Freedom of choice or astronomical price tag? The sound bytes for and against Proposition 101 can paint a confusing picture for voters. Even the name of the proposed constitutional amendment - Freedom of Choice in Health Care Act - implies there isn't choice now.
Proponents, led by two local physicians and conservative anti-tax groups, say the amendment is needed to guard against the possibility of a mandatory single-payer, universal health care system.
Opponents, including Gov. Janet Napolitano, hospitals and business groups, argue that the amendment could increase costs and leave thousands of Arizonans uninsured.
"Anybody who tells you, categorically, that they know what the impact would be is not being honest with you," said John Rivers, CEO of the Arizona Hospital and Healthcare Association.
Backers of Proposition 101 say the measure is simple, and would not have the dire consequences its opponents claim.
It would amend the state constitution to guarantee that Arizonans can make their own health care and health insurance choices, effectively banning health care reforms that restrict medical options, force enrollment in specific plans or charge companies under a "pay-or-play" health coverage model.
That protects consumers, who would not be at the table during health care reform negotiations, against the special interests - such as hospitals and insurance companies - who would be, said Dr. Eric Novack, a Glendale surgeon and chairman of Medical Choice for Arizona.
"The intent of this isn't to prevent things. The intent of this is to create some basic constitutional protections," Novack said. "This is more of a civil rights issue."
Novack said the climate may not be ripe now in Arizona for a universal single-payer health care system, but things could change. He believes there's an urgent need for health care reform, but worries that patients would be the big losers.
"There's a lot of disagreement about how health care reform ought to go," he said. "But unless we give people some rights, special interests will go behind closed doors and take away our rights."
The primary argument against Proposition 101 has been that it could unravel the Arizona Health Care Cost Containment System, the state's version of Medicaid that has been a national model of efficient, full-service indigent health insurance. AHCCCS pays a set fee to state-approved providers to cover about 1 million Arizonans with incomes below the federal poverty level.
AHCCCS Director Anthony Rodgers touched off a legal battle last month with a three-page letter warning that the ballot measure could cost taxpayers $2 billion, not counting the legal fees to sort it all out.
If Proposition 101 applied to AHCCCS, Rodgers said, it's possible that patients could seek any and all types of medical care, with the state footing the bill. That would change the system from a managed care to a fee-for-service plan, which AHCCCS estimates could cost $1 billion.
That scenario could also cost the state its Medicaid waiver, according to AHCCCS, which provides $1 billion in federal funding.
"Our concern is that Proposition 101, with all its ambiguities, might be interpreted by a future court in a way that would destroy AHCCCS and leave the public with astronomical and unreasonable costs in the provision of healthcare for the poor," Rodgers wrote.
GOING TO COURT
Novack and Medical Choice for Arizona took Rodgers to court, arguing that he broke the law by using public funds to influence an election.
A Maricopa County Superior Court judge on Wednesday sided with the state, saying the Rodgers letter was a lawful analysis of the proposition intended to educate the public and didn't cost the state any money.
Novack maintains that the measure would have no impact on AHCCCS because it is a public system that people join voluntarily.
"This constitutional amendment doesn't force the government to pay for anything," he said. "They've just made up these numbers."
Proponents of the measure also complained when Napolitano came out in opposition to the measure, appearing in a photograph with the state seal prominently displayed behind her. The Stop the Prop. 101 campaign agreed to change the ad, but not before thousands of direct mail pieces went out under the headline "Save Our Health Care!"
TOO MUCH CHOICE?
The AHCCCS argument aside, Arizona State University health policy professor Eugene Schneller said there's such a thing as too much choice, particularly if consumers don't have high-quality options.
"I think it's a terrible piece of legislation," Schneller said. "Unrestricted choice is not something that characterizes a good health care system."
Schneller said any fundamental health care reform would be hampered by states having separate laws that could restrict it.
"You've got states making 50 different decisions," he said. "To me, that's just not the way to run a health care system."
During a relatively short, low-budget campaign, both sides have used endorsements to make their case.
Sen. Jon Kyl, and Rep. John Shadegg, both R-Ariz., have joined NFIB Arizona, the Arizona Restaurant Association, the state Dental Association and the Osteopathic Medical Association in support of the measure, along with conservative columnist George Will.
"We have these great freedoms," Novack said. "The freedom to be in control of your own health is absent."
Opponents include the Arizona Chamber of Commerce, the hospital association, the Arizona chapter of the American Academy of Pediatrics, the Children's Action Alliance and the governor.
"I think we should be sure before we enact constitutional change," said Rivers, of the hospital association. "Especially when the downside is chaos for the health care system."