Arizona Moves on Medicaid Expansion
By Marina Byrd, CSG Graduate Fellow
As the patchwork of state decisions about Medicaid expansion unfolds across the country, several states have yet to finalize their decisions. Governors of both Arizona and Ohio support Medicaid expansion but face opposition from their legislatures.
The Arizona Senate voted 19-11 on May 16 to approve an $8.8 billion state budget that includes a proposal for expansion. The expansion plan would cover people earning up to 138 percent of the federal poverty level. An additional 300,000 Arizonians would join the already 1.2 million people on Medicaid.
Gov. Jan Brewer supports the Senate decision to pass the proposal.
“Voters of Arizona have voted twice for expansion,” Gov. Jan Brewer said in an interview with The Arizona Republic. And when you look at all the fights, and the discussion, and you look at all the facts and figures, and you do the math, there’s no other way … other than to implement it here in Arizona. We can bring home Arizona taxpayer dollars that they sent to the federal government.”
Some senators still are not convinced expanding Medicaid is the best approach to reaching a healthier Arizona.
“Expansion of Medicaid falls short of what we want to accomplish—high quality, cost effective health care for as many people as possible,” Sen. Kelli Ward said. “There are several articles/studies that show that those covered on Medicaid are not even as healthy as those without insurance or with private insurance and, in fact, may have worse health outcomes than the other populations. As a family physician who has worked with the (Arizona Health Care Cost Containment System) system over the last 14 years, I will tell you that there is both good and bad in the program.”
As the proposal makes its way through the House, the good and bad of the bill will be discussed, along with amendments added by the Senate.
“The good comes from providing coverage for the truly needy and the working poor—short-term benefits to offer a hand up rather than a handout,” Ward said.
Opponents say Medicaid expansion may not be the best means to accomplish quality health care for those who need it. Those opposing the bill say downfalls of the proposal include “over-utilizing the emergency department, urgent care and ambulance services” Ward said.
“The bad also includes long wait times, limited specialists for referral, and program cuts,” she said, and “not having enough primary care physicians and other providers to handle the workload.
She said physicians and hospitals will receive lower compensation rates, which are supposed to made up for in volume.
“There is only so much quality care that can be delivered,” Ward said.
The Senate proposal is similar to one put forth by Gov. Jan Brewer with two significant amendments.
The first requires the Medicaid expansion to terminate on Jan. 1, 2017. Senate Majority Leader John McComish told the Arizona Daily Star the sunset provision would enable future reconsideration of the issue.
The other key difference between the plan is a requirement for hospitals to assess uncompensated care after expansion begins. The Arizona Health Care Cost Containment System is responsible for disclosing uncompensated care in hospitals.
In Ohio, the General Assembly failed to include Gov. John Kasich’s Medicaid expansion proposal in the state budget. Kasich’s plan would cover Ohio residents who earn up to 138 percent of the federal poverty line—an additional 275,000 people.
Kasich is still pushing for expansion, despite the exclusion of his proposal by the House. According to the Cincinnati Enquirer, Kasich argues that expansion is a must in order to help Ohio residents struggling with drug addictions, mental illness and unemployment.
While the General Assembly does not plan to include Medicaid expansion in the budget, both the House and Senate are looking for alternatives. Senate President Keith Faber told The Columbus Dispatch that he considers expansion limited to those with mental illness and drug addictions. The Dispatch reported expansion could become a ballot initiative for 2014 if the governor and General Assembly cannot pass a health care bill.
A ballot initiative requires a petition to bring the issue to voters. The vote, however, would take place in 2014, which means the state would miss one year of the 100 percent federal funding. The federal government will fund new enrollees at that level for the first five years and drop funding in 2017 to 95 percent.