Gila County has reported the highest growth rate in the state in the past 12 months when it comes to people signing up for the Arizona Health Care Cost Containment System as newly eligible people take advantage of the expanded coverage through the federal Affordable Healthcare Act.
The number of people on AHCCCS in Gila County has grown by 13 percent in the past 12 months to nearly 16,000. That means 30 percent of Gila County residents depend on the income-based health plan for their medical coverage. Only Cochise County had a higher growth rate at 14 percent.
Statewide, the program grew 8 percent to 1.4 million, which means about 21 percent of Arizonans depend on AHCCCS for their healthcare. The program covers both medical care for low-income families and nursing home bills for people who have exhausted all their other resources. The Arizona Long-Term Care System pays about half of the nursing home bills in the state.
So Gila County residents have lots at stake as the political battle over whether Arizona should accept federal money to expand its AHCCCS program continues to rage on.
This week Gov. Jan Brewer vetoed a measure that would have limited coverage under the program to five years, even if the person’s income remained low enough to qualify. The program used to cover women and children with poverty-level incomes. The state pays one third of that cost, with the federal government paying two thirds.
But the Affordable Healthcare Act provided the states with an incentive to expand the program to cover families making up to 134 percent of a poverty-level income as well as childless adults. That’s about $27,000 annually for a family of three. Arizona voters had previously approved a similar expansion, but the Legislature cut those people off to save money during the recession.
The federal government has promised to cover the costs of the expansion for the first five years. After that, the state will have to pay a share. However, most of the hospitals in the state agreed to a surcharge on their bills in hopes the expansion will reduce their hefty uncompensated care bills for people without insurance. As a result, at least during the initial years, participating in the program will actually contribute to the general fund.
However, critics fear the federal government will eventually cut support for the program in future years and the state will have to drop it or face big budget problems. Current law would drop the expanded coverage if the federal share for the added population falls below 80 percent.
However, House Speaker Andy Tobin — who is running for the Republican nomination to challenge Congresswoman Anne Kirkpatrick who represents Southern Gila County — pushed through a bill that would impose a lifetime, five-year limit on coverage under the program. HB 2367 would have also required anyone on the program to have a job, actively seek one or be enrolled in a job-training program. Many of the people on AHCCCS work, but that often poses a problem for women with minimum wage jobs that barely cover the cost of childcare.
Brewer in her veto message said the measure could ultimately force a third of the people covered out of the program. Such a move would bring the system to a “breaking point.” She noted that, “As we all know, their medical needs will still exist.”
Federal law requires emergency rooms to treat any patient who shows up with a medical emergency, even if they don’t have insurance. That’s one reason Arizona hospitals have generally supported the expansion of the AHCCCS program.
But Brewer estimated the bill would mean kicking about 212,000 people out of the program immediately, plus another 253,000 children once they turn 18 — since the time they spent covered as children would count against their lifetime eligibility.
On the other hand, a state Court of Appeals panel cast new doubt over the future of the AHCCCS expansion recently when it ruled that lawmakers can proceed with a lawsuit seeking to overturn it.
The case turns on whether the assessment on hospital bills amounts to a new tax. Gov. Brewer won expansion of the program with the votes of all the Democrats and a block of Republican moderates. None of Rim Country’s representatives supported the expansion. The package included the assessment on the hospitals. However, Arizona law requires a two-thirds vote in the legislature for any new tax. Gov. Brewer argued that the Legislature has the right to decide what qualifies as a tax increase — and therefore what measures require a two-thirds vote.
The appeals court panel rejected that argument for taxes, fees or assessments and sent the case back to the trial court.
Gov. Brewer says she’ll appeal that ruling to the state Supreme Court.
The case won’t immediately overturn the hospital assessment, on which the AHCCCS expansion in Arizona rests. A trial court had ruled in favor of Gov. Brewer’s argument. If the state Supreme Court either refuses to consider the case or upholds the appeals court ruling, the case will go back to the trial court for arguments on the hospital assessment.
If the court ultimately nullifies the assessment because it lacked a two-thirds majority, it will cost the state $256 million in the upcoming budget year.
In the meantime, some 60,000 people have applied for coverage by AHCCCS through the federal Marketplace at www.healthcare.gov. However, many people seeking coverage have reported long waits, confusing instructions, lost applications and other problems that have delayed actually obtaining coverage by months.