Lawmakers Still Fighting Ahcccs Expansion

Judge throws out lawsuit, but committee approves new restrictions

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Republican state lawmakers continue to fight tenaciously to prevent the federally funded expansion of health care coverage for low-income residents — despite setbacks in court and the equally insistent opposition of Republican Gov. Jan Brewer.

Last week, Maricopa County Superior Court Judge Katherine Cooper threw out a lawsuit brought by the Goldwater Institute and 36 Republican state lawmakers attempting to block last year’s expansion of the Arizona Health Care Cost Containment System. The expansion will bring in an estimated $1.6 billion in federal funds to provide health care for an estimated 300,000 state residents, with a $266 million hospital levy more than covering the state’s share of the expansion.

Meanwhile, the state House Committee on Reform and Human Services last week approved House Bill 2234, introduced by Rep. Adam Kwasman (R-Oro Valley). Kwasman is running for the Republican nomination in Congressional District 1, in hopes of unseating Rep. Ann Kirkpatrick (R-Flagstaff), whose sprawling district includes all of Southern Gila County.

In a press release last week, Kwasman touted his bill to repeal last year’s vote and indicated that Rep. Brenda Barton (R-Payson) “might” attend to support the measure.

Rep. Barton did not respond to a request for comment prior to press time.

Gov. Brewer forced through the expansion last year with the unanimous support of state legislative Democrats and a handful of Republicans.

House Speaker Andy Tobin and Kwasman both opposed the governor’s plan to accept federal money to increase coverage from 100 percent of poverty to 133 percent of poverty for families with children as well as childless adults.

Tobin is also seeking the Republican nomination in Congressional District 1 and Kwasman has criticized him for not fighting hard enough to prevent the expansion of AHCCCS.

However, Tobin also sponsored HB 2367 that passed committee last week and would impose a requirement for AHCCCS recipients to prove they’re looking for work, limit the expansion to five years and require AHCCCS patients to pay a co-pay for ambulance rides and emergency room visits if it turns out they didn’t have a medical emergency.

The federal Affordable Care Act offered to pay the full cost for the first few years of any expansion in state Medicaid programs like AHCCCS. That expansion was supposed to account for about half of the roughly 30 million Americans expected to get coverage under the federal law. So far an additional 100,000 Arizonans have signed up for the expanded coverage through AHCCCS, far fewer than the 350,000 projected. Nationally, about 3 million people have signed up for coverage so far, according to the Department of Health and Human Services.

A recent report by the Congressional Budget Office noted that technical problems with the federal and state Web sites have sharply limited enrollment so far. The non-partisan budget office report concluded that about 2.3 million Americans who rely on their jobs for health care might quit working or reduce their hours if they can get coverage through the Affordable Care Act by 2021. Most of those workers would retire early, start their own business or take care of children because they no longer need the job to qualify for health care. The law requires insurance plans to cover people with pre-existing conditions. Meanwhile, many businesses have also kept the hours of part-time workers below 32 a week to avoid the requirement to provide health care for full-time workers or pay a fine. However, the nonpartisan report also concluded that so far there’s no evidence that the health care law has significantly affected employment overall.

The Congressional Budget Office forecast predicts that about 25 million will sign up for health care this year at the online marketplaces and another 13 million will get coverage through Medicaid programs like AHCCCS.

Nonetheless, state legislative Republicans including all of Rim Country’s representatives continue to bitterly criticize the federal health care law and Gov. Brewer’s expansion of AHCCCS.

Normally, the federal government pays only two-thirds of the cost of AHCCCS, which even before the expansion provided coverage for 30 percent of Gila County residents. The federal government will cover 100 percent of the cost for the expanded population for the first few years, which then drops to 90 percent.

As part of the expansion, Brewer pushed through a surcharge on hospital bills to cover any state costs. The hospitals supported the surcharge in hopes the dramatic increase in coverage will reduce their unpaid bills for the uninsured.

The lawmakers and the Goldwater Institute challenged the majority vote approval of the hospital surcharge violated the voter-approved constitutional amendment in Proposition 108 requiring a two-thirds legislative vote to approve any tax increase. Gov. Brewer argued the surcharge wasn’t a tax. The Maricopa County Superior Court judge ruled that the Legislature itself determines when the 2/3-vote requirement applies.

The governor’s office hailed the court ruling.

The governor’s office has previously estimated that the AHCCCS expansion will actually boost the general fund by $64 million in 2014, $136 million in 2015 and $166 million in 2016, while also providing coverage for an additional 240,000 people plus 50,000 childless adults already added to the rolls.

The AHCCCS expansion includes a provision to drop the expanded coverage if the federal match ever falls below 80 percent.

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