Gov. Jan Brewer’s effort to accept federal money to cover about 380,000 low-income Arizona residents has touched off a Civil War within Republican ranks, with normally ignored Democratic lawmakers standing by in bemusement.
The latest twist in the strange saga turns on efforts by some Republican lawmakers to add a provision to ensure the expanded, federally funded plans don’t provide money for abortion or any services offered by Planned Parenthood.
The developing controversy has plopped Gov. Brewer down in a swamp full of quandaries. If she inserts anti-abortion-family-planning provision to scrounge up the handful of Republican votes she needs, she may well start to lose votes from the otherwise solid Democratic block.
Republicans have big majorities in both the House and the Senate. However, Gov. Brewer has been counting on the support of all 24 House Democrats and the 13 Senate Democrats to enact the plan. If that support holds, she only needs seven Republicans in the House and three in the Senate to approve the measure.
The three members of Rim Country’s legislative delegation have all expressed opposition to the expansion at one time or another. That includes Rep. Brenda Barton (R-Payson), Rep. Bob Thorpe (R-Flagstaff) and Sen. Chester Crandell (R-Heber).
The standoff between Gov. Brewer and Republican legislative leaders on the Arizona Health Care Cost Containment System (AHCCCS) expansion has stalled the state budget, leaving schools, universities and a host of other state priorities in limbo.
Gov. Brewer proposed accepting 100 percent federal funding to expand eligibility for the AHCCCS up to 133 percent of the federal poverty level — that’s an income of about $15,000 for a family of four.
The expansion of state Medicaid programs with the new federal money accounts for a big chunk of the coverage expansion offered by the federal Affordable Care Act — reviled by conservatives as Obamacare. Expanding Medicaid would provide medical coverage for 15 million of the 32 million expected to gain coverage from the federal reforms.
Advocates say the expansion will sharply reduce the estimated 45,000 Americans who die prematurely each year because they don’t have medical insurance. Critics say that expanding coverage, fining business and individuals who don’t get insurance and adding to the AHCCCS rolls amounts to a government takeover of health care and will in the end only increase the cost of the world’s most expensive health care system.
About 30 percent of the residents of Gila County receive their health care through AHCCCS, which currently covers women and children with incomes below the poverty line and impoverished nursing home residents.
Gila County has one of the highest AHCCCS percentages in the state and one of the highest rates of people without any medical insurance.
Gov. Brewer maintains the expansion will inject about $2 billion annually into the state’s economy, protect rural hospitals struggling to cover the bills of the uninsured, keep state tax money from flowing to other states and actually boost the state budget.
Her plan would revoke the expansion if the federal matching share ever falls below 80 percent. She also has proposed a tax on the state’s hospitals to cover the state share of the cost of the expansion, reasoning that influx of federal money and sharp drop in the ranks of the uninsured will benefit hospitals. Most of the state’s hospitals have publicly supported the expansion — and the tax. The tax would produce an estimated $256 million annually, with $100 million going into the state’s general fund.
Still, State Senate President Andrew Biggs and House Speaker Andy Tobin have both opposed the governor’s plan. Many Republican county committees across the state have also passed resolutions of opposition — and in many cases vowed to find candidates to challenge in the Republican primaries any incumbent Republican who supports the plan.
Much of the opposition rests on the assumption that the federal government would, in the next few years, shift more of the cost of covering the 400,000 people added to the AHCCCS rolls to the state. Typically, the federal government pays two-thirds of the cost of AHCCCS, which covers more than a million Arizona residents — about 20 percent of the population. About a quarter of the money goes to pay the bills of medically bankrupt nursing home patients.
AHCCCS spent $8.7 billion in fiscal 2012, $8.9 billion in fiscal 2013 and is projected to rise to $9.4 billion in the governor’s budget proposal for fiscal 2014. Federal money covers most of that bill. The cost of the program has grown faster than almost any other major component of state spending, with the possible exception of prisons.
AHCCCS uses a health maintenance model and outside studies have concluded it provides better than average results compared to other Medicaid programs at a cost that’s 5 to 10 percent lower per patient.
The most cogent criticism of AHCCCS has focused on the inexorable rise of the cost of the program. But that applies to Medicare, private insurance and every other medical program.
The United States spends nearly three times as much per person on medical care as a comparison group of 34 other advanced countries, according to a recent study by the Organization for Economic Co-operation and Development. The U.S. now spends almost 18 percent of the world’s largest Gross Domestic Product on medical care, compared to 9 to 12 percent in most other advanced, industrialized countries.
Despite far greater spending, the U.S. has a lower life expectancy, fewer doctors per capita and fewer hospital beds per capita than a comparison group of 34 other industrialized counties. The U.S. spends about three times as much on administrative overhead as other industrialized countries.
The U.S. system does yield a longer cancer survival rate, brings prescription drugs to market faster and spends far more on medical research. However, on most other measures the world’s most expensive system yields mediocre results.
For instance, a coronary bypass in the U.S. costs 50 percent more than in Canada, Australia and France and twice as much as in Germany. However, the higher cost doesn’t result in higher survival rates from heart disease or bypass surgery. U.S. doctors also make more money than their counterparts elsewhere and perform two or three times as many diagnostic tests, without increased survival rates for any disease besides cancer.
Critics of the effort to expand insurance coverage for the estimated 40 million to 50 million uninsured say adding more people with coverage to the system will simply increase the speed at which costs rise.
Advocates say that expanding coverage will cut costs by allowing people to get treatment in doctor’s offices instead of emergency rooms and make it much easier to shop for medical insurance through the proposed health insurance exchanges.
In the meantime, the deadlock over the expansion of AHCCCS continues in the state Capitol.