Gov. Jan Brewer submitted a plan to the federal government Thursday to save transplant funding — but at the expense of eventually eliminating care for close to 140,000 who now get regular care from the state.
The proposal to Health and Human Secretary Kathleen Sebelius is designed to save the state about $500 million this coming fiscal year, close to half of the anticipated gap between revenues and expenses. It would include new requirements for enrollees in the Arizona Health Care Cost Containment System, the state’s Medicaid program, to pay small fees for their care and financially penalize those who use hospital emergency rooms for treatment that could be done elsewhere.
There also would be additional charges for AHCCCS recipients who smoke. Those who are obese or have chronic conditions like diabetes would have to adhere to a care plan or also face additional charges.
And those enrolled in AHCCCS would have to prove they remain eligible every six months; current law keeps coverage in place for a year.
Brewer’s move comes despite a proposal by the Arizona Hospital and Healthcare Association to tax its members to raise enough money to much more sharply limit the number of people who would need to be cut from the program to balance the budget. The hospitals say that, aside from increasing the number of uninsured in Arizona, Brewer’s plan would force layoffs at hospitals.
It also is going to trigger a lawsuit if and when Sebelius approves the change.
That is because Brewer hopes to phase in her plan by immediately refusing to enroll any childless adults and some parents with children. But attorney Tim Hogan of the Center for Law in the Public Interest said these people remain eligible for AHCCCS coverage under a 2000 ballot initiative that requires the state to provide care for anyone below the federal poverty level, about $18,310 a year for a family of three. And a state constitutional provision generally bars lawmakers from altering or repealing voter-approved measures.
Brewer press aide Matthew Benson insists, however, there is wiggle room in the wording of that mandate. He said the expansion is financed by tobacco tax revenues, Arizona’s share of a settlement with tobacco companies and other ``available sources.’’
``Given that we’ve cut well over a billion dollars (in) last year’s budget, more the year before, certainly well over a billion dollars in next year’s budget, I think it’s clear the state doesn’t have the available sources to fund this program,’’ he said.
Hogan said that’s not true.
``They’ve just chosen to reprioritize their funding obligations,’’ he said.
``They spend a billion dollars on prisons. They spend $3.5 billion on K-12,’’ Hogan continued. ``The principle here is you’ve got to fund your legal obligations first. And this is a legal obligation.’’
He vowed to sue the moment Brewer signs the budget bills with the changes.
Earlier this year the governor signed legislation that would have paved the way for cutting care for about 280,000 people out of the approximately 1.3 million now enrolled in AHCCCS. That provoked an angry reaction from some elements of the business community.
Glenn Hamer, president of the Arizona Chamber of Commerce and Industry, said those forced off the AHCCCS rolls eventually would end up in hospital emergency rooms with more serious conditions because they can’t get the routine care they now are provided. Hospitals, which are precluded by federal law from turning away patients with emergencies, then would pass the cost on to other patients, meaning higher rates and higher insurance premiums. And that, in turn, could cause some employers to drop coverage.
The modified plan submitted to Sebelius Thursday is designed to save the same amount of money as the original proposal.
It keeps the original concept of eliminating coverage for some. But it allows anyone already in the system to stay. The theory is that some people will get better or get jobs. And once they lose eligibility, they would not be allowed to re-enroll. And everyone else with chronic conditions will be allowed to remain in the program.
The plan also includes repealing a decision made by Brewer and lawmakers last year to no longer fund what were said to be transplants where the ultimate outcome did not really extend the life of the patients. That saved about $1.1 million but left close to 100 AHCCCS recipients who had been on waiting lists without coverage.
Several people have died in the interim. And there have been arguments to lawmakers that the data they relied on to determine long-term survivability were flawed.
Brewer said that the changes she is proposing leave enough to restore coverage.
All that, however, requires cutting elsewhere.
One service that would disappear is what is known as the ``spend down’’ program. This provides temporary care for those whose recent income makes them ineligible but who have suffered some catastrophic illness or injury whose costs would eat up most of their resources.
Brewer also figures the state can save money by requiring people to reapply every six months. That is critical for a state like Arizona which pays insurers a flat monthly fee to provide care to everyone signed up regardless of how much or how little care that person needs.
``This proposal ensures that the Medicaid program serves only those who are eligible,’’ Brewer wrote to Sebelius. ``This is a common-sense change that will not change coverage for anyone who remains eligible for the program and who completes a simplified redetermination process.’’
Brewer also defended what she called the ``personal responsibility’’ elements of the plan, including co-pays and financial penalties for those who miss appointments. And she said the ``wellness’’ provisions ``are critical to ensuring that enrollees are making decisions that positively impact their health and well-being, and that they have a financial stake in those decisions.’’