Gov. Jan Brewer proposed a state budget back in January.
The state Senate approved a modestly trimmed version of that budget two weeks ago.
And the state House finally held hearings on Monday on House Speaker Andy Tobin’s version of a state budget, after a detour to debate two side issues.
The first issue involves whether to expand
eligibility for the Arizona Health Care Cost Containment System.
The second hot-button issue involves whether to allow the state to conduct warrantless, surprise inspections of abortion clinics, a measure the 9th U.S. Circuit Court of Appeals has essentially already barred.
Last week, Speaker Tobin finally relented and said he would allow the House to consider a budget proposal. He had previously refused to schedule hearings on either Gov.
Brewer’s budget or the Senate budget because both included a provision to accept federal money to add an estimated 300,000 residents to the AHCCCS rolls.
Tobin finally relented just weeks ahead of the constitutional deadline for adopting a budget, even though supporters of the AHCCCS expansion say they have the 31 votes they need to approve the expansion on the floor. Observers expected hearings last week.
Rim Country’s representatives in the House have both said they have grave questions about the wisdom of expanding AHCCCS coverage. They fear the federal government will renege on covering almost all of the costs of the expansion — and worry that putting more people in the program will only accelerate the already rapid growth in the cost of the program.
House Rep. Brenda Barton (R-Payson) last week said she still hasn’t decided how to vote on the proposed expansion, but worries the state will end up shouldering greater costs when the feds run out of money.
“Can’t we address health care for those in need without creating a bloated program that may break the fiscal back of our state?” she said in an e-mail. “That’s what I want — health care that meets the needs of those in need, but doesn’t become another federal fiasco that balloons out of control.”
She also cited a May 22 study published in the New England Journal of Medicine that looked at the medical records of 6,387 people added to Oregon’s Medicaid program in 2008. The study found that receiving coverage from the Oregon version of AHCCCS increased the odds patients would be diagnosed with diabetes, but did little or nothing when it came to diagnosis of heart disease risk factors or their use of medicine to treat conditions like high blood pressure — often cited as a major advantage of providing medical insurance. However, coverage did increase the use of preventative services, lower rates of depression and almost eliminated “catastrophic, out-of-pocket medical expenditures,” the chief cause of bankruptcy in this country.
Rep. Bob Thorpe (R-Flagstaff) did not respond to requests for comment.
The budget Tobin and the Republican House leadership proposed totaled about $8.8 billion, a $289 million increase over the current year, but still $46 million less than the Senate budget and $129 million less than Gov. Brewer’s budget. All three budgets feature an increase in the reserve funds, despite expiration of a $1 billion boost in the sales tax.
The proposed House budget would not include the controversial expansion of AHCCCS eligibility, which would add childless adults living in poverty and raise the income threshold for women and children. The federal government has offered to pay the full cost of adding those groups to the AHCCCS rolls — at least initially. Advocates have said the expansion would inject into the state’s economy about $1.6 billion annually and reduce deaths due to lack of medical treatment. At least 20 percent of Arizonans lack medical insurance, one of the nation’s highest rates.
The Grand Canyon Institute estimates the expansion will generate about 21,000 Arizona jobs. Voters have twice approved coverage for some of those groups, but the Legislature essentially revoked the referendums to deal with a huge state deficit two years ago. Most hospitals in the state have supported the expansion as a way to reduce the heavy toll of providing care for people without insurance, even though Gov. Brewer has proposed covering the state’s costs with a tax on hospitals.
The House budget would also include less money than the governor’s proposal for a variety of other programs. That includes $9 million less for child support services, $20 million less for computer upgrades for a statewide school rating and tracking system, $5 million less for universities and $4 million less for school facilities, according to a summary published last week in Capitol Times.
Gov. Brewer’s budget for the first time in three years avoided cuts in state support for K-12 schools and universities, with most of the new money earmarked for programs to help schools implement state mandates. That includes a requirement that schools to link teacher evaluations to student test scores, reward schools where test scores rise and penalize schools with low scores.
Attempts to restrict abortion and continued opposition to the expansion of AHCCCS dominated the first House budget hearings — six months into the start of the legislative sessions and just two weeks before a constitutional deadline for adopting a budget. Despite the lack of a state budget, the Payson Unified School District and Payson have had to comply with state budget deadlines that compelled them to reducing staffing without knowing how much money they will get from the state.
The House budget hearings took an unexpected lurch into a debate about whether the state should have the right to make unannounced inspections of medical facilities that perform abortion, the latest effort by the Legislature to regulate abortion providers.
The hearing Monday focused on a law that would seek to nullify the 2010 9th U.S. Circuit Court of Appeals ruling that a previous bill allowing warrantless searches of abortion providers violated constitutional guarantees of equal treatment embodied in the Fourth Amendment to the U.S. Constitution. State and federal law already allows unannounced inspections with an administrative warrant.
Arizona is also appealing to the 9th U.S. Circuit of Appeals another lower court ruling that the state Legislature couldn’t bar AHCCCS payment to Planned Parenthood for non-abortion services. The lower court ruled that such a prohibition was illegal because it infringed on patients’ rights to get services from the health care provider of their choice.
The Monday hearing also aired the objections to Gov. Brewer’s push to expand AHCCCS, as part of the federal Affordable Care Act. Gov. Brewer has pushed for the expansion, which would add 300,000 people to the AHCCCS rolls and prevent changes that would force the state to drop about 63,000 people now covered. The program covers about a third of Gila County residents, mostly single mothers and their children and nursing home residents.