Three public interest law firms are making a last-ditch effort to keep the state from scaling back its health care program for the poor.
Attorneys on Thursday asked the state Supreme Court to bar the Arizona Health Care Cost Containment System from proceeding with plans to stop enrolling some otherwise-eligible people beginning July 1. Attorney Tim Hogan of the Center for Law in the Public Interest wants no change in coverage until at least the end of September.
Hogan chose that date because the high court has previously agreed to consider complaints that the cuts to the program are illegal - but not until Sept. 20. By that point, he argued, some of the damage will already have been done, citing estimates from AHCCCS that in the first month alone, about 17,000 people who today are entitled to AHCCCS would be turned away.
"This is a stunning number of human lives irreparably harmed," Hogan wrote.
"This population often seeks health care and enrollment with AHCCCS only when confronted with a serious and immediate health problem," he continued in his legal brief to the court. "If they are denied even that, then these individuals will not receive treatment of any kind until their conditions become life threatening and require treatment in an emergency room."
And Hogan said that, in turn, will create a tremendous burden on hospitals who are legally precluded from turning away patients who are in an emergency situation, even if these people cannot pay.
But the ultimate bottom line from Hogan's perspective is that any move to scale back the program runs afoul of Proposition 204, a 2000 voter-approved initiative requiring the state to provide free care for anyone below the federal poverty level.
Matthew Benson, press aide to Gov. Jan Brewer, said there's a good reason for the Supreme Court to rebuff Hogan's request: money.
The freeze on enrollment is part of a larger plan by Brewer to meet a directive by the Legislature to cut state spending on AHCCCS by $500 million this coming fiscal year.
One element of that plan largely involves childless adults whose income is below the federal poverty level. The federal government, which provides about two-thirds of the funds for AHCCCS, does not require states to include them in their programs.
Beginning July 1, the state plans to stop enrolling anyone in this category, though those already in AHCCCS could continue to get care. The same thing would happen to parents whose income is at least 75 percent of the federal poverty level, though their children would remain eligible.
Benson said the justices should reject Hogan's bid to delay any change in the program because it would undermine the balanced budget. He said any injunction would mean "millions and millions of dollars would go out the door while the state continues spending at its current clip."
Hogan said this particular change is anticipated to save "only $207 million." And he said a recent legislative budget report predicted that tax collections this current budget year are estimated to be $252 million higher than anticipated.
"What is clear is that the speculative impact on the budget that would result from requiring compliance with Proposition 204 is outweighed by the known and quantifiable human cost of noncompliance," Hogan wrote.
But Benson said Hogan's claim of irreparable harm has no merit, saying the Medicaid programs in 44 other states do not - and never did - provide coverage for childless adults.
"Are they irreparably harmed in those states or just here?" Benson said.
The outcome of the legal fight over what the state does or does not have to do will depend on how the court interprets the language of that 2000 initiative.
In requiring coverage for anyone below the federal poverty level, the ballot measure spelled out that the expansion was to be paid for from tobacco taxes, the state's share of the settlement of a nationwide lawsuit against tobacco companies, and "supplemented as necessary by any other available sources, including legislative appropriations and federal monies."
Hogan, along with attorneys from the Arizona Center for Disability Law and the William E. Morris Institute for Justice, contends that language is a mandate for the state to provide other funds when it is necessary to cover the expenses of the program.
Benson, however, said the condition of the state budget shows there is no extra money "available" to fund the program.