Gov. Jan Brewer is blasting congressional ideas for a national health plan, saying it could cost Arizona taxpayers billions of dollars.
Much of that cost would occur if Arizona is forced by the federal government to provide care to everyone who already is eligible now.
In a letter to Sen. Max Baucus, D-Mont., the governor called it “incomprehensible that Congress is contemplating an enormous unfunded entitlement mandate on the states.” Baucus plays a key role in the debate, not only as chairman of the Senate Finance Committee but as the sponsor of one of the health reform bills being considered.
Part of Brewer’s concern is loosening standards to make more people eligible for the Arizona Health Care Cost Containment System, the state’s Medicaid program. While the federal government picks up two-thirds of the cost, the balance is borne by state taxpayers.
But the governor told Capitol Media Services that eligibility expansion is only part of the problem of what is being considered.
She said even if a national plan makes no changes in who qualifies for AHCCCS, the legislation would require enrollment of all those who meet the income criteria rather than leave the choice to the individuals. That, she said, would create a “woodwork effect.”
Specifically, she figures Arizona has about 200,000 residents whose income now makes them eligible for AHCCCS but who have not signed up. If all of them are located and enroll, the state’s share of the cost would be about $4 billion over the next five years.
Brewer said there’s a reason those folks haven’t signed up: They are young and, for the moment, healthy.
“They’re out there, and they feel they’re immortal and they don’t obviously worry about it,” she said.
Brewer acknowledged that when they do get sick, they end up in hospital emergency rooms with expensive conditions — and hospital bills that state taxpayers are now forced to pick up.
One of the things that makes AHCCCS different than most state Medicaid programs is that it is set up essentially like a health maintenance organization: The state pays a flat fee to providers for all care under the premise that that gives them an incentive to keep those enrolled in the program healthy through regular checkups and preventative medicine.
The governor said, though, she has to look at any changes through the lens of the state’s current fiscal mess.
“We know that, at this point in time, with our economic issues, fiscal problems that we’re facing, that we’re looking to cut” state expenses, not add to them, she said. Brewer said that, even with the federal government providing partial financing for any national health care plan, it is not fair for Congress to assume states will pick up the balance.
But Rep. Kyrsten Sinema, D-Phoenix, said Brewer is off base with her objections.
“Yes, it could be a problem financially,” she said.
“But those people could turn around tomorrow and enroll anyway,” said Sinema, the No. 2 Democrat in the state House. “And there’s nothing we could do about it,” she said, given the requirement under state law to provide care for everyone below the federal poverty level.
That isn’t the only problem. Several of the plans under consideration actually would make more people eligible for AHCCCS.
Right now AHCCCS provides coverage for anyone up to the federal poverty level, a figure that computes out to $18,310 a year for a family of three. At that level, more than 1.2 million Arizonans already are getting free care, a figure that exceeds one out of every six residents.
Several bills — including one crafted by Baucus — would take that to at least $24,353. That change could add another 400,000 to the rolls, putting one out of four Arizonans into the government-run program.
Sinema was more sympathetic to Brewer’s concerns about expanded eligibility at state expense.
“That’s not fair because states don’t have the money to do that,” she said.
Sinema does support a national health plan. And she said if Congress wants help from the state in an expanded system it should phase that in, with the federal government picking up the entire cost at first and gradually asking states for a larger contribution.
Brewer said she hasn’t made up her mind about whether there should be some sort of national health care plan.
“It is a huge, complicated issue,” she said. And Brewer said she has no particular solution in mind to dealing with high health costs and a large number of people who lack insurance.
“But we know that, in these economic times, that we are not in a position to have any further unfunded mandates sent down to the states,” she said.