Last Monday at her State of the State address, Gov Brewer presented a practical proposal for expanding Arizona’s Medicaid program to take advantage of funding available under the Affordable Care Act, popularly known as Obamacare.  Her proposal was greeted by stunned looks from many members of her own party.

Brewer recounted her strong opposition to the President’s health care plan, which led her last year to join a coalition of states that sought to block the program in court.  She candidly acknowledged, however, that the law was upheld by the U.S. Supreme Court, Obama was re-elected and his party now controls the U.S. Senate.  These realities have prompted her to acknowledge that “the Affordable Care Act isn’t going anywhere – at least not for the time being.”

She also acknowledged that residents of Arizona have voted on two separate occasions to expand our Medicaid program to cover several hundred thousand medically indigent Arizonans.

Under the Affordable Care Act, the federal government will provide generous financial assistance to states that opt to expand Medicaid eligibility to families and individuals with incomes at or below 133 percent of the current federal poverty level.  The governor’s plan will impose a tax on hospitals to raise $220 million a year, which she claims will cover the state’s share of costs of expanding Medicaid eligibility under the Arizona Health Care Cost Containment System (AHCCCS).  The federal share will amount to $1.6 billion a year, enabling our state to provide Medicaid coverage to about 240,000 additional  residents.  Other key features of the governor’s plan include:

• It will protect both rural hospitals and urban safety net hospitals from being pushed to the  brink of bankruptcy by their growing costs of caring for the uninsured.
• By taking advantage of the infusion of federal funds, it will inject close to 2 billion dollars into the state’s economy, saving and creating thousands of jobs.  According to analyses conducted by the Grand Canyon Institute, a bi-partisan think tank, the proposed Medicaid expansion would create some 21,000 jobs and increase Arizona’s growth by nearly 1 percentage point!
• And most importantly from a human perspective the expansion will avail hundreds of thousands of low-income Arizonans to quality health care, dramatically increasing their quality of life and saving thousands of lives in the process.

Viewing the governor’s proposal strictly from a business perspective, the resultant 1:7 cost/return ratio represents a phenomenal return on the proposed up-front investment, to be covered by a tax levied on hospitals rather than through dipping into the state’s coffers.

To anyone looking at the situation rationally, the Governor’s proposal to take advantage of funding available under the Affordable Care Act to expand our Medicaid program would appear to be a no-brainer.  Under the current system, Arizona has a disproportionately large number of uninsured residents who already present themselves at doctors’ offices and hospital emergency rooms – an extremely expensive source of care.  Hospitals throughout the state, which have been providing an unsustainable amount of uncompensated care, have been hemorrhaging financially to the point where some facilities are considering closure.  Here in Tucson the Carondelet Health System, which operates St. Mary’s and St. Joseph’s Hospitals, has been hit particularly hard and Tucson Medical Center reports that its burden of uncompensated care has close to tripled over the past 18 months.

In unveiling her proposal, Brewer correctly pointed out that the uncompensated care burden that hospitals and other providers are forced to bear results in major cost-shifting as insurance premiums rise to cover the difference.  Dramatizing her point, Brewer stated that these premium increases amount to a hidden tax estimated at nearly two thousand dollars per family per year!

Prospects for passage

The Medicaid expansion proposal is receiving strong support from the healthcare community and the Arizona Hospital and Healthcare Association.  Chambers of commerce throughout the state can also be counted on to be overwhelmingly in favor of the Medicaid expansion due to the boost that passage would provide to communities throughout the state.  Democrats overwhelmingly support the proposal and centrist/moderate legislators should be supportive of passage – one does not need to be a rocket scientist to do the math!

As readers are well aware, however, both houses of our state legislature have sizable contingencies of conservative members, a number of whom are prone to oppose Medicaid expansion on ideological grounds.

The current State Senate President, Andy Biggs, has told the press that he opposes the expansion, while the Tucson Weekly reports that in 2011 he actually sponsored legislation to eliminate Arizona’s Medicaid program.  When recently interviewed Senator Al Melvin (R-District 11, Oro Valley) stated “Frankly I hate to see it…I wish she would stand shoulder to shoulder with her fellow Republican governors and resist this as much as we can.”

Thus, despite the many merits of the Governor’s proposal for Medicaid expansion, its passage is by no means a slam-dunk.  There are, however, a number of hopeful signs, including:

• Governor Brewer is well liked among Republicans, and I believe she can be counted upon to wield considerable clout in persuading her colleagues in both the  house and senate to see the light.
• When viewed solely from a common sense perspective, the Medicaid expansion makes overwhelming sense in both economic and humanitarian terms.
• For obvious reasons, passage enjoys strong support from both the hospital/health care community and chambers of commerce throughout the state.
• I believe there is a growing contingency of bright legislators in both parties who are primarily concerned with providing what is best for the people of Arizona.  As such, I hope and pray that they will focus their wholehearted efforts on convincing their colleagues to do the right thing.
• I also believe that the greater majority of Arizona voters will strongly support Medicaid expansion, provided that they are made fully aware as to what is at stake!

Be a part of the solution

As concerned citizens we must band together to ensure that expansion of our state’s Medicaid program passes both houses.  Presented below are some suggestions on how to become proactively involved in furthering this cause:

• Contact Gov Brewer’s office and congratulate her on bringing this important issue to the front burner, while urging her to do whatever it takes to get her colleagues in the legislature to stand fully behind her.  The address for the Governor’s website is www.azgovernor.com and the phone number is 602-542-4331.
• Contact the two representatives and senator from your own district, expressing your strong support of the Medicaid expansion proposal.  Especially be sure to contact Republican legislators who may be either opposed to the proposal or sitting on the fence.  Be courteous – highlight your selling points: be sure to emphasize the tremendous boost that passage will bring to our state’s economy, together with the humanitarian aspects.  Appeal to their better nature and tell them that you hope they will support this measure and work with their colleagues to garner their full support.
• The House Health Committee and the Senate Health and Human Services will each play a vital role in determining the fate of the Medicaid expansion proposal.  I urge you to send an email to members of each of these committees, expressing your strong support of this proposal.  Members of each committee and their email addresses are listed below:

House Health Committee:

Chair: Heather Carter (R-28) hcarter@azleg.gov

Vice Chair: Paul Boyer (R-20) pboyer@azleg.gov

Kate Brophy McGee ((R-28) kbrophymcgee@azleg.gov

Sally Ann Gonzales (D-3) sgonzales@azleg.gov

Phil Lovas (R-22) plovas@azleg.gov

Eric Meyer ((D-28) emeyer@azleg.gov

Victoria Steele (D-9) vsteele@azleg.gov

Kelley Townsend (R-16) ktownsend@azleg.gov

Senate Health and Human Services Committee:

Chair: Nancy Barto (R-15) nbarto@azleg.gov

Vice Chair: Kelli Ward (R-5) kward@azleg.gov

David Bradley (D-10) dbradley@azleg.gov

Judy Burgess (R-22) jburgess@azleg.gov

Katie Hobbs (D-24) khobbs@azleg.gov

Linda Lopez (D-2) llopez@azleg.gov

Kimberly Yee (R-20) kyee@azleg.gov

• If possible, arrange a small group meeting with a targeted legislator who has either stated that he or she is opposed to the expansion proposal, or is sitting on the fence.   All legislators want to be perceived as being attuned to the needs of their constituents, and you can count on having their undivided attention!  Again, be polite, present your selling points – especially those that will appeal to their constituency – and appeal to their better nature.
• And last but by no means least – do whatever you can to educate your friends, neighbors and other members of your community concerning the importance of this issue!  Talk with your minister, priest or rabbi and ask to make an announcement on this topic at your church, synagog, mosque or other religious institution.  Many if not most religious leaders will embrace the humanitarian appeal of educating their congregation on this vital issue.  Letters to the editors of the Daily Star, Arizona Republic and other papers are critically important as they provide an excellent vehicle to make sure that your points are noted by thousands of concerned citizens!

In summary, Gov Brewer’s proposal to expand our state’s Medicaid program is a classic example of a win-win proposition.  Let’s all join together to ensure passage of this vitally important measure!!