During her State of the State address in January, Gov. Jan Brewer announced a budget-cutting blueprint that included drastically scaling back the Arizona Health Care Cost Containment System, or AHCCCS. She said that program's expansion—approved by voters in 2000—was costing more than expected.
"While we agree we must provide essential services for those with no place else to turn," the governor said, "we must only offer those benefits when necessary."
State Senate President Bob Burns concurred. The Peoria Republican hinted that there was plenty of support among his colleagues to send the AHCCCS expansion back to voters. And he suggested that our health system for poor people is badly bloated. "It's hard for me to believe," he told Capitol Media Services, "that one-sixth of the population of the state of Arizona has to have government assistance in their health care.
"They make choices in how they spend the money they earn," said Burns. "So maybe health care needs to be put up in a little higher category."
As a state employee, Sen. Burns enjoys health care that's generously provided by Arizona taxpayers. For the most affordable plan, he would pay a mere $39 per month, says Senate controller Travis Swallow. Sen. Burns also has federally funded Medicare, according to his staff.
Annual premiums for that state plan would cost Sen. Burns $468 per year. Compare that to the nationwide average of $4,004 per worker in payroll deductions, estimated in a report last spring by the consulting firm Milliman Inc. Those employees also paid an average of nearly $3,000 in out-of-pocket expenses.
It's safe to assume that Gov. Brewer enjoys the same health-care benefits as Sen. Burns, although her office didn't return several calls seeking confirmation or comment.
Over in the House, Speaker Kirk Adams has likewise leaned toward AHCCCS cuts. In recent years, the Mesa Republican has also steadily attacked Healthcare Group of Arizona, a state-run program that provides insurance for small businesses. Unlike commercial insurance companies, Healthcare Group does not underwrite, meaning that potential members aren't screened for pre-existing conditions. That lack of pre-screening, combined with a period of explosive growth—from around 16,000 members at the end of 2005 to almost 27,000 two years later—left Healthcare Group with a surprising storm of claims.
That also made it a prime target for conservatives such as Adams, who has sponsored legislation to gut the program. Although he didn't succeed, Healthcare Group was forced to enact sharp rate increases that eventually brought it into the black, but which also squeezed out many employers.
But Adams has another dog in this fight: His insurance firm, The Adams Agency, sells policies for Blue Cross Blue Shield of Arizona, a competitor with Healthcare Group.
Rep. Steve Farley, a Tucson Democrat, says attacking these health-care programs may make for good Republican politics, but the remarks by Sen. Burns also reveal a shallow viewpoint.
"It is hard to believe that one-sixth of Arizonans are below the poverty line," Farley says. "But we need to change that fact, and not take away their health care. These are not people who are poor because they are somehow lazy. They're not poor because they're somehow defective. They're not poor because they are not true members of society. They're poor because of a whole series of bad things that have happened to them.
"Nobody wants to be poor," he says. "I don't know any poor person who loves their lifestyle."
Farley hopes that perspective reaches the ballot box in November. "There are hundreds of thousands of Arizonans—working families—who have spent their whole lives supporting this social safety net," he says. "Now it's being slashed apart just when they need it the most."
During her speech, Gov. Brewer said that the voter-approved expansion of AHCCCS costs the state $1 billion a year. But that assertion raised eyebrows, given that the entire program is budgeted at about $1.2 billion annually.
Prior to 2000, AHCCCS was available only to those at one-third of the federal poverty level. But that year, voters mandated that anyone below the federal poverty level—currently around $18,000 for a family of three—would be eligible for the program. Today, the expanded AHCCCS serves 1.2 million Arizonans, including more than 20 percent of Pima County residents. If the cuts espoused by Gov. Brewer and Republican leaders are enacted, 310,000 people would be dropped from those rolls.
According to social-service organizations, those cuts would reach deep into the former middle and upper classes.
Terri Patt-Smith is associate director of Interfaith Community Services, an agency located next to a towering church on Tucson's northwest side. Standing among food boxes and case files, she says the face of poverty is changing.
"I had a real estate agent—a top agent—whose house was foreclosed, and she's living in her car. I have a lot of construction workers who made good money, and now there are no jobs because of that industry being hit. We have truck drivers. ... You know, it's really impacted a lot of areas."
Of course, losing a job also means losing health-care benefits. "A majority of people coming to us are unemployed," she says, "and those people are without insurance because they can't afford COBRA."
(COBRA is an acronym for the Consolidated Omnibus Budget Reconciliation Act, a 1986 law allowing people to keep their health insurance after leaving a job. However, they are required to pay the full cost for that insurance.)
Nor can the newly unemployed qualify for AHCCCS right away. "So most of those people are without anything," she says. "They have no coverage, and their children have no coverage."
Interfaith Community Services taps its discretionary funds to buy prescriptions for people with life-threatening illnesses ranging from heart problems to diabetes. Clients are also referred to low-cost clinics such as El Rio Community Health Center. "But I'm sure (those clinics) are getting maxed out on what they can do on a sliding-fee scale," says Patt-Smith. "We're getting hundreds of calls a day for assistance, and I don't have places to refer them to, because everybody is in the same boat.
"These people were making good money, and were able to have houses and health insurance and everything. Now they've tapped out their 401(k)s and credit cards. We're going to have a whole new set of homeless people if something doesn't happen to create jobs. And health insurance is all a part of that."