After spending months building up public support, Gov. Jan Brewer unveiled her draft legislation to extend Medicaid coverage to Arizonans below 133 percent of the federal poverty line last week.
Brewer has been pushing the expansion of the Arizona Health Care Cost Containment System, or AHCCCS, since she delivered her State of the State address in January.
She and her allies—including most of Arizona’s hospitals, a bunch of chambers of commerce and other biz organizations such as the Southern Arizona Leadership Council, and even the Arizona Sheriffs Association—say that the expansion will bring $8 billion from the federal government to Arizona in the first four years.
To make it work, however, Arizona has to come up with hundreds of millions of dollars in matching funds over those four years—which is where a voluntary assessment on hospitals comes in.
The hospitals, with a few exceptions, are willing to pay the assessment because they know that they’ll get back a lot more in return once more of their patients have insurance.
It’s no surprise that hospitals are willing to pony up that money. As AHCCCS Director Tom Betlach explained at a recent town hall in Tucson, hospitals have seen the cost of providing care for uninsured Arizonans double since the Brewer administration froze enrollment in the program for childless adults below 100 percent of the federal poverty line in an effort to balance the state’s budget.
“And if we do nothing, then it will double again,” Betlach warned. “And that will be felt by the consumers, the carriers and the businesses in this state.”
At that same town hall, Brewer’s policy adviser on health care, Don Hughes, said that the assessment would also free up $136 million in the state’s general fund, “which can be spent on other priorities, such as K-12, universities, CPS, and public safety.”
Brewer has included what she calls a “circuit breaker” to stop the program if the federal government lowers its share of the match below 80 percent.
“The Arizona Legislature won’t have to take another step,” Hughes said. “So if Congress and the White House lower the reimbursement rates, then it’s an automatic repeal and the onus will be on the Congress and the White House. This sends a very clear signal to them that ‘You may have your own budget problems, but don’t think about balancing them on the back of the state.’”
But most Republicans in the Legislature have been cool to the idea and rank-and-file GOP activists have been downright hostile. Legislative districts and county parties across the state have been condemning the expansion as a way of supporting the federal Affordable Care Act—aka Obamacare—and a general assault on the principles that made our country great.
“Obamacare is going to have 46 percent of the American people on public health care,” Rep. John Kavanagh, who chairs the House Appropriations Committee, told Phoenix 12 News political reporter Brahm Resnik over the weekend. “It unsustainable. The reason I oppose this expansion is that even though they’ve crafted it so there’s no immediate cost to Arizona—although there is risk down the road—the American people can’t afford this. … This is going to bankrupt the country.”
A few GOP lawmakers, however, are leaning toward supporting the proposal, as are legislative Democrats. If the legislation can get out of committee and to a vote of the full House and Senate, it can probably get more than 50 percent of the lawmakers to support it.
But that’s where some of the legal trouble comes up. Any kind of tax increase requires approval of two-thirds of the Legislature. Brewer hopes to sidestep that requirement by saying the assessment is a voluntary fee administered by the AHCCCS administrator and not a tax—a novel way around the two-thirds requirement.