Foes of the governor’s plan to expand the state’s Medicaid program laid out their objections and alternatives Thursday, including one that actually would dump thousands of people from the program who are now getting care.
“We have a choice: More socialism and bigger government or more freedom and fiscal stability,” said Rep. Warren Petersen, R-Gilbert, one of the leaders of an ant-expansion rally on the Capitol lawn.
Sen. Kelli Ward, R-Lake Havasu City, called the care provided under Medicaid “substandard” and said entitlement programs like this “disincentivize the poor from improving themselves.”
And Rep. Justin Olson, R-Mesa, said an expanded Medicaid program means more tax dollars for family planning services to be paid to Planned Parenthood which has “this mission of terminating life before it’s even born.”
Thursday’s rally came as Senate President Andy Biggs, who also opposes what Gov. Jan Brewer wants to do, drew a line in the stand. He vowed to do all he can to not even allow a vote on her proposal.
Biggs’ position does give him vast powers to sideline legislation.
“I’m not going to allow late introduction of a bill,” he told Capitol Media Services, pointing out the deadline for that was months ago. And Biggs said even if what the governor wants does end up at the Senate, whether from a House bill or an amendment to something else, “I never made a commitment I’d put it on the floor” for a vote.
House Speaker Andy Tobin has not taken such an absolute stand. But Tobin said he would not allow a vote in his own chamber on Brewer’s plan as it now stands.
The Arizona Health Care Cost Containment System, the state’s Medicaid plan, makes coverage available for most individuals below the federal poverty level, about $19,500 a year for a family of three. The federal government provides $2 for every dollar of state funds.
Under the Affordable Care Act, states can expand up to 133 percent of the poverty level, with the federal government picking up virtually all of the additional cost.
Brewer figures Arizona could add about 300,000 to the AHCCCS rolls of 1.3 million. That includes about 140,000 childless adults below the poverty level who were getting care from the state but were dropped from the program, at Brewer’s behest, to save money for the state.
More to the point, the governor contends that expanding coverage to 133 percent of the poverty level actually makes money: Its share would be paid by a tax on hospitals that actually would leave dollars left over.
Biggs, however, said the flaw in all that is the argument that the federal government actually will live up to its side of the bargain and provide the extra dollars for an expanded program.
One of the options presented is to simply no longer provide coverage to childless adults. That
affects not only the 140,000 who already have left the program but would actually end services to the estimated 63,000 who were in the program when the enrollment freeze was implemented in 2010 and are still getting care.
That idea drew fire from Brewer, who sent a letter to legislative leadership calling that option` `morally repugnant and fiscally irresponsible.” It would not, though, endanger the funds for the rest of the Medicaid program as federal law does not require states to provide coverage to childless adults.
But gubernatorial press aide Matthew Benson said Petersen is ignoring one fact: A 2000 ballot measure requires the state to provide free care for everyone below the federal poverty level, including childless adults.
Brewer, though, could have a hard time making that case in court -- especially as she argued just the opposite only two years ago.
It was Brewer who in 2010 pushed through the freeze on enrolling new childless adults, claiming the state just could not afford the cost. That resulted in a lawsuit by groups contending the move violates the specific direction of voters.
But Brewer’s lawyers argued -- and the appellate courts agreed -- the 2000 measure simply requires the state to fund expanded care with tobacco taxes and Arizona’s share of a nationwide settlement with tobacco companies.
The ballot measure does require lawmakers to supplement those dollars with other “available sources” of money. But the judges ruled the question of what funds are “available” is strictly a political one.
“In these circumstances, we are ill-equipped to inquire into and second-guess the complexities of decision-making and priority-setting that go into managing the state’s budget,” appellate Judge Patricia Norris wrote.
Biggs said there is another option: have the state alone provide care for all childless adults.
“We have enough money in our ‘rainy day’ fund,” Biggs said, at least for the foreseeable future. “At bare minimum, we have three years to watch Obamacare implode around the nation while we don’t have to suffer the same detrimental effects.”
And Biggs said there’s another benefit to having that part of the program funded only by the state: No federal prohibition against things like co-pays and deductibles.
The stalemate on Medicaid is having ripple effects. Most notably, lawmakers cannot adopt a budget for the coming year because how much Arizona needs to set aside for health care costs depends on whether the state joins the expanded Medicaid program and taxes hospitals to pay the cost.