The state House voted Thursday to put a five-year lifetime cap on government-funded health – but not for everyone.
The 35-22 party-line vote came even after House Speaker Andy Tobin agreed to remove the harshest provisions of his legislation. Most notably, the final version of HB 2367 would not affect those who are working but simply unable to earn enough to make them no longer eligible for Medicaid.
“Many of the members have made a great case for making sure that we better evaluate who is and who is not qualified,” he said.
Tobin said he remains concerned that Arizona needs a plan for cutting its costs if the federal Affordable Care Act, which expanded Medicaid, fails to live up to expectations and federal dollars evaporate.
“I think we hit the soft spot,” he said.
Current state law provides health care for all whose family income is up to 138 percent of the federal poverty level. For a family of three, that is $26,951 a year.
Tobin's legislation would require the state to annually petition the federal government, which pays the majority of the costs, for exemptions. That includes a requirement that all able-bodied adults be working, actively seeking employment or be attending a job-training program.
But the most notable change would be an absolute five-year lifetime limit on benefits, even if the person was still working but whose earnings still were below that eligibility cap.
Tobin actually got the Republican-controlled House to give preliminary approval to the harsher version earlier this week. But on Thursday, he brought the issue back for some significant changes.
The new version of HB 2367 keeps the requirements for able-bodied people to at least be looking for work or training. But Tobin told Capitol Media Services that those who are working as hard as they can but whose earnings are still below the eligibility figure should not be penalized and have their health care suddenly cut off.
Tobin called it the “Wal-Mart exception,” referring to the fact that employees of the retail giant could be working full time and still be earning below the eligibility figure.
“That's a better, more reasonable approach,” he said.
That's not the only change to which Tobin agreed.
Under the new plan approved Thursday, that five-year cap also would not apply if a Medicaid recipient is pregnant, sole caregiver of a family member who is younger than 5, is current receiving long-term disability benefits, or who may be 18 but is still attending high school as a full-time student.
Despite the major concessions, House Democrats who opposed the original version were no more impressed – and no more willing to support the plan.
“Just because someone is poor does not mean they are lazy and unemployable,” said Rep. Juan Mendez, D-Tempe. “But because they are human, they do deserve basic health care.”
Thursday's 35-22 vote sends the measure to the Senate.
Tobin stressed that even if the measure becomes law, no one is in any immediate danger of losing benefits.
Arizona cannot unilaterally change eligibility rules without approval of the U.S. Department of Health and Human Services. That is because two-thirds of the cost of covering everyone below the federal poverty level comes from Washington; the federal share is even higher for the expanded program under the Affordable Care Act.
Tobin said Arizona needs to be ready to trim its costs, especially if federal support is reduced.
The chances of getting the necessary waiver are questionable at best.
Last year federal officials turned down a bid by Utah Gov. Tom Corbett to include a work requirement in that state's Medicaid plan.
Federal approval is not the only issue.
Arizona voters approved legislation a decade ago that requires the state to provide free care for everyone below the federal poverty level. Tobin conceded that even if he gets a waiver from Washington, that might apply only to those in the expanded Medicaid program – above the poverty level – approved as part of the Affordable Care Act and pushed through the Legislature last year by Gov. Jan Brewer