Recently I have been asked by many for my thoughts on the governor’s Medicaid expansion proposal. This is a complex issue and there isn’t a simplistic or short form answer. It is my hope that your newspaper will print my thoughts to you without editorializing or editing because this is an extremely important decision and will have significant impacts on the lives of the residents of Arizona and Legislative District 6.
Until a week ago, any comments I could have made regarding the governor’s Medicaid expansion proposal would have been speculation, because the governor had not released her proposal.
A week ago, against a backdrop of white coats and hospital scrubs on the House lawn reminiscent of President Obama’s Affordable Care Act announcement, Governor Brewer announced her intention to expand Medicaid in Arizona. There are two required steps to the full implementation of what is termed “Obamacare” in Arizona; one is the full expansion of Medicaid and the other is the establishment of a health care insurance exchange. The governor has opted for a federally managed exchange.
Voters approved of Prop. 106 two years ago which essentially was a referendum against a federally imposed health care program. But now in 2013 the mood of the voters appears to have changed.
As of this report to you, I have not received a copy of the governor’s lengthy proposal; and as they say, the devil is in the details. As much as I would like to ensure the health care coverage of every resident of Arizona, there are some serious concerns with the governor’s current proposal and the program overall.
I understand that to raise the funds necessary to pay for Arizona’s portion of the Medicaid expansion, the governor in union with the state’s health care insurance lobby, has proposed what amounts to something akin to a hospital bed tax, much like funding tourism and the local chamber through a hotel bed tax.
Additionally, I have been advised by several members of Congress that the federal funds for the first year of the Medicaid expansion are no longer available, and funding for years two and three are in doubt. This should be of considerable concern to your readers; Arizona will enact a new tax to fund its share of this program while simultaneously the federal funds to cover the bulk of the funding may not be available.
This is in stark contrast to the $8 billion the governor is asserting Arizona will receive from the federal government. Is this simply more borrowing from overseas creditor nations? I honestly do not know the source of this federal windfall.
Another concern to your readers should be the fact that the state has identified about 400,000 persons who will be eligible initially for coverage under the Medicaid expansion. Here’s the rub however, this does not include those persons who will become eligible once their employers cease their employer assisted health care insurance and encourage their employees to apply for Medicaid. This also does not include our residents who are here without legal status; they too will qualify for the Medicaid expansion. It is easy to see that 400,000 can climb abruptly to over 600,000. The cost estimates for the Medicaid expansion are only calculated for a maximum of 400,000. There is no provision for funding the potential additional persons who may apply that are not currently factored into the present proposal by the governor.
Finally there is the federal phase out of support beginning in year three. The federal government has committed to paying for 100 percent of the Medicaid expansion for the first three years, but by 2016 will reduce their share by 5 percent and eventually the federal funds will cover only 90 percent. This will leave Arizona taxpayers to cover 10 percent of the health care costs for perhaps over half a million new Medicaid accounts.
As revenues are currently projected, our state budget choice may be simple: educate; incarcerate or medicate. I invite your readers to a community discussion of this issue and urge them to put aside simplistic partisan talking points and evaluate the hard evidence when deciding their thoughts on the governor’s Medicaid expansion. And, as your elected representative, please let me know what your thoughts are.
Let me leave you with one of the most used opening newspaper paragraphs for the week of March 11, 2013: “Some Americans could see their insurance bills double next year as the health care overhaul law expands coverage to millions of people. The nation’s big health insurers say they expect premiums — or the cost for insurance coverage — to rise from 20 to 100 percent for millions of people due to changes that will occur when key provisions of the Affordable Care Act roll out in January 2014.”