More than 100,000 Arizonans risk losing Medicaid coverage

Proposed bill targets people below poverty line, smokers and obese

By Erika DeLeo
Staff Writer

Arizona Gov. Jan Brewer plans to trim Medicaid in an effort to close the budget gap. The cuts would affect those those living under the poverty level as well as the health care facilities that care for them, such as Yavapai Regional Medical Center (YRMC).

The proposal seeks to eliminate coverage for over 100,000 Arizonans. Most affected would include families and childless individuals living in the top quarter of poverty-level income. Smokers and obese individuals who fail to lose weight could also face a $50 annual fine.

The health care cuts may cause hundreds of local job losses in 2012. A recent study by the Arizona State University W.P. Carey School of Business projected that if this proposal goes through, 676 jobs will be lost throughout Yavapai County, not just in health care, but others sectors of the economy as well.

The state struggles with a $3.2 billion gap this year, and health care is one of its largest expenses. If Brewer’s plan is enacted, which would not happen until October 1, 2011, the state will save more than $500 million in the first year. Due to the federal government’s recent takeover of certain programs, including Arizona’s Medicaid program, the state must now ask permission to make changes to such agencies.

Arizona families did not receive state medical assistance until 1982, when the state enacted its version of Medicaid. They called it the Arizona Health Care Cost Containment System, or AHCCCS, commonly pronounced “access.” It currently serves about 1.3 million Arizonans. The average amount the state currently pays yearly for each enrollee is about $2,000.

Prescott’s YRMC serves more AHCCCS patients per capita than any other hospital in the state. It is the region’s largest employer, with about 1,700 employees, according to John Amos, Chief Operating Officer for the East Campus.

Fifteen percent of patients who come through YRMC’s doors are AHCCCS enrollees. Their medical bills amounted to about $26 million in 2010. Because half of these enrollees are in the top 25 percent of the poverty strata, YRMC will lose millions in funding due to the cuts, Amos said.

“[One of] our main commitments is to make sure our emergency departments [remain] available.” The uninsured are still covered for medical emergencies under the Emergency Medical Treatment and Active Labor Act.

Since the financial crisis began in 2008, AHCCCS enrollment has grown 46 percent, increasing the cost of providing AHCCCS by nearly 65 percent. According to the January 2011 Budget Summary, it currently makes up 28 percent of the state’s budget.

Brewer’s $50 per year “lifestyle” fees are being debated. In 2009, 26 percent of Arizonans were obese, or had a Body Mass Index (BMI) of at least 30, according to the Centers for Disease Control and Prevention (CDCP). Obesity contributes to the risk for cardiovascular disease, certain types of cancer, and type 2 diabetes, the CDCP has long warned. To treat AHCCCS patients for such diseases comes at a cost to taxpayers, Brewer is saying.

Dr. Raymond Lemberg, a psychologist in Prescott with over 30 years of experience and who specializes in eating disorders, calls the fee “discriminatory.” He said 50 percent of obese people are so because of an eating disorder, genetics, or poor understanding of nutrition. “They’re not trying to be obese. … It lacks any compassion [for these people].”

According to a smoking survey by AHCCCS in 2006, 46 percent of Arizona’s Medicaid recipients smoke. Lemberg commented that smoking is one of the toughest habits to break. “It’s not all about effort, willpower, or desire, it’s about getting the help to [quit] … Many people don’t have the powers to address it.”

One piece of legislation stands between Brewer and her proposed cuts. Proposition 204, which state voters approved in 2000, assured coverage for all individuals up to the poverty line. On account of this discrepancy, the Arizona Center for Law in the Public Interest would sue the state.

On March 30, 2011, a group of several hundred gathered in Tucson to protest the AHCCCS cuts. “These services have to continue … If the legislators walked one day — no — one hour in my shoes, [they would not enact these cuts],” said Gina Blair, a mother of two children with disabilities who rely on government help for their health care.

This article appeared in the May 2011 print edition of The Raven Review.


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