Posted by AzBlueMeanie:
Oh, here we go again . . . the usual suspects in the Arizona legislature are threatening to harm the poor and the sick out of ideological extremism against President Obama and blind hatred for his "ObamaCare," and the poor and sick generally.
The Arizona Capitol Times (subscription required) reports AHCCCS expansion on the ropes after federal matching funds decision:
The U.S. Centers for Medicare and Medicaid Services announced Dec. 10 that states won’t get extra federal money to expand their Medicaid programs unless they implement the full expansion enshrined in the Affordable Care Act. The health care law dramatically increases the federal matching funds available to states that expand Medicaid coverage to include people earning up to 133 percent of the federal poverty level.
For Arizona, where many had hoped to get the enhanced federal matching funds to restore Arizona Health Care Cost Containment System coverage to 100 percent of the federal poverty level, the federal announcement was a gut check.
Proposition 204, a 2000 ballot measure, expanded AHCCCS coverage to 100 percent of the federal poverty and extended coverage to include childless adults. But Brewer and the Legislature froze enrollment for childless adults during Arizona’s budget crisis, and more than 100,000 people lost Medicaid coverage as a result.
The federal government provides a two-to-one match to states for their Medicaid programs, supplying 66 percent of the funding for AHCCCS. The enhanced match available under the Affordable Care Act provides 85 percent of the funding.
The cost difference for Arizona is staggering. With the enhanced match, Arizona could have restored the Prop. 204 coverage for $135 million in fiscal year 2015. With the traditional two-to-one match, however, the cost skyrockets to about $478 million, according to the Joint Legislative Budget Committee.
[This is a technical term known as a "no-brainer."]
Some say the state’s best option is now to embrace the full expansion of Medicaid under the Affordable Care Act, which would provide coverage to anyone earning up to 133 percent of the federal poverty level. According to JLBC, the full expansion carries the same $135 million price tag in 2015 because the federal government would initially pay the full cost of all Medicaid patients who earn between 101 percent and 133 percent of the federal poverty level.
And here is the obligatory bullshit alert. Tea-Publican legislators who are ideologically opposed to ever implementing "ObamaCare" are going to cite budget projections for future years that are highly subjective and highly speculative at best. No one really knows. Bottom line is, these guys are opposed to expanded Medicaid (AHCCCS) and "ObamaCare" on an ideological basis, regardless of the cost. It could be free and they still would reject it.
[M]any lawmakers are concerned about the long-term costs of the full expansion. After 2016, the federal match for people who are above the federal poverty level drops to 90 percent, and no one is sure how much the state will have to pay after that. In addition, some worry that the deficit-wracked federal government won’t be able to afford the 90 percent match in the long run either.
* * *
Senate President Andy Biggs, R-Gilbert, said the Centers for Medicare and Medicaid Services decision on enhanced matching funds is likely a death knell for Prop. 204 restoration.
“It does make it harder,” Biggs said. “It seems to me that we have a potential huge problem if we do this.”
If the state only had to spend $135 million to restore the Prop. 204 coverage with enhanced matching funds, Biggs said that might leave some extra money to boost K-12 spending. But the $478 million price tag that Arizona now faces doesn’t leave policymakers any room to maneuver.
“If you spend $200 (million) to $300 million (more) over here on the childless adults, all of a sudden, where do you find that money to spend on K-12 education?” Biggs said. “We’re on an unsustainable path economically and for us to accelerate the unsustainability of that path doesn’t really seem the wisest move.”
* * *
House Speaker Andy Tobin called the federal decision on the enhanced matching rate a “blatant attempt” to force states like Arizona to implement the full expansion.
“With far too many unanswered questions regarding how the Affordable Care Act will be fully implemented, this will be imposed on us with no latitude to adapt our program to suit Arizona’s unique health care needs,” said Tobin, R-Paulden. “Aside from those concerns, Arizonans know that this federal government has not consistently upheld its budgetary commitments and we will be on the hook for any shortcomings.”
* * *
Rep. John Kavanagh, chairman of the House Appropriations Committee, agreed, saying many lawmakers were cool to the idea of expanding AHCCCS coverage to begin with.
“It’s not going to happen,” said Kavanagh, R-Fountain Hills.
Sen. Rick Murphy, R-Peoria, said AHCCCS expansion is essentially unaffordable now, and said the feds’ decision on matching funds likely ends any chance that it will happen.
“Even if all of us really, really want to do it tomorrow, which isn’t necessarily the case, we simply don’t have $380 million to implement the first year of it, much less ongoing years,” Murphy said.
Other Republican lawmakers echoed those sentiments. Rep. Kate Brophy McGee, R-Phoenix, said hospitals will “bear the brunt” if AHCCCS coverage isn’t restored because more patients end up in uncompensated care. The hospitals are pushing lawmakers on the issue, she said.
“The question still is, how in the heck will we pay for it (Prop 204. restoration)?” Brophy McGee said.
* * *
Sen. Don Shooter, who chairs the Senate Appropriations Committee, said Brewer’s proposal will be a factor in his decision. For now, the Yuma Republican said he’s still trying to gather information.
“I’m always skeptical of expanding any program. I have that natural bias or that natural worldview. So I just think in general it’s a bad idea to expand the role of government,” Shooter said. “Having said that, we’ve got to do what’s prudent. And I’m still trying to determine what that might be.”
* * *
Some Republicans don’t want to take any more federal money for Medicaid, regardless of how high the match is, because they don’t want to exacerbate the enormous federal debt. Sen. Al Melvin, R- SaddleBrooke, said the country’s debt, much of which is borrowed from China, will be a severe problem in the future. He referred to the debt as “generational theft.”
“It’s our patriotic duty to be looking at this national debt of $16 trillion and to realize that 40 cents on the federal dollar is borrowed. So before we insist on or try to get more federal money, we need to be aware of it,” Melvin said. “There will be a day of reckoning.”
There are two things the legislature can do immediately. First, accept the expanded Medicaid provisions under "ObamaCare." Second, reconsider the hospital tax proposal from the hospital associations floated this past year but rejected by the legislature because of their ideological "no new tax" pledge to their lord and master, the Tax Fairy, Grover Norquist.
Peter Wertheim, vice president for strategic communications at the Arizona Hospital and Healthcare Association, said his organization may be open to a provider tax, but isn’t ready to commit to anything.
“It’s a tricky solution but it’s certainly one we absolutely do not want to take off the table or discount. If that ultimately becomes the most viable direction to head, we’re certainly prepared to step up.
But right now I think we need to be careful not to lock ourselves into one approach just yet,” Wertheim said. “If we can find a way to help with the financing, certainly I think we’re capable of coming together with the business community and offering up some solutions.”
Senate Minority Leader Leah Landrum Taylor, D-Phoenix, said Arizona would be far better implementing the full expansion, emphasizing that it will now cost far less than simply restoring coverage for childless adults under Prop. 204.
“With that being the case, I’m hoping something can be done,” Landrum Taylor said. “We need to look at a plan to move in that direction so that we are able to get those enhanced funds.”
Landrum Taylor acknowledged that the state will probably need more revenue for either the restoration or the full expansion. She said lawmakers should consider eliminating tax credits and loopholes, a popular idea among legislative Democrats.
“There are ways. We have got to come up with ideas for how this can happen. And it’s a hard conversation. I know it’s hard,” Landrum Taylor said.
More about this in the next post.