge Ducey signed onto during his 2014 campaign as a more accurate measuring tool for whether or not Ducey fulfilled his campaign promises. In Ducey’s “pledge to the people of Arizona,” Ducey promised to defend citizens’ 2nd Amendment rights, the right to life and pledged to appoint conservative judges and support civil-justice reform legislation to end frivolous lawsuits, among other campaign promises mentioned in this story.
Here’s a glance at some of Ducey’s major campaign promises from 2014, and what he has done on those issues since he stepped off the campaign trail and into the governor’s office:
Ducey has always aimed to lower the state’s individual and corporate income tax rates “as close to zero as possible,” but he hasn’t succeeded in that goal. In the meantime, the governor has whittled away at the state’s taxes, making small cuts each year that he’s been in office — upholding a different campaign pledge.
Lowering Arizona’s individual and corporate income tax rates may well have been one of Ducey’s loftiest self-imposed goals. Even in 2014, Ducey said that reducing the income rate would require two terms, a growing economy and a shrinking government.
When he was asked about the unfulfilled campaign promise at the end of the legislative session, Ducey said Arizona faced a $1 billion budget deficit when he took office. Now that Arizona has its finances in order, the state can look toward some sort of tax reform, he said.
During his time in the executive office, Ducey has chipped away at Arizona’s taxes, but never made a major dent. Ducey entered office in January 2015 facing a massive budget crisis that tied his hands when it came to major movement, or even moderate moves on tax cuts, but he still managed to pass legislation to index the state’s tax rates eliminating what Ducey called a “hidden tax increase” that returned tens of millions back to taxpayers.
The following year, Ducey passed legislation that increased the amount of depreciation Arizonans can claim on new property, something they can deduct from their state taxes. He also pushed through a budget deal that carved out $18 million for minor tax reductions proposed by lawmakers.
In the latter half of his term, Ducey passed a personal income tax exemption for inflation. This year, he pushed through a tax cut for veterans, though he did have to pare back his original proposal in order to free up more money for teacher pay raises.
During his first term, Ducey boosted K-12 education funding, but per-pupil spending has not rebounded to pre-Recession funding levels.
Last year, Ducey signed into law an expansion of Arizona’s Empowerment Scholarship Account program — school vouchers thatallow students to use taxpayer dollars for private school tuition.
Ducey’s actions angered David Garcia — a former Democraticcandidate for Superintendent of Public Instruction — to the point that he jumped into the governor’s race. The expansion also spurred the creation of Save Our Schools Arizona — a grassroots movement opposed to school-voucher expansion that is taking the fight to voters in the form of a ballot measure.
In 2016, Ducey fulfilled his campaign pledge to “fully fund the wait lists” at the state’s top-performing charter schools. Ducey pushed through legislation to create the Public School Credit Enhancement Program, which is intended to give A-rated schools more favorable interest rates when borrowing money to expand their facilities. The program is largely seen as a boon for charter schools.
Ducey has boosted K-12 education funding since taking office, but he got off to a rough start in the first year of his term. Ducey pushed a “Classrooms First” agenda that critics called misleading because they argued Ducey’s budget only funded schools enough to meet growth and inflation.
Ducey and Republican leaders cut about $117 million in non-classroom spending in the 2016 fiscal year budget, but touted K-12 spending increases elsewhere in the budget. The catch, though, was that the spending increases were legally required because the state has to meet a certain level of per-pupil funding.
State education spending has jumped from $4.4 billion in 2014 to $5.3 billion this year, which is also up from the $5.12 billion the state spent on K-12 aide in the 2007-2008 pre-recession school year.
The most recent figures do not account for the hefty teacher pay raises Ducey promised that will go into effect in the next fiscal year and the two years following.
No new taxes
There are some grays areas on whether or not Ducey held true to his vow not to increase taxes.
This legislative session, Ducey extended the Proposition 301 sales tax for K-12 education funding. The 0.6-cent sales tax will renew in 2021 and last until 2041. Some have argued, extending the sales tax amounts to a tax increase — something the governor’s office and Ducey’s campaign staff have adamantly refused.
This was meant as a generational funding stream for education, said Ptak, Ducey’s campaign spokesman.
“The idea that this is a tax increase, when it goes into effect in two years, will anybody’s taxes actually go up?” he said.
Extending the tax required a two-thirds vote of the state Legislature — a requirement of any increase in state revenues. A majority of Republican lawmakers joined all Democrats in both chambers to overwhelmingly approve the bill.
“This is a funding program, and we’re going to continue a funding program,” Ducey said last year.
Ducey also signed a bill this session to create a new car registration fee that will cost all motorists approximately $18 per year. Some legislative Republicans cried foul, calling the move a tax increase in disguise because lawmakers will not set the exact rates. That will be set by the director of ADOT. Per an Arizona Supreme Court ruling, agency-raised fees are not subject to a two-thirds vote in the Legislature. Ducey argues the new vehicle-registration fee does not count as a tax.
“A fee is a fee, a tax is a tax,” he saidwhen reporters asked about the new fee earlier this year.
Ducey promised to cut unnecessary regulations upon entering office, and the governor’s first executive order was a moratorium on any new regulations. The governor has renewed the moratorium every year since.
One of Ducey’s common talking points in speeches is that he pledged to cut 500 regulations by the end of 2017. Then he gleefully reveals that he exceeded expectations and cut more than 600 regulations, with the total number being 676 last year.
The governor’s office claims the cuts saved Arizona businesses more than $48 million. Among the axed regulations are obsolete rules on lottery installment payments, several fees that hadn’t been charged by the Department of Environmental Quality in years and Arizona Department of Transportation rules that failed to differentiate between taxis and ride-sharing vehicles like Uber and Lyft.
But when Ducey talks about regulations as of late, his critics tend to bring up Uber’s autonomous vehicle testing program, which the company shuttered in Arizona after one of their vehicles hit and killed a pedestrian in Tempe.
Ducey didn’t cut regulations for the technology company, but he signed an executive order in 2015 aimed at luring Uber to test its technology in Arizona. Once Uber shifted its operations from California to Arizona, the company’s autonomous vehicle testing program operated with little-to-no oversight, while Ducey touted a win over California and its “burdensome regulations.
Affordable Care Act
Ducey has remained steadfast in his opposition to the Affordable Care Act, which critics refer to as “Obamacare.”
Last year, Ducey, after some hesitation, gave U.S. Sen. John McCain the go-ahead to oppose the so-called “skinny repeal” of the Affordable Care Act. But despite getting Ducey’s permission to pass the bill, McCain cast a decisive vote against the repeal-and-replace plan.
The day before the vote, Ducey tweeted “the bill on the table clearly isn’t the right approach for Arizona,” but the next day, Ducey granted Arizona’s two U.S. senators permission to vote for the bill, with the hope that the “skinny” legislation would be ironed out in conference committee.
Ducey’s major concern throughout the process had been whether Arizona would be penalized for expanding Medicaid under the Affordable Care Act, meaning the state could potentially be on the line for millions more in health care costs.
Months later, Ducey also expressed his support for the repeal plan presented by U.S. Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., that would turn to a block grant system to give money back to the states for them to maintain their own health care structures. At the time, Ducey acknowledged the overhaul bill was not a total fix, but it was a start to ending President Barack Obama’s signature health care policy.
McCain also opposed the Graham-Cassidy repeal-and-replace plan, which may have been a blessing in disguise for Ducey as a JLBC analysis projected Arizona would lose more than $10 billion in health care funding from 2020-2026 if the bill had passed.
I recently wrote to U.S. Sen. Martha McSally to express disappointment over her October 30 vote to allow insurance companies to sell “junk” health plans that don’t cover pre-existing conditions. While I appreciated McSally replying to similar criticism, her response was filled with a number of mischaracterizations and outright falsehoods about the Affordable Care Act and her own record on health care.
In her reply, McSally said that “there is no doubt” that the Affordable Care Act has negatively impacted Arizona’s economy and the rights of individuals. That’s simply not true. In fact, the ACA has saved the U.S. economy $2.3 trillion. This year, Arizonans can choose among more plans than ever before.
McSally has said she supports protections for those with pre-existing conditions and allowing children to stay on their parents’ insurance until age 26. But thanks to the ACA, those protections already exist, and now that she’s voted to allow insurers to sell junk health plans, those protections are threatened once again.
She said that “having an illness should not be a ticket to bankruptcy.” I couldn’t agree more. That’s why I was so disappointed by her vote to let insurers sell junk plans that don’t offer basic protections, including coverage for those with pre-existing conditions.
Lastly, McSally said that health care plans “must not discriminate against women.” Again, I agree, but I’m not sure McSally is updated on her own voting record. Before the ACA, pregnancy was considered a pre-existing condition, which allowed insurance companies to charge mothers more.
Sen. McSally, please stop misleading Arizonans about your health care record.
Democrats from across the country are uniting around a new legislative proposal, “Medicare for All.” This Obamacare 2.0 reboot would in fact cripple and bankrupt our underfunded Medicare system, while denying crucial benefits for our seniors who have paid into it during their entire working lives.
Our seniors depend upon their Medicare benefits. Adding millions of new, younger recipients to the Medicare rolls would destabilize the underfunded health care system designed specifically for our seniors, and threaten the very coverage long promised to them. Many Americans, without the financial means, would be forced to pay higher taxes for such a massive, multi-trillion-dollar government boondoggle.
I am not an economist, but I have read the estimates of what this single-payer proposal would cost our taxpayers. For example, this government takeover of your health care could increase the proposed 2020 federal budget of $4.76 trillion to $7.96 trillion, and cost an additional $32 trillion over the next decade. This equates to massive increases in taxpayer debt, where U.S. unfunded liabilities currently exceed $123.7 trillion, which includes $30.3 trillion for Medicare’s share. Currently, the U.S. national debt and unfunded liabilities combined exceeds $1,181,000 per taxpayer.
About 181 million Americans receive health insurance through their employer’s plans, and about 70 percent of these individuals report that they are happy with their current coverage. Once again, Democrats are selling you a rose-colored fairytale about what their health care proposal will actually cost and how it will negatively impact our nation.
Just seven years ago, while selling the Affordable Care Act, or Obamacare, President Obama and the Democrats repeatedly told us that you could keep your plan and keep your doctor, and that “your premiums will go down” (Obama speech, July 2012). House Speaker Nancy Pelosi told us: “We have to pass the bill so that you can find out what is in it.” However, few in Congress ever bothered to read the entire 2,300-page Affordable Care Act, and as of September 2016, it has now grown by approximately 16,000 additional pages of regulations. In addition to its many unfulfilled promises, most Americans now pay more for unaffordable health care under Obamacare.
It’s perfectly clear that “Medicare for All” is grossly unaffordable, unsustainable and ultimately just another name for the socialists’ goal of single-payer government-controlled health care. The United States can ill afford to adopt a broken, European style health care system with prohibitive costs, prolonged delays for basic services, care rationing and denial of services for elderly patients.
After all the broken promises of fixing the U.S. health care system with Obamacare, can we afford to believe the Democrats once again, who now want to muddle with our health care system a second time in less than a decade? Just like other ineffective, bloated government programs, “Medicare for All” is actually quality health care for none.
Rep. Bob Thorpe, R-Flagstaff, has been a member of the Arizona House of Representatives since 2013. He is chairman of the Federalism, Property Rights and Public Policy Committee.
It should come as no surprise that I am not a proponent of the Affordable Care Act. It created a forced marketplace that failed to address affordability, and, at its inception, it set up a system that was doomed to fail. The current state of the ACA leaves Arizona with limited choices, and some areas in the state are seeing no coverage at all. While Obamacare has been a marketplace failure, repeal and replace does present an opportunity to consider innovative ways to provide health insurance for Arizonans.
Our state has already enabled innovative care models, such as Direct Primary Care practices and Health Care Sharing Ministries. By lifting the regulatory burdens that create barriers to health care choice, these models have met the needs of thousands in Arizona, and the number of participants is growing annually.
Arizona has also empowered consumers to compare the cost of services through our price transparency protocols. Patients can now save hundreds or even thousands of dollars by being savvy shoppers. Consumers have the potential to significantly change the competitive landscape. States that promote “Right to Shop” bills, combined with online, price-transparency tools, can revolutionize the market. We need to lead by example and think outside the box to find ways to cover more people than Obamacare has. Waiting for the federal government to act is not a viable option if we want change soon.
When it comes to Medicaid, the threat of lower federal match rates is always a concern from a budgetary perspective. Expansion states face the difficult reality of raising taxes or cutting services when funds are cut and costs are shifted stateside. Arizona is confronted with a double challenge if the tax mechanism used to fund the expansion population is ruled unconstitutional. We need to be very careful when we go down the path of partnering with the federal government. They may not always be fiscally reliable, and lives are at stake. I have never been comfortable with this arrangement for that reason. The pending renewal of the CHIP program is another prime example.
American innovation thrives on the ability to control our own health care. Unless the ACA is repealed, that freedom remains out of reach for many. Nevertheless, more state flexibility is possible under these circumstances, and states should act on those opportunities.
— Sen. Nancy Barto, a Republican, represents District 15 in Phoenix.
Arizona missed its own deadline to send a waiver to the federal government asking for work requirements for able-bodied adults on the state’s Medicaid program.
A state law passed in 2015 requires the Arizona Health Care Cost Containment System to file a waiver with the Centers for Medicare and Medicaid Services by March 30 of each year.
But, despite getting plenty of public comment on the plan, Arizona still hasn’t sent in the waiver request.
AHCCCS and Gov. Doug Ducey’s office say the national health care limbo, with daily changes to potential Affordable Care Act repeal-and-replace plans and a new, friendlier administration, led to a delay in the waiver process.
The 2015 law says the state must ask the federal government to allow AHCCCS to require all able-bodied adults to be working or seeking work, and verify their compliance with that requirement each month.
The waiver would also kick someone off AHCCCS if they didn’t report a change in their income or falsely reported compliance with work requirements.
There could also be a lifetime limit on AHCCCS of five years for able-bodied adults, with some exceptions.
More than 1.6 million Arizonans get care through AHCCCS.
AHCCCS held public forums throughout the state in January and required public comments to be submitted by March 29. Public comments from organizations and individuals roundly panned the work requirement and lifetime limit, saying it would cut thousands off from care.
CMS, under the Obama administration, rejected the work requirements and time limit last year, saying they could deny care to those in need.
But CMS allowed the state to start charging a small monthly premium to those on Medicaid who are above the poverty line, which would go into health savings accounts.
AHCCCS spokeswoman Heidi Capriotti said the state hasn’t finalized its waiver submission yet partly because of the changeover in the president’s office.
Seema Verna, the head of CMS, helped craft a Medicaid expansion plan in Kentucky that included a work requirement, and many expect work requirements to have a better reception under President Trump than they did under Obama.
Tom Price, the secretary of the U.S Department of Health and Human Services, has “indicated his commitment to providing governors with greater flexibility on how they use Medicaid resources,” Capriotti said.
AHCCCS is working with Ducey’s office on different options to include in the waiver, including those required by the 2015 law. The ultimate waiver submission will include options that are “fiscally responsible and in the best interest of the health care needs of Arizonans,” Capriotti said.
Daniel Scarpinato, Ducey’s spokesman, said the state has been following the health care debate in Congress closely as it relates to state flexibility, and the waiver will likely be submitted later this year.
He said the Ducey administration also wants to thoughtfully look at the public comments that were submitted on the potential waiver.
There could be changes to the forthcoming waiver as the Affordable Care Act repeal-and-replace plan gets ironed out, Scarpinato said.
“Our view is we want to make sure a waiver request has the best chance of being considered and being granted,” he said.
This year, with a new administration in the White House and constant talks about ACA repeal-and-replace, means the state is “maybe in a unique situation you wouldn’t have in another year” with respect to asking for changes to its health care system, Scarpinato said.
Arizona House Speaker J.D. Mesnard said he wasn’t too concerned that the AHCCCS waiver for able-bodied adults wasn’t sent to the feds on time.
Since the Trump administration is friendlier to the Republican-controlled Arizona government than Obama, Mesnard said he was “a little less anxious” about what could happen if the waiver wasn’t filed by the March 30 deadline.
While Mesnard said he hasn’t spoken with the Governor’s Office about the waiver issue, he said he would defer to the executive branch’s best judgment.
Congress is still stuck at an impasse on the Better Care Reconciliation Act, and it’s not clear if that bill, an amended version, or another one entirely will pass.
“There’s so many unknowns and unanswered questions,” which make the waiver process more difficult, Mesnard said.
Before the Affordable Care Act (ACA) took effect, I personally experienced discrimination in the individual health insurance market and struggled to get coverage for a pre-existing condition. So when an email from Rep. David Schweikert bearing the subject line, “Myth vs. Fact on Healthcare” landed in my inbox, I opened it with a healthy dose of skepticism.
Schweikert writes, “Attempting to stay well-informed on healthcare policy given the volume of information can be a full-time job in itself.”
Yes, my skepticism was well founded. But to fully appreciate the irony here, we need to travel back in time.
May 4, 2017: the U.S. House of Representatives is poised for a vote on the American Health Care Act. A last-minute scramble to secure additional votes has resulted in changes to the bill that haven’t yet been scored by the Congressional Budget Office. So lawmakers will cast their votes without knowing if the bill would insure more people or provide more affordable coverage. But for the first time since the Affordable Care Act was passed in 2010, Republicans now have a lock on the legislative and executive branches of government – and their dreams of obliterating the ACA won’t wait. As then-Rep. Martha McSally famously says, “Let’s get this f*cking thing done”.
Meanwhile, Schweikert takes to the House floor and begins a slightly less salty speech, surrounded by his usual assortment of charts and graphs:
“Since 1986…we in the United States have statutes that say if a sick person walks into a hospital, they have cancer, they’re bleeding, they’re going to get health services. …there’s no such thing as not receiving care in this country. It may not be the care you want at the place you want, but it’s the law and it’s been the law for 30 years.”
Now, the Emergency Medical Treatment and Labor Act does require hospitals with an emergency room to screen all patients and to stabilize those with an identified “emergency medical condition” before transferring them. But this doesn’t mean that people like me can show up in the ER and get free lab tests, a free endocrinologist appointment, free prescription medication, or free surgery.
Someone who was serious about his full-time job of staying well-informed on health care policy would have known that. Which brings me back to the present – and Schweikert’s email.
“I want to set the record straight: I support protecting individuals with pre-existing conditions.”
What follows can only be described as AHCA fan fiction, cherry-picking the bill’s meager protections – while failing to mention that the law would have been a devastating setback for people like me who live with pre-existing conditions. But don’t take it from me.
Take it from the American Medical Association: “We are deeply concerned that the AHCA would result in millions of Americans losing their current health insurance coverage.”
Take it from the American Psychological Association: “…we oppose the American Health Care Act due to the adverse impact it will have on Americans with mental health, behavioral and substance use disorders.”
Take it from a coalition of patient advocacy groups, including the American Heart Association, March of Dimes, and Cystic Fibrosis Foundation: “Weakening protections in favor of high-risk pools would…undermine the ban on discrimination based on health status.”
And take it from the final CBO analysis, which was released on May 24 (almost three weeks after Republicans pushed the AHCA through the House on a party-line vote) and predicted that the law would reduce coverage and increase prices in the individual market, with over 23 million more Americans uninsured by 2026.
If Republicans had cared in 2017 about providing a robust set of protections for people with pre-existing conditions, they would have met with key constituencies before drafting the AHCA. They would have incorporated key policy components like Community Rating, Cost Sharing, Essential Health Benefits, and bans on annual and lifetime caps. They would have kept the ACA’s 3:1 age band. They would have done better research on the historical performance of high risk pools.
And if Republicans care today about protecting people like me, they’ll put the brakes on the lawsuit that currently threatens to dismantle the ACA with no backup plan. I’m not optimistic.
I am optimistic, though, about the November election. Arizona’s 6th Congressional District has an opportunity to ditch the “free care in the ER” guy and elect a representative who’s actually worked in an ER: Dr. Hiral Tipirneni. While Schweikert wants to rewrite history about a piece of legislation that was universally rejected by patients, doctors, and hospitals, Dr. Tipirneni understands the challenges in our health care system and wants to build on the ACA with a public option.
When it comes to health care, most Americans want essentially the same thing – lower costs, better quality, and improved access for those who need it most. While it suffered from some bumps in the road during its implementation and rollout, the Affordable Care Act has done a decent job at expanding coverage to an additional 20 million Americans who did not previously have access to care while protecting patients with pre-existing conditions.
The ACA may not be perfect, but with the right policies, we can make it stronger and more effective. However, instead of rolling up their sleeves and working to improve our current health care system, some legislators in Washington seem more preoccupied with building an entirely new one from scratch. At least that’s how it would seem given the introduction of yet another public option health care proposal in Congress.
Introduced by Senators Michael Bennet, D-Colo., and Tim Kaine, D-Va., the Medicare-X Choice Act would have an enormous impact on America’s health care landscape — just not necessarily the kind the senators would like to see. If passed, it would introduce a public option to compete with private and employer-sponsored health care plans. As well-intentioned as their proposal may be, the result would unfortunately be higher taxes on working Americans and reduced access to care in vulnerable communities.
According to a study released in February, a government-controlled health insurance system like the public option could place a significant financial burden on working families here in Arizona and across the country during an economic crisis, forcing them to pay an additional $2,833 in taxes annually by 2050. This – at a time when hardworking Arizonans and Americans nationwide are barely getting by – is quite frankly a non-starter.
As if that weren’t enough, the consequences of a public option could be devastating for our health care community. As it stands, America’s hospitals are already struggling just to keep their doors open in the wake of the pandemic, nationwide physician and health care worker shortages, and increased rates of provider consolidation. A separate report details how a public option could increase revenue losses at America’s hospitals and health care providers by up to 60%, hindering their ability to respond to the current pandemic and prepare for future health care crises.
Sadly, the facilities that would be hurt the most by these cuts are the same ones that need our support the most, including hospitals, clinics, and other health care providers serving our many rural, hard-to-reach communities where access and affordability already act as high barriers to care. Rural hospitals in Arizona and throughout the country are operating on razor-thin margins as it is.
In order to improve upon our current health care system, we must continue to build on what is working today and fix what’s broken. That sentiment is shared by two-thirds of voters compared to 40% who support imposing a Medicare for All system. This should be a clear sign for lawmakers in Washington pushing the Medicare-X Choice Act of 2021 that they need to reverse course and work together to improve the health care system we have today rather than trying to build a new one from scratch.
Our senators and representatives in Washington, D.C., should focus on practical solutions to improve upon our current health care system, not experiment with one-size-fits-all government systems that fail to address rising costs while threatening the very institutions we rely on to keep our communities safe and healthy. These kinds of proposals will only result in higher taxes, longer waiting times, and reduced access for hard-working Americans.
Let’s focus on lowering costs and improving access by building on what’s working in our current health care system and continuing to fix what isn’t. Ultimately, we are all in this together and it will take all of us working together to find the right solutions to America’s health care problems.
Patrick Montroy is an elected representative of the International Association of Sheet Metal, Air, Rail, and Transportation Workers’ Local 359.
Hoping to remind voters of her foe’s history, Republican senatorial contender Martha McSally said Monday that Kyrsten Sinema, her Democratic foe, is guilty of supporting “treason.”
Near the end of the hour-long debate on KAET, McSally brought up a radio interview Sinema did in 2003 during her anti-war days. Asked if it was OK to fight for the Taliban, she said “fine, I don’t care if you want to go do that.”
Much of the campaign against Sinema has been focused on who she was more than a decade ago, including her opposition to war in the Middle East. McSally hopes to convince voters that Sinema, who since being elected to Congress in 2012, is not the moderate that she proclaims.
After the debate, Sinema brushed aside the questions of what she said years ago.
“Martha’s chosen to run a campaign that’s based on smears and attacks and that’s her choice,” she said. And what happened in the past, Sinema said, is history.
“Over time I think it makes sense for individuals who are willing to learn and to grow,” she said.
But Sinema wasn’t the only one on the defensive as the pair, in a virtual dead heat to replace retiring U.S. Sen. Flake, each sought to score points with the perhaps 10 percent of Arizonans who say they are undecided.
Sinema accused McSally of being an “apologist” for anything that the GOP – and Donald Trump in particular – want. And McSally was defensive about questions about her views on President Trump and her open support of him this year, versus her refusal to endorse him two years ago.
“Nothing’s changed,” she said.
McSally, first elected to represent Congressional District 2 in Southern Arizona in 2014, said she was focused on representing her district.
“But he’s in office,” she said. And that, McSally said, means she needs to work with him, as she said she did to preserve the A-10 attack aircraft that the Obama administration had tried to scrap.
She was a little less straightforward when asked if she was proud of Trump.
“I am proud to be working with him to provide more opportunities and to make sure we keep our country safe,” McSally said.
And she made it clear that she backs much of what the president has done.
“He’s a disrupter,” McSally said of Trump. “He went to D.C. to shake things up and he’s doing that.”
It is that attitude, she said, that has led to him make major strides like trying to remove nuclear weapons from the Korean peninsula and updating old trade policies.
But Sinema said the flip side has been a trade war.
“That is devastating for Arizona’s businesses and for our agricultural community,” she said.
And the effects, Sinema said, trickle down to everyone else. She cited the increase on tariffs on aluminum, something that will make cans more expensive.
“That’s something we all can agree on: Beer should not be more expensive,” she said.
McSally defended her votes to scrap the Affordable Care Act even as she conceded that the law she voted to repeal has made insurance available to some who did not have it before.
“We cannot go back to where we were before,” she said. But McSally said the program, known as Obamacare, just does not work as constructed and is financially unaffordable.
That, however, still leaves the hot-button question of what would happen to those now enrolled.
While the program has proven controversial, there is widespread support for a key provision: a requirement for insurance companies to provide coverage irrespective of preexisting medical conditions. Sinema charged that the GOP efforts to repeal the law would have once again left those people without insurance.
McSally said that while she wanted to scrap the Affordable Care Act she supports such a requirement. The problem, she said, is that “Obamacare was the wrong approach.”
Sinema, however, said the alternatives offered by McSally and Republicans would return the country “to the time when people couldn’t afford health insurance.”
“The solutions Martha has voted for actually make the system worse and hurt Arizonans,” Sinema said.
The issue of abortion underlined one of the stark differences between the candidates.
Sinema said that issue should be strictly between a woman and her doctor. McSally defined herself as “pro-life.”
But McSally sidestepped the question of whether she wants the U.S. Supreme Court to overturn the historic 1973 Roe v. Wade decision that legalized the right of women to terminate a pregnancy.
“I would support appointing justices that are looking independently at the Constitution and the laws that we make,” McSally said.
McSally also gave a full-throated endorsement to the decision of President Trump to nominate Brett Kavanaugh to the Supreme Court and the Senate vote to confirm him.
“He is highly qualified and he has shown I think what we need to be looking at in judges and justices, which is that they’re not going to be activist but they’re actually going to interpret the Constitution and the laws that we make in Congress,” she said.
Sinema was less direct in her answer, calling the confirmation hearings “a circus” in which both political parties participated. And she questioned both his demeanor and whether he lied during the hearings, ultimately saying she would have voted against confirmation.
McSally, whose congressional district includes a large stretch of the international border, said Sinema, whose district covers parts of Phoenix and Tempe, does not understand the issue of security. McSally said this is not just about illegal immigration but also drug and human smuggling.
Sinema said she did support a $1.5 billion border security appropriation which included money for Trump’s border wall
“I’m fine with a physical barrier being part of a total solution she said. But Sinema said it also requires more than “an 18th century solution to a 21st century problem.”
The questions McSally raised about Sinema’s fitness were not limited to her anti-war activities.
She pointed out that Sinema had accepted $53,000 in donations from the owners of Backpage.com, a now-defunct web site that prosecutors say was a front for prostitution. Sinema eventually donated the money to charity.
And McSally also lashed out at Sinema for her days as a legislator when she worked to alter a bill about penalties for men who had sex with underage girls to put in a requirement that the “john” actually knew the girl was not of legal age.
In the midst of a global health crisis and approaching the most important election of our lifetime, voters look to Sen. Martha McSally’s reprehensible record on health care to make their decision.
Six weeks to live. This was the fate Jeff Jeans’ doctor prescribed to him while diagnosing the Sedona small-business man with a curable yet fatal throat cancer. Out of a job and uninsured, Jeans – a lifelong conservative Republican – relied on the Affordable Care Act (ACA) to access the health care services that saved his life. What Jeans quickly learned was that in life or death, no one is a Republican or a Democrat – we are all just people whose diagnoses should not mean a death sentence or bankruptcy and whose fundamental rights include access to health care.
Fast-forward to 2020, and Jeans took the stage at the Democratic National Convention to advocate for the ACA and one of its critical supporters, Joe Biden. Jeans’ riveting journey from one side of the political aisle to the other is deeply symbolic of how one’s livelihood supersedes political ideology. Moreover, Jeans’ experience highlights some of the issues that matter most to Arizonans.
Health care is a top priority for Arizona voters, especially in light of the COVID-19 pandemic that has highlighted its faults and cracks. As we approach November, health care is shaping up to be a defining issue in the race for U.S. Senate: for Sen. Martha McSally, the inability to escape her record on health care was the nail in the coffin for her 2018 failed campaign against Sen. Kyrsten Sinema. As much as McSally attempts to invoke the same tactic on voters again this year, her voting record will do all the talking for her.
There are three fundamental truths at play. The simple truth is that McSally has done everything in her power while in office to undermine and destroy health care coverage, particularly for those with pre-existing medical conditions like Jeff Jeans. The gut-wrenching truth is that if McSally, who repeatedly voted to repeal the ACA during her terms in the House of Representatives, had gotten the “f–king thing done” – a phrase she used in 2017 to encourage her GOP colleagues to join her on the vote – there is a very real possibility that Jeans would not be alive today to tell his story. The promising truth is that Arizonans deserve better than a comically transparent phony politician attempting to backtrack on a continuous and deliberate effort that could have cost them their lives – and are fired up to vote this November.
At NextGen Arizona, the organization leading the largest youth vote mobilization in the state, we hear from thousands of voters each week expressing that health care is a driving force for them casting their ballots this year. With the pandemic ravaging through our Republican-led state, posting record numbers of hospitalizations and deaths and leaving thousands without jobs and uninsured, a system without the ACA is unimaginable. We are talking to countless Republicans, much like Jeff Jeans, who are reckoning their ideologies with their livelihoods. Many of these voters are now feeling the failures of our leadership very deeply and personally, no longer blissfully detached from the grievances gone unaccounted for in a pre-COVID world.
With the nation’s eyes on us in less than three months, we are reminded that Arizona is on the brink of palpable change. In an election where voting could literally mean life or death, and we have the power to vote against the same people who attempt to destroy our health and livelihoods, let’s get this f–king thing done.
Kristi Johnston is the Arizona press secretary for NextGen America.
A federal judge in Texas (Judge Reed O’Connor) dealt a blow to the Affordable Care Act in December when he ruled in Texas v. Azar that the ACA is unconstitutional in its entirety, including the implementation of market reforms (e.g. protections for folks with pre-existing conditions), the health insurance marketplaces, and the expansion of Medicaid.
Fortunately, he didn’t issue an injunction ordering the administration to stop implementing the law – so the ACA will remain the law of the land for now.
Back in February, 20 states (including Arizona) filed the lawsuit seeking to invalidate the three legs of the ACA stool: pre-existing condition exclusions, community rating, and guaranteed issue.
The ACA prevents health insurance companies from: 1) denying someone health insurance because they have a pre-existing condition – called the “guaranteed issue” requirement; 2) refusing to cover services that people need to treat a pre-existing condition – called “pre-existing condition exclusions”; and 3) charging a higher premium based on a person’s health status – called the “community rating” provision.
The U.S. Department of Justice isn’t defending the ACA because they agree with the plaintiff states. In fact, the Justice Department has urged the court to strike down the law. Luckily, several states including California are defending the law.
The plaintiffs (including Arizona) argue that since the new federal tax reform law removed the financial penalty for not having health insurance, the ACA is now unconstitutional.
So, Will the Supreme Court Uphold the ACA Again?
The December ruling isn’t the last word. The case will certainly be appealed in the federal appellate court system and then to the U.S. Supreme Court, which has a different cast of characters than it did when the ACA was originally upheld back in 2012 by a 5-4 vote.
Since then, Justice Gorsuch replaced Justice Scalia and Justice Kavanaugh replaced Justice Kennedy. Both Scalia and Kennedy voted against the ACA – so presumably not much on that score has changed.
Chief Justice Roberts voted with the majority that upheld the law. His argument rested on the ACA’s link to the financial penalties for not having health insurance. But remember, the financial penalties for not having health insurance were removed from the IRS tax codes in last year’s federal tax overhaul, pulling out the structure that Roberts used in his argument.
In the 2012 ruling, Justice Roberts wrote that: “… the Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax… because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
Roberts rejected the Obama Administration’s argument that the federal government’s authority to regulate interstate commerce provides the authority needed for the ACA to be constitutional (the court struck down that argument 5-4).
The bottom line is that the ACA, including its protections for folks with pre-existing conditions, may very well be in jeopardy if Chief Justice Roberts views the ACA as fundamentally different now that the financial penalties for not having health insurance are gone.
What Happens in Arizona if the ACA Goes Away and How Can We Prepare?
It’s easy to see how the ACA could end up being struck down in a couple of years once this case gets to the highest court. Gone would be the health insurance market reforms like protection for folks with pre-existing conditions, community rating pricing and guarantee issue as well as Medicaid expansion and the health insurance marketplaces.
Fortunately, Arizona is partially in control of our own destiny if the ACA is struck down. We couldn’t do much about Medicaid rolling back to pre-ACA levels or the loss of subsidies on the marketplace, but we could have some control over the market reforms like pre-existing condition exclusions, community pricing, and guarantee issue.
Several states already have their own laws that incorporate some or all the ACA insurance market protections. Arizona could do the same.
The good news is that we have time before the Texas v. Azar case makes it to the Supreme Court. A reasonable first step would be for the governor to ask the Arizona Department of Insurance, the Arizona Department of Health Services and AHCCCS to generate (or commission) a report outlining the real-life impact in Arizona in the event that the Texas v. Azar suit is ultimately successful. The report would also put forward options for state-based health insurance market reform laws that could be enacted to require things like prohibiting pre-existing condition exclusions.
Such a report would give the Arizona Legislature an analysis with which to evaluate public policy options for state-based market reforms.
I know what you’re thinking: It’s impossible to pass these kinds of market reforms in Arizona. Maybe, but many thought Arizona’s expansion of our Medicaid system back in 2013 was impossible.
That case study shows that with the right kind of leadership on the Ninth Floor, anything is possible.
— Will Humble is the executive director of the Arizona Public Health Association and former director of the Arizona Department of Health Services.
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