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Phoenix, AZ – State lawmakers directed the Arizona Health Care Cost Containment System to cut expenses this coming year by $520 million. The plan crafted by Gov. Jan Brewer does that by phasing out coverage for childless adults and some others. Everyone now in the program can remain. But no one else can sign up. During a two-hour hearing Monday on that plan, Sarah Kander of the Arizona Center for Disability Law told AHCCCS officials that's not fair.
(The proposed cuts to AHCCCS coverage will have a negative and disproportionate effect on people with disabilities. It is unfortunate that the Arizona state government is balancing the budget on the backs of the most vulnerable, especially when other options are available.)
Some, like Tami Johnson of the Morris Institute for Justice, objected to some very specific elements in the plan. For example, the state not only want to impose premiums on those enrolled but add a surcharge for smokers and for those who are obese and do not follow the regimen ordered by their doctors. Johnson said there has been research in this area.
(And what it showed, and in the guidelines for the states, that positive incentives, not negative ones work to change behavior. The stick or penalty approach does not work .)
But Monica Coury of AHCCCS said that, at the moment, it's just a concept Arizona has proposed to federal officials who regulate all state Medicaid programs -- and who never have approved such an idea.
(It does not currently contain any operational detail because the idea was to discuss it in terms of the federal government's interest in such a program, basically similar to what many employers are doing with their employees, which is requiring higher premiums for those who smoke and so forth.)
Coury said the real bottom line is that mandate to cut $520 million. She said if federal officials reject this package of enrollment freezes, co-pays and new fees, that leaves the original plan to kick 230,000 people off the AHCCCS rolls. But Eddie Sissons of the Arizona Center for Behavioral Health said that's not exactly true. She said a ballot measure approved in 2000 requires the state to provide coverage for everyone below the federal poverty level. And the Arizona Constitution precludes lawmakers from altering voter-approved programs. That leaves one option if anyone who is supposed to get coverage under the initiative loses it: Sue the Legislature.
(So hopefully we will get them to understand that doing this program as outlined does the most harm to the neediest in our community without resources to secure their own health care. This freeze is simply, simply, contrary to the voters' wishes.)
But Coury said it's not all that clear. She noted the 2000 ballot measure said the expanded care would be paid for with higher tobacco taxes and the state's share of a nationwide settlement with tobacco companies.
(The ballot language also directed that the tobacco settlement monies be supplemented as necessary by any other available sources and federal monies. The Legislature based its authority to change eligibility because of a lack of other available resources. Ultimately, this would be a matter for the courts to decide.)
That lawsuit is pretty much a sure thing. Attorney Tim Hogan of the Center for Law in the Public Interest said he is just waiting for federal Medicaid officials to approve the state's plans. For Arizona Public Radio this is Howard Fischer.