The state House finally seems ready to grapple with reality.
No telling how it’s going to come out — but at least they’re grappling.
The House on Monday started budget hearings after months of delay and deadlock, mostly centered on whether to accept about $1.6 billion annually from the federal government to add between 300,000 and 400,000 residents to the Arizona Health Care Cost Containment System.
House Speaker Andrew Tobin had refused to even assign the bundle of budget bills to committee since back in January, when Gov. Jan Brewer proposed the AHCCCS expansion. She tried to address reasonable fears the federal government would run out of money and leave the states holding the fiscal bag for the added patients by putting in a provision that would drop the added people if the federal share ever goes below 85 percent — which is still much higher a share than the federal government pays for the existing AHCCCS population. She even won the backing of most of the state’s hospitals for a bed tax that would cover any state costs associated with the expansion. The hospitals fully realize that providing insurance for 32 million of the 50 million Americans without coverage will sharply reduce their uncompensated care burden.
AHCCCS already covers about 30 percent of Gila County residents — and 20 percent of all Arizona residents.
The people added to the AHCCCS rolls would include the impoverished childless adults Arizona voters themselves have twice voted to make eligible for the program as well as women and children making up to 133 percent of a poverty-level wage.
Rep. Brenda Barton, who represents Rim Country, has raised understandable questions about the long-term impact of adding so many new patients to the AHCCCS rolls. AHCCCS continues to consume an ever-larger share of the state budget. AHCCCS has done better than most Medicaid programs at controlling costs and providing service, but it suffers along with Medicare and private insurance plans in the face of the relentless rise in the cost of medical care.
Rep. Bob Thorpe (R-Flagstaff) has also expressed doubts about the value of the expansion, but so far has not offered much detail about his concerns — or his vote.
The United States now spends about 20 percent of the world’s largest economy on a patchwork system that costs two or three times as much per person as almost any other industrialized country. Despite the enormous expenditures, we have a shorter life expectancy, a higher infant death rate and lower rates of childhood immunization than many other industrialized countries. Studies have shown that a distressing number of our high-tech interventions like colonoscopies, MRIs and heart stents not only cost far more per procedure than anywhere else — but are often applied so recklessly that they do more harm than good.
To bolster her qualms about supporting Gov. Brewer’s proposal, Rep. Barton points to a very interesting study in the New England Journal of Medicine that found surprisingly limited benefits in treating chronic conditions like high blood pressure when Oregon expanded its Medicaid program. She raised good points about the cost benefits of our ruinously expensive medical system.
On the other hand, a study in Arizona found that a small, but significant decrease in the death rate among patients added to AHCCCS under the terms of a voter-approved initiative. National studies estimate that 45,000 Americans die prematurely each year for lack of medical insurance — a terrible number we should treat as a national crisis.
Critics have raised good questions about the details of the complex overhaul of the system embodied in the Affordable Care Act, which would foot the bill for the expansion of AHCCCS. But few of those critics have proposed any morally defensible alternative to letting those 45,000 people die each year — year in and year out.
Certainly, the reforms won’t solve the underlying problem of cost. The few cost-control elements in the legislation don’t seem likely to have a big impact. We wish that the critics would stop staging pointless votes to repeal and instead seek bipartisan solutions to repair the grave defects in our medical system. If we don’t do something about the costs, the bill for medical care will bankrupt both the state and federal governments — and betray the generational contract of Medicare.
In the meantime, we hope that enough House Republicans will join with the Democrats to adopt Gov. Brewer’s budget — with the AHCCCS expansion included.
Time to vote. Time to face reality.