After dramatic vote, McCain returns to Arizona for treatment

This June 3, 2016, file photo shows Sen. John McCain, R-Ariz., delivering a speech in Singapore. (AP Photo/Wong Maye-E, File)
This June 3, 2016, file photo shows Sen. John McCain, R-Ariz., delivering a speech in Singapore. (AP Photo/Wong Maye-E, File)

After casting the deciding vote that derailed Republicans’ seven-year quest to repeal the Affordable Care Act, U.S. Sen. John McCain is headed to Arizona to resume treatment following his diagnosis of an aggressive form of brain cancer.

McCain will be treated at Mayo Clinic, and on Monday will begin a post-surgical regimen of radiation and chemotherapy, his office said.

During that time, his office said, McCain will maintain a work schedule, and he plans to return to Washington after the August recess.

Following a surgery to remove a blood clot from above his left eye and the diagnosis of brain cancer, McCain left for Washington, D.C. to initially vote for advancing debate on a proposal to repeal Obamacare.

But he also admonished his colleagues and delivered a stinging rebuke of the hyper-partisanship that has engulfed Congress. He also made clear that he would not support any of the proposals to repeal Obamacare without substantial changes.

Last night (early morning in D.C.), McCain joined U.S. Sens. Susan Collins of Maine and Lisa Murkowski of Alaska in voting against “Skinny Repeal,” which sought to undo the mandate to Americans to buy insurance and to business to provide medical coverage to their workers. With Democrats unified in their opposition, the three Republicans’ vote sank the legislation.

McCain said Obamacare should be repealed and replaced with a plan that increases competition, lowers costs and improves care, but the repeal legislation would not accomplish those goals.

Its failure, he said in a news release, provides Congress a “fresh start” and the opportunity to craft bipartisan health care legislation.

“It is now time to return to regular order with input from all of our members – Republicans and Democrats – and bring a bill to the floor of the Senate for amendment and debate,” he said.

Brnovich, Contreras debate on cases AG has taken

From left are Attorney General Mark Brnovich, debate host Ted Simons of KAET, and Democratic AG candidate January Contreras. Brnovich and Contreras squared off in a televised debate Oct. 10, 2018. (Capitol Media Services photo by Howard Fischer)
From left are Attorney General Mark Brnovich, debate host Ted Simons of KAET, and Democratic AG candidate January Contreras. Brnovich and Contreras squared off in a televised debate Oct. 10, 2018. (Capitol Media Services photo by Howard Fischer)

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.”

Christina Corieri: Childhood musical sparks life of public policy

Christina Corieri (Photo by Jenna Miller/Arizona Capitol Times)
Christina Corieri (Photo by Jenna Miller/Arizona Capitol Times)

Christina Corieri can pinpoint precisely the moment she became interested in politics.

She was a first grader when she reluctantly had to forgo a viewing of “Sleeping Beauty” because her parents made her watch “1776,” a musical about the Declaration of Independence.

“I was fascinated by these discussions of liberty and independence and freedom for self-determination. I’d never heard of John Adams or Thomas Jefferson before, and I insisted the next day that we go to the bookstore and I get the presidential encyclopedias for children,” she said.

Now, as a senior policy adviser to Gov. Doug Ducey, Corieri crafts ideas into public policy in the state’s highest office.

Cap Times Q&AYou advise the governor on health care policy. Ducey came out in favor of a couple repeal-and-replace options despite a lot of criticism of the plans themselves from various groups. Why support plans like that?

I think the governor has been very clear since day one that he didn’t agree with Obamacare. And everybody who is weighing in often is based on an interest that they have, but also not looking at the bill in full, which is what we were trying to do. We recognize that Medicaid has – the costs at the federal level have grown exponentially. If you look at the costs from 2000 to now, it’s increased about threefold. That’s not something that’s sustainable. We recognize that. But we wanted to be part of the discussion to make sure reforms were ones that would work here, and bringing some of the positive things that we’re doing (in Arizona) to other states. … I think a lot of the concern from people here was largely around Medicaid. We felt that was something that we could work with. But we were also looking at the people that have lost their insurance, the people that have faced narrow networks, and the people who’ve really largely been locked out of the market and getting some relief to them.

One thing repeatedly mentioned by this office is not pulling the rug out from underneath people on health care. What kind of policy would ensure this?

If you had a bill, for instance, that said it’s going to end Medicaid expansion on January 1, 2018, 2019, no transition, nowhere for these folks to go, that would be, quite literally, pulling the rug out from under someone. They had coverage, and the next day they don’t. That wasn’t what we were looking at doing, and that wasn’t what any of these plans the governor endorsed did. Graham-Cassidy allowed states to continue coverage, it just changed the funding mechanism behind it, and that’s why we were supportive of it.

What do you say to families who are waiting in the balance here as these health care changes are being discussed?

I understand anxiety that families have on both sides. We hear from people who are concerned about losing their coverage and we hear from people who can’t afford coverage. It’s a difficult situation for all of them.

Before you joined the administration, when you were at the Goldwater Institute, you were a vocal critic of Medicaid expansion. How do you feel about it now?

Well, I was, that’s no surprise to anyone. I think that might have made a few people nervous when I came here, though I will say I always tried to be respectful and never take it to the personal level that I think some other folks did. When I was at Goldwater, my opposition was to expanding a welfare benefit program. I think it is a different conversation when you’re talking about rolling back an existing one. So Medicaid expansion was passed in Arizona, it was signed by Governor Brewer, it is a fact on the ground, and we have a few hundred thousand people that are on it. We are not seeking to remove coverage from people. That’s a very different story. That’s not to say that there aren’t reforms that should be looked at and that we are looking at, but we’re not looking at yanking coverage.

You were the chief of staff to Sal DiCiccio, who is in the minority party on the Phoenix City Council. Now you’re working in the majority. What’s the difference in how you approach the job?

I can’t speak to the Legislature, I never worked in the Legislature. But it’s difficult when you’re at the City Council, you know that there’s minimal chances for getting something passed. … It was fun because in addition to learning policy, you got to learn a little about communications and how to get your message out in a way that citizens will understand, so I enjoyed that.

You have a law degree from Arizona State. Are you a lawyer?

I’m not a practicing lawyer. I always wanted to go to law school, but I really wanted to do policy instead of law. I think it gives you a great background in how to write better laws, how to look at the bills that are coming up and understand the effects and maybe where people would challenge it.

You describe yourself on Twitter as a foodie, and your family has some restaurants in the Valley. What food would you make for the governor?

I would make my family’s tortellini. My grandparents, my nonna and papa, are Italian. My nonna started teaching all of her granddaughters how to make tortellini en brodo when we were very little. She would make this veal and mortadella filling and then you wrap them around to make the tortellinis. … And then we make a really rich stock that’s a chicken broth infused with beef marrow bones and parmesan cheese rinds. And you strain all that out and cook the tortellini in it and eat it as a soup. We make it for all the holidays. It is the favorite food of everybody in my family.

Ducey defends support of Graham-Cassidy


Gov. Doug Ducey is defending his support for the latest bid to repeal the Affordable Care Act even though he has no idea how much federal aid that would cost the state and how many Arizonans would lose health care.

“The numbers are important,” the governor said Wednesday. Ducey said his staff is analyzing the elements of the Graham-Cassidy bill on the Arizona Health Care Cost Containment System, the state’s Medicaid program, which U.S. Senate Republican leaders are trying to get voted on before the end of the month.

But the governor said he remains convinced that what comes next will be better than what exists now, even without yet knowing the effect on the state and its residents.

“Obamacare is a failure,” he said. “It’s time for it to go.”

Yet Ducey sidestepped a question of whether he could guarantee that none of the 400,000 people who have been added to the rolls of the state’s Medicaid program because of the Affordable Care Act would again find themselves without health insurance.

“Well, I haven’t seen the final bill,” the governor said of the legislation he has endorsed. Anyway, Ducey said he believes the measure will provide Arizona with “the longest possible transition so that we can move people from Medicaid into a superior insurance product.”

He did not say what that would be.

Ducey also acknowledged that the proposal by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would financially penalize states like Arizona, which expanded Medicaid eligibility long before there was an Affordable Care Act. That’s the result of voter approval in 2000 of Proposition 204 which guaranteed care for everyone up to the federal poverty level at a time when Medicaid eligibility was far less.

In fact, the governor cited a similar provision in earlier bills in a letter to Arizona Sen. John McCain as one of the “critical changes” that needed to be made to those now-failed attempts to make them acceptable.

“I don’t want a bill that is going to penalize Arizona,” Ducey said Wednesday despite what is in the current version of the measure. But the governor said he believes that even if Graham-Cassidy does become law and the penalty is in it, it won’t be the end of the discussion.

“It will take this bill and more to do and get our health care system in the right shape,” the governor said.

That’s assuming Senate Majority Leader Mitch McConnell can line up the votes, particularly that of McCain whose opposition to the earlier “skinny repeal” helped to doom that measure.

As of Wednesday the state’s senior senator was still undecided. But he repeated his statement that he wants the issue considered in “regular order,” meaning full-blown hearings and the opportunity for amendment.

That’s not what McConnell is considering, with the latest proposal being a single hearing in the Homeland Security Committee and a Sept. 30 deadline for action.

Ducey’s strong and early support of the new federal legislation puts him at odds with some of his Republican colleagues.

In a letter Tuesday, Kasich of Ohio, Charles Baker of Massachusetts, Phil Scott of Vermont and Brian Sandoval of Nevada all urged McConnell to scrap the plan and instead support “bipartisan efforts to make health care more available and affordable for all Americans.”

All are from states that several studies have shown will be, like Arizona, financial losers under the Graham-Cassidy plan.

One study from the Center for Budget and Policy Priorities puts the annual loss to Arizona at $1.6 billion by 2026.

“The estimates you are referring to right now come from a left-wing or left-leaning organization that has a real stake in maintaining the status quo,” Ducey responded.

A separate report from Avalere Health which does consulting for the health care industry has cumulative losses between 2020 and 2026 at $11 billion. At least part of that is because the federal block grants to states would grow at a set rate rather than based on the number of people who enroll.

And after 2026, all the block grant dollars would go away.

For Ducey, however, the touchstone is getting rid of the Affordable Care Act.

“If anything, I think the deciding issue of the last eight years in terms of elections has been Obamacare,” the governor said. “It’s time for it to go.”

Ducey said he wants a bill to give states “maximum flexibility,” not only for Medicaid but also in the private insurance market. And he sniffed at the idea that what’s being proposed will result in fewer dollars from Washington, even as reducing federal expenditures has been one of the key goals of all of the proposals to undo the Affordable Care Act.

“There is no federal money,” Ducey said.

“All of the money is our money that is sent to Washington, D.C. and then comes back to us in a lower figure,” he said. “Somewhere there must be some overhead.”

But Ducey provided no specifics on how Arizona will be able provide care to as many people who are in the Medicaid program now with fewer federal dollars. In essence, the governor said he’s just convinced it would be better and more efficient.

“We know how to do things in the state of Arizona,” he said, noting that AHCCCS and its system of prepaid care on a per-capita basis has been cited by many as superior to fee-for-service Medicaid programs in other states.

Ducey also took a slap of sorts at the Arizona Hospital and Healthcare Association and its national affiliate, both of who have come out against the Graham-Cassidy plan. He said what’s in place now “you can’t even call it a health care system.”

“A system actually delivers a product or service,” the governor said. “This is a system that begins in Washington. D.C. and then it takes care of the insurance providers, the pharmaceutical companies and the hospital organizations before it runs over the doctors and leaves the patients with an insurance card the health care system won’t accept.”

In a statement Tuesday, Greg Vidor, president of the Arizona group said the plan “falls short” on the goal of quality and affordable care.

“This proposal erodes critical protections for patients and consumers, and would lead to costlier premiums for many individuals, especially those with preexisting conditions,” he said in a prepared statement. “Millions would lose coverage altogether.”

Ducey says he still supports health care bill

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.”

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Ducey: Immediate health care fix more important than ‘procedure’


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.

Sen. John McCain, R-Arizona (Photo by Claire Caulfield/Cronkite News)
Sen. John McCain, R-Arizona (Photo by Claire Caulfield/Cronkite News)

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.




Group tries to dodge fine for campaign finance law violation


A group that spent $260,000 attacking a 2014 foe of Doug Ducey in his first gubernatorial race is trying again to escape paying a fine for violating state campaign finance laws.

Attorneys for the Legacy Foundation Action Fund contend that the Citizens Clean Elections Commission lacked the power to impose a $96,000 fine for the commercials targeting former Mesa Mayor Scott Smith. They say there was no proof that the ad was done to advance the political fortunes of anyone else in the Republican gubernatorial primary.

Beyond that, the lawyers contend that the commission lacks the authority to enforce the campaign finance laws.

Christopher Whitten
Christopher Whitten

So far that argument has not held water. Maricopa County Superior Court Judge Christopher Whitten ruled in August that the lawyers for the fund were misreading the law.

Now the fund is seeking intervention by the state Court of Appeals.

This is actually the second time the Legacy Foundation Action Fund has challenged the ability of the commission to police campaign funding. An earlier claim was thrown out by the Arizona Supreme Court after the justices ruled that the fund waited too long to appeal the fine.

But in that ruling, Justice Clint Bolick said the group was free to pursue other, unspecified legal challenges. That led to the current litigation.

The case stems from a commercial that ran in early 2014 when Smith was pursuing the Republican gubernatorial nomination.

Produced by the Legacy Foundation Action Fund, it noted that Smith, who was mayor of Mesa, also was president of the U.S. Conference of Mayors. More to the point, it focused on some of the stands the conference had taken.

“They fully endorsed Obamacare from the start,” the commercial said. And it said the conference supported the Obama administration’s efforts to regulate carbon emissions and “backed the president’s proposal to limit our Second Amendment rights.”

On the screen were photos of Smith placed next to pictures of a smiling Obama.

Jason Torchinsky, one of the attorneys for the fund, argued there was nothing improper about the commercial.

More to the point, he said it was not designed to influence the election but simply to educate Arizonans about Smith. Torchinsky noted that the ad made no reference to Smith’s race against Ducey nor even to Smith’s status as a candidate.

The Clean Elections Commission, however, concluded otherwise, ruling that its true purpose was to affect the GOP gubernatorial primary. And what that meant, the commission concluded, was that the Legacy Foundation Action Fund, by virtue of attempting to influence an election, was required to publicly disclose the spending, which it did not.

That failure led to the $96,000 penalty – a penalty that the commission is still trying to get paid.

Now attorneys for the Legacy Foundation Action Fund are raising new arguments about why it was never required to disclose the spending and, by extension, why it doesn’t have to pay the fine.

Some of this is a rehash of the original arguments.

Attorney Brian Bergin argues that the commission, in concluding the purpose of the commercial was to affect the 2014 GOP primary, ignored the plain language of what viewers saw.

“The Arizona advertisement discusses issues: government spending, Second Amendment rights, and the regulation of carbon emissions,” Bergin wrote, while telling viewers the policies “are wrong for Mesa” and urging them to call Smith “and tell him to support policies that are good for Mesa.”

Tom Collins
Tom Collins

But Tom Collins, the commission’s executive director, said that ignores other facts.

He pointed out that the positions taken by the mayors’ organization – the ones that Legacy Foundation said it was educating Mesa voters about – all were taken before Smith became president of the group.

And then there was the fact that by the time the commercials aired Smith was no longer its president. But he was running for governor.

“Taken together, allegations (about Smith) that were not correct, the timing of the ad and other factors, there’s really no way to see the ad as anything other than what it is: an attack ad designed to urge folks to vote against Mayor Smith for the Republican gubernatorial nomination in 2014 because he was ‘Obama’s favorite mayor,’ ” Collins said.

And Whitten said he was legally bound to accept the commission’s findings about the purpose of the commercial.

Bergin also says there’s a key flaw in the commission’s case against his client. He contends that the commission is required to identify the candidate that the commercial was made “by or on behalf of.”

“Legacy is certainly not a candidate and was not working “on behalf of” any candidate,” Bergin said.

Whitten, in the ruling now being appealed, did acknowledge that the commission never identified on whose behalf Legacy was spending the money. But he said there’s no such requirement in the law.

“The statute does not explicitly demand names,” the judge wrote.

The trial judge also rebuffed Bergin’s contention that only the secretary of state has the power to enforce campaign laws and not the commission, which was created by voters in 1998.

“The purpose of the CCEC is to ensure that election laws are enforced without favoritism by partisan officials,” Whitten wrote.

No date has been set for the Court of Appeals to hear the case.

Lawmakers, AG look to keep pre-existing condition coverage if Obamacare voided


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.”

Let’s expand what’s working with ACA, address what’s not


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.

Carrie Collins Fadell
Carrie Collins Fadell

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.    

Look back: Did Ducey deliver on major tenets of his 2014 campaign?

Gov. Doug Ducey (Photo by Katie Campbell/Arizona Capitol Times)
Gov. Doug Ducey (Photo by Katie Campbell/Arizona Capitol Times)

Editor’s note: This story has been updated. 

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.

But what happened to the slew of assurances on the campaign trail four years ago? He pledged to improve the state’s economy, reduce income tax rates, cut taxes, fight the Affordable Care Act and swore not to allow any new taxes.

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:

Income taxesIncome taxes

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.

In his 2014 campaign, Ducey promised to veto any budget that cut education spending and vowed to expand school choice.

Last year, Ducey signed into law an expansion of Arizona’s Empowerment Scholarship Account program — school vouchers that allow students to use taxpayer dollars for private school tuition.

Ducey’s actions angered David Garcia — a former Democratic candidate 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.

But per-pupil spending dropped from $4,949 to 4,760 during the same time frame, according to Joint Legislative Budget Committee figures. When accounting for inflation, the current per-pupil spending is $4,157.

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 taxesNo 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.

In 2012, Ducey led the opposition to a 1-cent tax extension that would have permanently boosted the state sales tax rate to 6.6 percent. At the time, Ducey labeled the tax extension as a tax increase. But when he took to defending the Prop 301 extension, Ducey billed it as something other than a straightforward tax increase.

“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 said when 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 ActAffordable 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.


Medicare for all is actually quality health care for none


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.

Bob Thorpe
Bob Thorpe

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.

Repeal and replace offers way out of ACA’s limited choices


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.

Sen. Nancy Barto
Sen. Nancy Barto

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.


The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

Sen. Collins’ opposition kills GOP health care drive

The last-gasp Republican drive to tear down President Barack Obama’s health care law essentially died Monday as Maine Sen. Susan Collins joined a small but decisive cluster of GOP senators in opposing the push.

The Maine moderate said in a statement that the legislation would make “devastating” cuts in the Medicaid program for poor and disabled people, drive up premiums for millions and weaken protections Obama’s law gives people with pre-existing medical conditions.

Collins told reporters that she made her decision despite receiving a phone call from President Donald Trump, who’s been futilely trying to press unhappy GOP senators to back the measure.

She said the legislation is “deeply flawed,” despite several changes its sponsors have made in an effort to round up support.

The collapse of the legislation marks a replay of the embarrassing loss Trump and party leaders suffered in July, when the Senate rejected three attempts to pass legislation erasing the 2010 statute. The GOP has made promises to scrap the law a high-profile campaign vow for years.

With their narrow 52-48 majority and solid Democratic opposition, three GOP “no” votes would doom the bill. GOP Sens. John McCain of Arizona, Rand Paul of Kentucky and Texas’ Ted Cruz have said they oppose the measure, though Cruz aides said he was seeking changes that would let him vote yes.

The only way Republicans could revive the bill would be to change opposing senators’ minds, something they’ve been trying unsuccessfully to do for months.

The Senate must vote this week for Republicans to have any chance of prevailing with their narrow margin. Next Sunday, protections expire against a Democratic filibuster, bill-killing delays that Republicans lack the votes to overcome.

It was unclear if Senate Majority Leader Mitch McConnell, R-Ky., would have a roll call if he knew it would lose.

Collins announced her decision shortly after the nonpartisan Congressional Budget Office said “millions” of Americans would lose coverage under the bill and projected it would impose $1 trillion in Medicaid cuts through 2026.

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State misses waiver deadline for able-bodied adults on Medicaid

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.

Gov. Doug Ducey
Gov. Doug Ducey (Photo by Katie Campbell/Arizona Capitol Times)

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.

House Speaker J.D. Mesnard (R-Chandler)
House Speaker J.D. Mesnard (R-Chandler)

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.

Treason, Trump, Obamacare at issue in Sinema, McSally debate

Martha McSally and Kyrsten Sinema face off Oct. 15, 2018, in their only debate for U.S. Senate (Capitol Media Services photo by Howard Fischer)
Martha McSally and Kyrsten Sinema face off Oct. 15, 2018, in their only debate for U.S. Senate (Capitol Media Services photo by Howard Fischer)

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.

“I’m not making this stuff up,” McSally said.

Trump lashes out at long, predictable list of foes in Phoenix rally

Anti-Trump protesters chant behind a barricade across the Phoenix Convention Center, where President Donald Trump is holding a rally, on August 22, 2017. (Ellen O'Brien, Arizona Capitol Times)
Anti-Trump protesters chant behind a barricade across the Phoenix Convention Center, where President Donald Trump is holding a rally, on August 22, 2017. (Ellen O’Brien, Arizona Capitol Times)

President Donald Trump disparaged the media, Democrats, Americans who want Confederate monuments taken down, “weak leaders,” his White House predecessor and a long list of other opponents at a rally in Phoenix tonight.

Trump always found large, energetic audiences when he campaigned in Arizona, and his supporters inside the Phoenix Convention Center tonight were no different.

Outside, protesters spoke out against Trump’s policies and a potential pardon of former Maricopa County Sheriff Joe Arpaio, which the president hinted is coming. Phoenix Police used tear gas to disperse protesters after the rally ended.

In a wide-ranging speech, Trump keyed in on several issues affecting Arizona. Here’s what you need to know about how his visit intersected with state politics:

**Arpaio pardon coming?**

Much of the speculation about today’s rally centered on a pardon for Arpaio, who was convicted of contempt of court for defying a court order related to his anti-immigrant policies.

Trump didn’t pardon Arpaio tonight, but hinted a pardon is coming soon.

In this Jan. 26, 2016, photo, Republican presidential candidate Donald Trump is joined by Maricopa County, Ariz., Sheriff Joe Arpaio at a campaign event in Marshalltown, Iowa. (AP Photo/Mary Altaffer, File)
In this Jan. 26, 2016, photo, then Republican presidential candidate Donald Trump is joined by then Maricopa County, Ariz., Sheriff Joe Arpaio at a campaign event in Marshalltown, Iowa. (AP Photo/Mary Altaffer)

“Do the people in this room like Sheriff Joe?” Trump asked the crowd, who responded with sustained cheering.

Trump said Arpaio was convicted for doing his job, and he should have been tried by a jury, something Arpaio’s lawyers also argued for.

“I’ll make a prediction,” Trump said. “I think he’s going to be just fine.”

But Trump said he didn’t want to pardon Arpaio tonight because he didn’t want to cause any controversy.

**McCain and Flake**

Though the president never mentioned either of Arizona’s U.S. senators by name, he went after them. He said aides had asked him not to name any names in his speech tonight, so he decided not to, which he called “very presidential.”

Trump repeatedly said the country was “just one vote away” from repealing and replacing the Affordable Care Act, a clear swipe at Sen. John McCain, who was the deciding vote against a “skinny repeal” plan a few weeks ago and whose opposition halted the repeal-and-replace effort for now.

Trump urged Arizonans to “speak to your senator,” meaning McCain, about health care. Trump also said he would repeal Obamacare even if he has to shut down the federal government.

He didn’t say Sen. Jeff Flake’s name either, but noted that Arizona’s other senator was “weak on borders,” eliciting boos from the crowd.

Plus, Trump added about Flake, “nobody knows who the hell he is.”

**No endorsement**

Sen. Jeff Flake, R-Ariz., left and Sen. John McCain, R-Ariz. (AP Photo/The Arizona Republic, Tom Tingle)
Sen. Jeff Flake, R-Ariz., left and Sen. John McCain, R-Ariz. (AP Photo/The Arizona Republic, Tom Tingle)

Despite his digs at Flake, Trump didn’t endorse or even mention anyone who is or could run against the incumbent in a Republican primary.

Some had speculated that a Trump tweet from last week praising Kelli Ward, the former state senator who is running against Flake, could mean a presidential endorsement today.

People entering the Phoenix Convention Center said they weren’t allowed to bring in Ward signs or wear Ward shirts, though some people standing in line had Ward campaign paraphernalia.

One man recounted how he had to borrow a shirt from a random person in line after he wasn’t allowed in because he wore a Ward t-shirt.

Former Arizona GOP chairman Robert Graham and Arizona Treasurer Jeff DeWit have been floated as potential Flake opponents who Trump could back, but they, too, remained unmentioned tonight.

**Where was Ducey?**

Gov. Doug Ducey (Photo by Katie Campbell, Arizona Capitol Times)
Gov. Doug Ducey (Photo by Katie Campbell, Arizona Capitol Times)

Gov. Doug Ducey met Trump and Vice President Mike Pence on the tarmac at Phoenix Sky Harbor Airport this afternoon, but he did not attend the rally.

Instead, Ducey spent the evening at the Emergency Operations Center, where state law enforcers worked to keep the downtown area safe for the large, tense event.

During the rally, Trump said he thought it was a good idea that Ducey decided to spend his time on security, though, the president joked, not that many protesters had shown up anyway. (Many protesters showed up and later clashed with the police.)

Trump said Ducey was a “hell of a governor.”


Arizona’s business and political leaders have for months emphasized how the North American Free Trade Agreement positively affects the state’s economy. But their efforts may not have worked, at least with the president.

Trump said the United States has been “badly taken advantage of,” largely by Mexico, through NAFTA, and he would “probably end up terminating” the trade deal. (Actually, negotiators from Canada, U.S. and Mexico this month began sifting through the decades-old trade deal.)

Trump told the crowd he had promised them from the beginning that NAFTA would be renegotiated or terminated.

“I personally don’t think you can make a deal without terminating it, but we’ll see. You’re in good hands,” he said.

**Arizona regulars**

As was the case during Trump’s campaign rallies, DeWit, who was also the chief operating officer of Trump’s campaign, kicked off tonight’s rally.

Arizona Treasurer Jeff DeWit

DeWit highlighted the stock market’s rise and new jobs added, and said Obamacare will hopefully be done for soon if Congress gets its act together.

“We elected our president to go and drain the swamp, and drain the swamp he’s doing,” DeWit said.

Trump also acknowledged and thanked Republican Reps. Andy Biggs, Trent Franks and Paul Gosar, who attended the rally tonight.

Democratic Rep. Raul Grijalva, meanwhile, led a peaceful anti-Trump protest in Phoenix before the rally began.

Once Trump took the stage, he praised Arizonans, saying they were “hardworking, American patriots,” and said the state has been on his side since he held his first rally here.

“You were there from the start, you’ve been there ever since, and I will never forget. Believe me, Arizona, I will never forget,” Trump said.