Arizona on right track with Medicaid copayments - East Valley Tribune: Columnists

Arizona on right track with Medicaid copayments

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East Valley resident Tom Patterson ( is a retired physician and former state senator.

Posted: Saturday, September 3, 2011 4:15 am | Updated: 3:01 pm, Tue Sep 6, 2011.

Americans have developed the attitude that there's something wrong with expecting anybody to pay doctor bills out of pocket and it's killing us. It's the number one reason that medical care costs have been so out of control for so long that they threaten to bankrupt a once proud nation.

That's why it is so encouraging that Arizona AHCCCS (Medicaid) officials decided to charge a modest - $5 to $30 dollars - copayment for services to Medicaid beneficiaries in Arizona. That's also why it is outrageous that the notorious federal Ninth Circuit appeals court struck down Health and Human Services Secretary Kathleen Sebelius' approval of the Arizona program.

Back in my emergency physician days, it was not unusual for AHCCCS patients, typically single mothers with small children, to utilize the ER at night for the treatment of common childhood illnesses like colds and ear infections. They would sometimes even insist that in addition to the ill child being treated, the other children without symptoms be checked, too, "just to make sure."

Most of us would regard this cavalier use of expensive services as "ER abuse." But why criticize the mother? She was acting in a logical manner to the incentives she was given. Federal law allowed no co-pays (or refusal of service) for Medicaid patients, so there was no reason for her to seek less costly alternatives. The health planners in charge deserve the blame.

Medicaid patients aren't the only ones driven to overutilization. Most employer-provided insurance and Medicare supplemental insurance plans also insulate patients from the economic consequences of their decisions and reward doctors for doing more procedures.

Over the years, these policies come back to bite you. In spite of strenuous efforts to bureaucratically control costs by regulating payment schedules, Medicare and Medicaid continue to grow 7 to 9 percent yearly. Meanwhile, under Obama's ministrations, the overall growth rate of the economy is under 2 percent.

The math here isn't good. At this rate, Medicare and Medicaid spending would exceed our entire economic output in 40 years, although economic collapse would occur long before that.

But what to do? Arizona, with unusually generous AHCCCS eligibility requirements, is facing unbearable cost increases which threaten to crowd out other critical spending needs. We received permission to charge co-payments for services under a provision permitting the Secretary of HHS to grant waivers from Medicaid law for programs with a "research or demonstration value."

But a panel of the Ninth Circuit Court of Appeals, the most overturned, most ideologically left-wing court in the land, overturned the decision. They claimed the decision was "arbitrary and capricious." That's judge-speak for "we didn't agree with it."

They also claimed that the covert purpose of the program was really just to save money. Aw, come on. Even in Arizona they wouldn't do something so heinous, would they?

The court's legal reasoning was lame, since there would clearly be "demonstration value" in determining if co-payments could moderate the demand for medical services without compromising essential medical care. The ruling seemed grounded instead in the ideology of "welfare rights," the notion that certain members of society are entitled to being taken care of by the rest of us and that asking anything in return is immoral and probably illegal.

So the judges simply substituted their judgment for that of Secretary Sebelius and the AHCCCS officials struggling with exploding health care costs. But judges are terrible when they venture into policy-making because they don't have to deal with the economic effects of their decisions. They don't have to solve the problem of where to get the money to carry out their "compassionate" edicts. They don't have to worry about how many patients may have to be cut from AHCCCS so that the ones in the program can enjoy lavish, responsibility-free benefits.

Secretary Sebelius deserves credit for granting the waivers to allow co-payments. The Obama administration's instincts are that government can control health care costs by fiat, but she was at least willing to allow the state to try another approach.

Now she's been kicked to the curb by the arrogant Ninth Circuit court. Hopefully, this Court will be reversed yet again on a well justified appeal.

• East Valley resident Tom Patterson ( is a retired physician and former state senator

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