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The Arizona Senate & Medicaid Expansion: A Lesson in Making a Bad Bill Worse

May 23, 2013 by Leave a Comment

By Christina Corieri

Last week, the Arizona Senate passed Medicaid expansion. Sadly, the proponents were not satisfied with merely passing a program expansion we can’t afford; they actively worked together to kill a series of common sense amendments that would have prevented extra expense and abuse.

One amendment would have activated the circuit breaker if the federal government ever dropped its share of the cost below the promised 90 percent, but every senate Democrat and five Republicans voted the amendment down, signaling that the Feds should feel free to increase Arizona’s costs.

Another amendment would have required an independent audit to ensure hospitals don’t pass the provider tax on to patients. Expansion proponents voted the amendment down, making it easier for hospitals to illegally pass the cost along without fear of being caught.

An amendment was offered to require an annual report on the quality of care provided by AHCCCS, Arizona’s Medicaid program. Although taxpayers have a right to know whether their money is being put to good use, these same senators voted the amendment down. Without this transparency, proponents can continue to assert how well the program works without risking evidence to the contrary.

This coalition also voted down amendments designed to curtail non-emergency use of emergency rooms and ambulances, which result in high, unnecessary costs to the state. Likewise, they voted down amendments to require health professionals and pharmacists to check the prescription monitoring database before authorizing or filling a member’s prescription for a controlled substance such as Oxycodone, Percocet, or Vicodin. These amendments would have saved taxpayers from paying for and enabling addictions to these medications.

While the Medicaid expansion is a costly and misguided policy, these amendments were not poison pills but sensible ways to mitigate some of the costs and prevent abuse. The proponents, however, made a bad bill much worse by rejecting these amendments. Thankfully, the Senate does not have the last word. While we hope the House declines the Medicaid expansion, at a minimum, we hope it supports some common sense amendments that will help protect taxpayers.

Christina Corieri is a health care policy analyst with the Goldwater Institute.

 

Filed Under: Economics, Federal Government, Health Care, Legislation, Spending, State Government Tagged With: , , , ,

Friday Poll: Do You Support/Oppose Obamacare’s Medicaid Expansion in Arizona?

May 17, 2013 by Leave a Comment

In case you missed it, the Arizona Executive and Legislative branches are embroiled in a battle over expanding Obamacare’s Medicaid program in Arizona. Here is the latest Friday poll gauging our reader’s position on this issue. Votes are scheduled in the Arizona House next week.

Filed Under: Entitlements, Health Care, Polls, Spending, State Government, Taxation Tagged With: , , , , , ,

NFIB Poll: Small Business Strongly Opposes Expanding Medicaid

May 14, 2013 by Leave a Comment

NFIBforwebSurvey reveals Arizona entrepreneurs’ deep skepticism of federal funding promises

PHOENIX, Ariz., May 14, 2013 — In a poll released today by their leading association, small-business owners overwhelmingly oppose the high-stakes effort at the Arizona State Capitol to expand Medicaid coverage to all Arizonans at or below 133 percent of the federal poverty level as envisioned by the federal healthcare law.

The recent survey conducted by the National Federation of Independent Business (NFIB/Arizona) found 79 percent of Arizona small-business owners opposed to the proposed eligibility expansion for the state’s Medicaid program, also known as the Arizona Health Care Cost Containment System or AHCCCS.

Eighteen percent support the Medicaid expansion proposal with less than 3 percent saying they are undecided.

NFIB Medicaid Poll ResultsThe controversial Medicaid proposal, a centerpiece of Gov. Jan Brewer’s legislative agenda, is principally backed by hospital systems and opposed by key legislative leaders like Senate President Andy Biggs and conservative activists.

The political impasse over Medicaid expansion has stalled the Legislature’s work on the state budget for the next fiscal year, which begins on July 1, 2013.

“Small businesses in Arizona clearly feel they are under siege by the Obamacare law, with its harsh employer mandates, new taxes and pervasive uncertainty,” said Farrell Quinlan, the Arizona state director for the National Federation of Independent Business. “Our survey found that Arizona’s small-business owners continue to strongly oppose expanding AHCCCS eligibility, because they have no faith in the federal government’s promises to pay for adding hundreds-of-thousands of Arizonans to our Medicaid rolls. Our small-business owners know Washington is more than $16 trillion in debt and Congress will be under increasing pressure to cut the biggest drivers of federal spending – entitlements like Medicaid.”

NFIB/Arizona’s May survey on Medicaid expansion reaffirms small business’ sentiments against expanding Medicaid found in a prior survey conducted before Governor Brewer announced her support for the policy change during her State of the State Address in January.

NFIB Medicaid Poll Results 1/13 and 5/13

In that poll, 77 percent opposed the expansion with 13 percent favoring it and 10 undecided.

“It’s instructive that after months of intense promotion and expensive radio and television advertising campaigns, pro-expansion forces have utterly failed to move the support needle with Arizona small business owners,” said Quinlan. “The public’s attitudes have clearly hardened on Obamacare and the fundamental transformation of health care occurring in the United States.”

Respondents to NFIB/Arizona’s survey were also given the opportunity to provide an open-ended answer on the Medicaid expansion issue and implementation of Obamacare in general. The majority viewpoint is best summarized by one respondent’s declaration: “Arizona won’t be able to afford AHCCCS expansion when Washington realizes America can’t afford Obamacare.” Another opponent expressed his profound ambivalence over the decision before Arizona lawmakers: “Either choice is going to be tough and expensive, but to trust the federal government is a mistake. I do not feel that they will make good on their promise to cover the expenses.”

A Medicaid-expansion supporter wrote: “As I understand it, the expansion goes away if/when the federal money goes away. That is the only reason I am supporting it now. When Obama doesn’t want to pay for it anymore, neither should Arizonans.” Another supporter exclaimed: “Believe we are trapped. If O C [Obamacare] stays this seems like the only way to go. But we must have the 90 percent funding from the Feds.”

The latest poll was conducted May 6 to May 13, 2013, as an online and fax-returned survey with 375 Arizona small-business owners responding. The prior poll mentioned above was conducted November 9, 2012 to January 4, 2013 consisting of 449 Arizona small business owners responding. Both polls tested the same question though the set-up explanations of what proponents and opponents say about the policy proposal were updated and expanded in the latest survey. The online version of the May survey can be viewed here.

NFIB routinely surveys its members to determine the organization’s public policy position on issues at the federal and state levels. Due to the overwhelming and consistent results of the two surveys, the upcoming votes by the Arizona Senate and Arizona House of Representatives on Medicaid expansion have been identified as ‘key votes’ eligible to be used on NFIB/Arizona’s legislative score card for the 2013 session.

Commemorating its 70th anniversary, the National Federation of Independent Business is the nation’s leading small-business association with 350,000 members nationwide and 7,500 in Arizona. NFIB has offices in Washington, D.C., and all 50 state capitals. Founded in 1943 as a nonprofit, nonpartisan organization, NFIB gives small- and independent-business owners a voice in shaping the public policy issues that affect their business. NFIB’s powerful network of grassroots activists sends its views directly to state and federal lawmakers through our unique member-only ballot, thus playing a critical role in supporting America’s free enterprise system. NFIB’s mission is to promote and protect the right of our members to own, operate and grow their businesses. More information about NFIB is available at www.NFIB.com/newsroom.

Filed Under: Arizona Politics, Debt, Entitlements, Federal Budget, Health Care, Legislation, Polls, Small Business, Spending, State Budget Tagged With: , , , , , ,

Medicaid Expansion: Been There, Done That

May 9, 2013 by Leave a Comment

AFP Arizona

To all Arizona taxpayers and health care consumers:

When it comes to the fiscal costs and human damage of expanding Medicaid/AHCCCS under ObamaCare, we know that things will turn out badly.  How do we know?  Because we’ve been there, and we’ve done that.  Here is what past experience, here in Arizona and elsewhere, tells us about the proposed expansion:

1)   The Medicaid expansion will cost much more than projected.
2)  The expansion may do nothing to help low-income Arizonans — and could hurt them.
3)  The so-called “hidden health tax” won’t get fixed.
4)  Arizona must bargain hard to get a better deal.
5)  The disgusting ploy to gut Prop 108 taxpayer protections will lead to more tax hikes.

You can read more about each of those items below, and TAKE ACTION HERE.  And click onthis link for info about the health care freedom protest at the Arizona Capitol on May 15.

1)  The Medicaid expansion will cost much more than projected.

None of the promised fiscal results of Arizona’s last Medicaid/AHCCCS expansion (enacted by voters through Prop 204 in 2000) actually materialized.  Prop 204 backers promised that the AHCCCS expansion would save money in the state budget.  The Joint Legislative Budget Committee was somewhat wiser, knowing that the expansion would cost the state money.  The committee projected that covering the Prop 204 population would cost $389 million in 2008.  But the actual cost was $1.623 billion — four times as expensive as projected!

And of course, the projected $2 billion in federal matching funds is not “free.” Certainly not for federal taxpayers — including millions of Arizonans.  According to the Goldwater Institute’sChristina Corieri, if Arizona and 11 other fence-sitter States join the 18 States that have already said No to the ObamaCare Medicaid expansion, the country could save $609 billion by 2022. That’s real money — even in Washington!

2)  The expansion may do nothing to help low-income Arizonans — and could hurt them.

Several studies suggest that Medicaid may actually hurt its supposed beneficiaries, but there has been only one randomized study (the Oregon Health Insurance Experiment) comparing persons on Medicaid to persons having no insurance at all.  According to results released last week, the study has so far failed to find any evidence that putting people on Medicaid saved any lives or made any improvements in several objective health markers (blood pressure, cholesterol levels, and diabetes).

Things will get worse in AHCCCS the longer ObamaCare goes without being repealed.  In Arizona, according to the Kaiser Family Foundation, 23 percent of doctors say they will not accept AHCCCS patients.  Combine large increases in the Medicaid population with a declining number of doctors, and the result will be longer waiting times for patients.  In medicine, longer waiting times often mean discomfort, disability and death.  Read more about the human cost of the Medicaid expansion HERE.

3)  The so-called “hidden health tax” won’t get fixed.

The proponents of the current Medicaid expansion estimate that there is a “hidden health tax” of $2,000 per family per year in higher insurance premiums caused by uncompensated care(uninsured or underinsured people using the emergency room).  13 years ago, backers of the Prop 204 Medicaid expansion made the same argument, claiming that the expansion was going to relieve the state’s uncompensated care problem.  But according to a Lewin Group study,uncompensated care in Arizona increased by an average of nine percent per year during the first seven years of the Prop 204 Medicaid expansion, and the average family’s health insurance premium increased from $8,972 in 2003 to $14,854 in 2011 – a 66 percent increase.

Before you believe the hospital lobby’s arguments about uncompensated care, be sure to read Christina Corieri’s latest post: Medicaid expansion will line hospitals’ pockets.

4)  Arizona must bargain hard to get a better deal.

The main reason Arizona’s Medicaid system (AHCCCS) is not as bad as that in most other States is that Arizona waited two decades to join the Medicaid program.  Because we held out, we were able to bargain for a better deal – a Medicaid program that has been better at controlling costs and has provided better options for patients than in many other States.

But Governor Brewer’s team has failed to even try negotiating with Obama’s department of Health and Human Services (HHS).  In its most recent message about the Section 1115 waiver, HHS said “we do not anticipate that we would authorize enrollment caps or similar policies” while still letting States get 2-to-1 matching dollars.  But of course, “we do not anticipate” is not the same thing as saying “No.”  Right now, HHS is in the position of having to negotiate with States, because 18 States have already said No to the Medicaid expansion, and 12 States are still on the fence.  At this point, we don’t know if HHS really means “No,” because the Governor’s team simply threw up the white flag and capitulated to the demands of the Obama Administration.

Further, the Governor’s cost projections are based on AHCCCS coverage under cookie cutter Medicaid rules – in other words, how much things will cost if we capitulate and run AHCCCS according to federal diktat, without negotiating for better ways to run the program.

5)  The disgusting ploy to gut Prop 108 taxpayer protections will lead to more tax hikes.

Proponents of the ObamaCare Medicaid expansion are trying to do an end-run around Prop 108, the most important taxpayer protection in the Arizona Constitution.  Under Prop 108, it is supposed to take a two-thirds majority of the Legislature to raise taxes.  But Medicaid expansion proponents want to allow an unelected bureaucrat at AHCCCS to raise state taxes (mainlyhospital bed taxes) by hundreds of millions of dollars per year — without a two-thirds vote of the Legislature!

In their efforts to squeeze a giant hospital bed tax (“provider tax”) through a tiny loophole in Prop 108, Governor Brewer and others are trying to pretend that the provider tax is not a tax — even though the provider tax is a TAX under the Social Security Act.  They are also trying to pretend that: the provider tax is not allocated according to formula, although it plainly is; the provider tax does not have a limit, although it is limited by federal law to six percent; and, we don’t know how much money will be raised by the tax, even though the Governor and some Legislators are building budgets around the expected revenue.

History shows that removing taxpayer protections inevitably leads to higher taxes.  If Arizona’s Legislators delegate to an AHCCCS bureaucrat the authority to impose gigantic taxes on hospital patients, they will kill Prop 108, clearing the way for other departments and agencies to raise taxes without getting approval by legislative supermajorities.

To block the ObamaCare Medicaid expansion and to stop the end-run around Arizona’s constitutional taxpayer protections, TAKE ACTION HERE. For more information about the May 15 health care freedom protest at the Arizona Capitol, go here.

For Liberty, Tom

Tom Jenney
Arizona Director
Americans for Prosperity
www.aztaxpayers.org

Filed Under: Entitlements, Health Care, Press Release, State Budget, State Economy, State Government, Taxation Tagged With: , ,

The Brewer Ruse: Offering Arizona on a Silver Platter to Obama.

May 7, 2013 by Leave a Comment

There is a ruse afoot. The highly paid political consultants are failing in their attempt to help Governor Brewer surrender Arizona to Obama so a deceitful plan is being hatched to secure a few votes.  As Obamacare collapses on the national stage the Governor doubles down determined to make Arizona the victory of the year for the Democrats. Arizona – land of SB1070 – leader of State Rights – what a trophy for the Democrats!

Surrender AZThe estimated whooping $750K provided by the Chamber and Hospitals to ram Obrewercare down our throats failed to bully the Legislators or change the mind of Arizonans. Two months of heavy handed intimidation of Republican county and legislative chairman, precinct committeemen, legislators, and weeks of TV ads saturating the public has resulted in the Governor losing 2 more Republican votes in the House and putting 5 votes from the FOR to “on the fence”.

Senate President Andy Biggs and Speaker Andy Tobin have maintained a stalwart stance defending the core Republican tenant of limited government and protecting the state from the train wreck that is Obrewercare. Last week the embattled Republican leadership hindered the Governor’s attempt to employ a downright rotten Nancy Pelosi parliamentary trick to bypass the normal legislative process – just to get her way.

So now Governor Brewer plots to give Arizona a deceitful amendment and utilizes yet another Obama skill: community organizing.

The Governor plans to add an “amendment” to Obrewercare that she knows the courts will rule as unconstitutional because they already have. The amendment will state that no money will go to Planned Parenthood. This is a cover for Pro-Life Representatives Boyer and Orr, and perhaps Pratt, and Mesnard to vote FOR Obrewercare. The problem is that the US Supreme Court just ruled that you cannot deny Federal money to go to Planned Parenthood.

Just in case this deceptive plan fails the governor has a backup plan. She is turning to a far extreme leftist organization for help since her highly paid political consultant is failing to deliver Arizona on a silver platter.

Yes you read that correctly. Valley Interfaith Project, VIP, proudly proclaims a Marxist mission defining itself as “a non-partisan organization of dues-paying member congregations, schools, unions and non-profits committed to building relational power through organizing people for sustainable social and economic improvement.”

Governor Brewer, Majority Leader John McComish, and top Brewercrat Heather Carter attended the VIP meeting to drum up support for Obrewercare! The Republican McComish relished his newfound community organizing role leading the way with rallying cries and inspiring phrases. McComish, who just this last week threw the precinct committeemen of Arizona’s star legislative district 18 under the bus, calling his PC’s an inconsequential minority, showed true leadership with his newfound socialist friends –  passing out signs and calling for widespread community organizing.

Let it be clear – Governor Brewer and the newly minted Brewerlib, John McComish, are utilizing a Marxist group to community organize against their own party.

Governor Brewer seems oblivious to the fact that she is handing the Democrats the victory of the year – Obamacare in Arizona.

 

Filed Under: Blogs, Health Care

Update on Obamacare-Medicaid Expansion in Arizona

May 1, 2013 by 1 Comment

Here’s a brief update on the push to expand Medicaid in the Arizona Legislature.

Rumors are circulating that Senator John McComish is attempting to orchestrate a coup d’état on Senate President Andy Biggs as former Senate President Steve Pierce looks on with plausible deniability. Why a coup? Because Senate President Andy Biggs is the one individual holding firm against a vote on Obamacare’s Medicaid expansion in the State Senate. Both McComish and Pierce are supporting Governor Brewer and trying to pave the way for her Medicaid plan. But you should also know that McComish and especially Pierce took thousands of dollars from higher-ups in the healthcare industrial complex during the last election cycle. (Biggs did not.) We are compiling the names and amounts of all the donations received by Medicaid proponents with the goal of connecting the dots. Just another example of the corporate-political incest (yes, it happens on both sides.)

Meanwhile in the State House, Governor Brewer does NOT have the votes to pass her Medicaid expansion. Proponents of Medicaid expansion are short the votes needed to require both a simple majority and two-thirds vote (Prop 108 requirement). House Speaker Andy Tobin is also holding back a vote on the legislation so you can imagine he is under tremendous pressure to let the legislation move for a vote.

At the same time all this is taking place, Democrats are getting very irritated with an effort to amend any legislation to prohibit our tax dollars from going to Planned Parenthood. (We all know that giving money to Planned Parenthood is an accounting game that allows them to free up other funds for abortions.) Democrats want the Medicaid bill to remain silent on tax dollars to abortion providers because they know Planned Parenthood would be feasting off the same steady stream of tax dollars “returning” from the federal government. In fact, House minority leader and likely Democrat gubernatorial candidate Chad Campbell sent an email out today expressing frustration, covering for abortion providers and urging individuals to call their legislators. His rhetoric has heated up calling social and religious conservatives “extremists,” “right-wing” and “special interests” all because they oppose using tax dollars to fund Planned Parenthood.

Keep your eyes on the players in this whole exercise of corporate cronyism and who stands to gain the most “free” tax dollars.

Filed Under: Arizona Politics, Elected Officials, Entitlements, Health Care, Legislation, Political Parties, Political Science, Sanctity of Life, State Government Tagged With: , , , , , , , , ,

The Obamacare Girls: Brewer & Pelosi

April 27, 2013 by Leave a Comment

Governor Brewer continues to galvanize the Republican Party with her stubborn refusal to face the fact that Arizonans reject Obrewercare. After her unsuccessful attempt to apply the intimidation techniques acquired in the ObamaCampaignTactics101 she now reaches deep into the Nancy Pelosi bag of tricks and pulls out a parliamentary stunt to get her way.

Stop OBrewercare in Arizona!

Stop OBrewercare in Arizona!

Getting her way is what this is all about – right? This week the Ohio Legislators stood up to their Governor and offered a budget minus the expansion.  The U.S. Congress Democrats are so concerned about the political price they will pay in 2014 they are pleading to postpone the implementation of Obamacare!

But Governor Brewer doesn’t care about the Republican majority in Arizona. Governor Brewer doesn’t care if she is hurting the political future of the republican legislators. Governor Brewer definitely does not care about the Arizona Republican Party because every republican legislative district (minus 2) and county openly opposes Obrewercare and yet she pushes on.

So now the Republican Governor is using the exact same maneuver to bring Obrewercare to Arizona that Nancy Pelosi used to bring us Obamacare - just to get her way.  The AZ Senate is considering forcing a vote on the floor.

NO public input.   NO committee debate.   NO expert testimony.  NO doctors – NO nurses – NO homecare providers telling the impact on their lives.

The Lobbyists are in control because our Republican Governor is handing our health care to them on a silver platter.

For a complete list of the Legislators supporting Obrewercare : http://fragaz.org/obamacare-girls-brewer-pelosi/

 

Filed Under: Arizona Politics, Blogs, Guest Opinion, Health Care

MIHS Meets in Closed Door Session to Discuss Controversial State Contract

April 23, 2013 by Leave a Comment


The Maricopa County Integrated Health Systems Board of Directors is currently meeting in closed-door Executive Session to discuss the current legal challenge and protest filed by Magellan and United RHBA against MMIC (Mercy Maricopa Integrated Care), MIHS CEO Betsey Bayless, and Maricopa County Special Health Care District.  The current agenda shows a 30-minute spot dedicated to discussion of this subject, all of which will be exempt from records requests and exempt from public inspection.

It is not surprising that the MIHS Board is keeping a low profile and is remaining tight-lipped about this controversial contract after being awarded a possibly illegal $2 billion to $3 billion dollar contract from the State of Arizona.  This came on the heels of a controversial pay raise for MIHS CEO Betsey Bayless that raised her taxpayer salary to $500,000.

Accountability and SunshineThe board will apparently receive legal advice on the protest to the bid and discuss options moving forward.  An administrative law judge is likely to uphold the Department’s awarding of the contract, leaving a lawsuit targeting the state as a possible option.  Magellan has already filed a civil suit seeking financial damages in Maricopa County Superior Court against MIHS and MIHS’ CEO Betsey Bayless.  Magellan alleges MIHS was awarded the contract improperly and used proprietary information from Magellan to win the bid.

The new contract was set to begin on October 1, 2013, but the protest and lawsuit are likely to delay implementation.  Previously MIHS responded to the formal protest with the following statement:

“We are studying those protests and will respond in the appropriate venues,” the statement said. “We are confident in the strength of our bid, and we are proud to offer a unique, collaborative approach to meet Maricopa County Medicaid recipients’ behavioral-health needs and to integrate the behavioral- health and medical services for those with serious mental illness.”

If you recall, the lawsuit also alleges “serious conflicts of interest” by MIHS because Mercy Maricopa both manages the system and provide services, which is “prohibited by the contract and by state law.” Magellan also alleges that the bidding process contained “serious irregularities,” such as the state’s bidding process being amended twice to unfairly benefit MIHS over their private competitors.  Additional claims include conflicts of interest, improper scoring, licensing problems, and disclosure of proprietary information to competitors. Magellan originally serviced the state contract since 2007.

The serious allegations require attention and deserve public scrutiny.  MIHS should be holding discussions on the contract and the protest, but they should be doing this in the face of the public.  Not behind closed doors immune from public records requests. MIHS is a government entity that collects nearly $60 million dollars in property taxes every year and is run by a publicly elected Board of Directors.  When the state awards a contract that could be worth up to $3 billion dollars, possible bias in favor of a taxpayer funded MIHS over private competitors deserves more sunshine and certainly more accountability.

If you’d like to contact the MIHS Board of Directors and demand more transparency for taxpayers, they can be reached via email as follows:

 

Filed Under: County Government, Elected Officials, Ethics, Guest Opinion, Health Care, Special Interests, Spending Tagged With: , , , , , , , , , , , ,

Arizona Stands for Health Care Freedom!

April 16, 2013 by Leave a Comment

AZAgainstObamacare

Please visit and like our Facebook page!

Filed Under: Conservatives, Federal Government, Health Care, Political Ad, State Government Tagged With: , , ,

Uninsured May Have Better Access to Care than Medicaid Patients, Survey Shows

April 16, 2013 by Leave a Comment

Reposted from AAPSonline.org

The public relations campaign to support Medicaid expansion frequently uses testimony by patients with serious medical conditions who have lost their private insurance. It is assumed that once they qualify for Medicaid, they will easily get their chemotherapy, hepatitis c treatment, or defibrillator battery replacement.

“The messages talk only about coverage, not care,” states Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). “But the real question is whether Medicaid provides access to care.”

An internet survey of AAPS members shows that about 47% of respondents think that it is more difficult for a Medicaid patient, compared with an uninsured patient, to get an appointment with a primary-care physician. Only 26% thought that the uninsured had more difficulty. For specialist appointments, 44% thought uninsured patients were better off, and 32% thought Medicaid patients were better off. Only 2% thought that Medicaid patients had “no problem” getting an appointment with a specialist.

When asked, “How easy is it for a Medicaid beneficiary to obtain drugs, medical equipment, or diagnostic tests?”, 48% said it could be “extremely difficult,” 27% said “moderately difficult at times,” and only 13% said it was “no problem.”

Of 166 respondents, 96 were physician specialists, 63 primary physicians, and 7 emergency physicians.

Open-ended comments were overwhelmingly negative about Medicaid. Rural patients who are unable to drive or travel may have no access to care at all except through charity. Some areas have no hand surgeons, endocrinologists, dentists, or rheumatologists who will accept Medicaid. Many cardiology tests, even echocardiograms on inpatients, are questioned or denied. Many drugs, even common generics, are unavailable without jumping through bureaucratic hoops. Treatment for chronic pain is especially difficult. It may be very challenging to get non-emergency surgery approved, no matter how necessary.

“Medicaid ends up as a jobs program for administrators and quasi-medical professionals,” writes one physician. “Very little of Medicaid money actually goes to the ‘health care’ part of the equation.” Another said that “poor customer service is the norm” and “excessive paperwork is routine.”

Because it may cost more to file a claim than a physician can hope to collect, physicians may lose on every Medicaid patient, and lose less if they just see the patients for free.

Stating that “denials were much more common than approvals for appropriate treatment options and diagnostic studies,” one physician concluded that “to expand such a horrendous program is insane.”

AAPS, which was founded in 1943, is a national organization representing physicians in all specialties.

Filed Under: Demographics, Entitlements, Federal Government, Government, Guest Opinion, Health Care, Legislation, State Government Tagged With: , , ,

Medicaid Expansion: What You Hear vs. What You See

April 16, 2013 by Leave a Comment

By Dr. G. Keith Smith
Reposted from AAPSonline.org

The strongest advocate for expanding Medicaid—and the likely source of funding for the massive advertising campaign—is the hospital lobby.

We hear that hospitals are going broke. They can’t make ends meet. The uninsured are breaking the hospitals’ backs from emergency room over-utilization. Hospitals won’t survive unless Medicaid is expanded. (This is the most interesting claim, as hospitals simultaneously complain that underpayment by Medicaid justifies their cost-shifting to others!)

These are the lies that are primarily responsible for bringing us ObamaCare.

But if we look around us, what do we see?

Hospitals are building everywhere. They sponsor sports franchises. They buy advertising in high-priced media outlets. They are ceaselessly buying physician practices—and also buying rural hospitals they destroyed by having bought all of the small-town physician practices and diverting their referrals. They are expanding their emergency rooms—and even building free-standing emergency rooms, so-called loss leaders for their institutions. They make multi-million-dollar “logo” changes. Their administrative staffs are huge and extremely well paid.

Why are patients terrified of becoming uninsured, or driven into bankruptcy by medical bills? It is not because of doctor bills. How many doctors have extracted such huge payments from patients as to cause them to lose their homes? It is hospitals that do that. Routinely.

After reading the recent article in Time magazine about abusive hospital billing practices, in which Oklahoma City’s own Mercy Hospital was named, one of my partners remarked that the rotating cross on top of their hospital should be replaced with a dollar symbol! My father recently asked me if any of the hospital administrators whose billing practices have bankrupted countless patients ever had face-to-face contact with those whose lives had been ruined by their greed. Or, he asked, were they like drone operators, destroying people’s lives in a remote, impersonal way, while they themselves remain safe in their office?

The truth is that, economically, hospitals are not unlike utility companies in that they have high fixed costs. As Thomas DiLorenzo explains in his brilliant book Organized Crime: the Unvarnished Truth about Government, once the plant is built and the power lines are present, the cost of adding another utility customer approaches zero. Once the emergency room is built and staffed, the actual cost of an additional patient approaches zero, other than the actual supply costs. As a physician who owns and operates a medical facility, I can tell you that the supply costs are not that high, even in a surgical environment.

Also, while the hospital spokesmen claim that they have to take everyone regardless of ability to pay, hospitals get paid even when they don’t get paid through the uncompensated care scam. As hospitals wave the charity flag with one hand, they are fleecing the taxpayers through this scam with the other.

When Jim Epstein of Reason magazine was writing an article about our facility, Surgery Center of Oklahoma, he discovered that the amount Medicaid paid local hospitals exceeded the prices we post publicly at http://www.surgerycenterok.com. Hospitals claim that these “horrible reimbursements” by Medicaid are one of the primary excuses used to justify the “hidden tax” they impose on uninsured (self-pay) and privately insured patients.

Think about this: if the costs for the indigent are shifted to others who do pay, or to taxpayers, how is it that the hospitals are providing “uncompensated” care? One way or the other, the hospital gets paid for everyone who comes through its doors.

We make a profit at the prices we have listed online. These prices are one-sixth to one-tenth of the prices charged for the same procedures at most “not for profit” hospitals. This is what you can see for yourself. What you now hear if you listen closely is a quiet panic engulfing those in the medical-industrial complex, as this free-market, transparent pricing model is getting noticed and gaining ground.

This movement, if allowed to grow, will reduce the cost of care and raise the quality bar, just like competition does in every other sector of the economy.

Why expand the bureaucratically encrusted waste and corruption-ridden Medicaid model that is bankrupting government, when freedom works so much better?

 

Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice. 

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available. 

Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.

Filed Under: Entitlements, Federal Government, Guest Opinion, Health Care Tagged With: , ,

Dr. Kelli Ward: Opposition to Medicaid Expansion is Real

April 14, 2013 by Leave a Comment
Dr. and Senator Kelli Ward

Dr. and Senator Kelli Ward

Since January, many of us at the State Capitol have been trying to determine a common sense way to approach reliable health care for our neediest citizens. It is clear that a full expansion of our Medicaid program to 138% above the Federal Poverty Level (FPL) will add 400,000 patients or more to an already overloaded system. After carefully studying this complex issue, I have determined the plan is unsustainable and potentially harmful to hardworking Arizona taxpayers. We simply do not have the doctors and other health care providers to offer primary care to these new patients. When people are sick or seek care for their chronic illnesses, they will not be able to get into a doctor’s office, so they will instead turn to our emergency departments. Not only will that be much more expensive to Arizonans, but the people are unlikely to get the kind of care they need most.

The last time we expanded AHCCCS (the Arizona Health Care Cost Containment System – AZ’s Medicaid); we grossly underestimated the number of people who would enroll. Three times more parents of Medicaid-covered children and two times as many childless adults signed up. Costs went from an estimated $315 million to an actual $1.2 billion. Voters were told tobacco settlement money under Prop 204 would cover the added patients, but quickly we had to dig into the general fund. Now we are being told a hospital bed tax will cover this expansion proposal and the Federal government will bear the burden of the majority of the costs until 2017. Remember, the Federal government gets its money from us – the taxpayers. While no one can predict the true future price tag, experience proves that the costs have always been much higher than estimated.

Do not let people tell you there are no alternatives and we either expand or do nothing – there are real options. We should request that HHS allow Arizona to continue our current plan for those under 100% FPL and for Arizona to determine the best way to provide care for our indigent population. We should find ways to complete treatment of Medicaid patients that are in the midst of potentially lifesaving therapy for catastrophic illnesses despite the expiration of our current Federal waiver on December 31, 2013 – we can find a way to make an exception for this small number of patients. People above 100% FPL that are not otherwise eligible for coverage are able to buy subsidized policies through the federal exchange, we should let them. We should consider providing catastrophic coverage policies for those under 100% of the Federal Poverty Level and a graduated plan for other services. Cost transparency should be our goal. We must seek tort reform to discourage the practice of defensive medicine which drives up the cost of healthcare.

Our Medicaid system in Arizona is one of the best in the country, but I don’t believe that we need to make it bigger and give control of the hundreds of millions of dollars to an unelected agency director. I will continue to seek free market solutions to our health care dilemma and find ways to care for those who are unable to care for themselves. If you only remember one thing, remember this: the Medicaid expansion plan is about increasing the entitlement to healthcare coverage without any guarantees of increased accountability, improved access to care, higher quality, or lower costs of healthcare – it is a step in the direction of socialized medicine and much bigger government.

Senator Kelli Ward

Senator Kelli Ward, D.O., MPH is a Family Physician with additional expertise in Health Policy, she represents Arizona’s 5th Legislative District and resides in Lake Havasu City, AZ with her family. She serves on the Senate Health & Human Services (Vice-Chair), Appropriations, Education and Government & Environment Committees.

Filed Under: Conservatives, Elected Officials, Entitlements, Federal Government, Guest Opinion, Health Care, Legislation, State Budget, State Government Tagged With: , , , , , ,

Poll: Obamacare Medicaid in Arizona

April 12, 2013 by 1 Comment
Filed Under: Entitlements, Federal Government, Health Care, Polls, State Government Tagged With: , , ,

In Case You Missed It – Montenegro on God v Obama

April 9, 2013 by Leave a Comment

Steve Montenegro

We almost missed this great quote about 10 days ago from State Representative Steve Montenegro who was interviewed by the Yellow Sheet, a publication put out by the people at the Arizona Capitol Times.  You can visit their site to read it in its entirety, but the story was about Governor Brewer claiming that her proposed Medicaid Expansion was “pro-life” and they spoke with a couple of pro-life lawmakers who disagreed with that contention.  One of the legislators they spoke with was Montenegro, whose quote summed up quite nicely the difference between the two rights and their origins — origins that the media usually has trouble telling apart.

“Montenegro, who is an associate pastor at Surprise Apostolic Assembly, told our reporter yesterday that Medicaid expansion is foremost a fiscal question, which overrides the governor’s proposition that it is also a moral and religious one, and added that he respectfully disagrees with the governor’s pro- life argument.”

“The Constitution speaks to the right to life, and it does not speak to the right to government-funded health care. And the right to life is granted to us by God. It is inalienable.  And a dramatically expanded government-funded health care program has been granted to us by Barack Obama.” said Montenegro.

Later in the story Montenegro reminds readers that the Bible’s instruction on charity applies to people, not governments, and that we should not be using government to coerce people into helping others.

Well said!

Filed Under: Arizona Politics, Elected Officials, Health Care Tagged With: ,

Ten Reasons to Decline Medicaid Expansion in Arizona

April 2, 2013 by 1 Comment

By Christina Corieri, Heath Care Policy Analyst, Goldwater Institute

1. Expanding Medicaid will cost Arizona hundreds of millions of dollars.

For the first three years, the federal government has promised to cover 100% of the medical costs for the newly eligible Medicaid enrollees, and yet the cost to Arizona’s General Fund for the first year alone would be $154 million. The costs to the state are a result of the fact that the federal reimbursement rate of 100% applies only to the direct medical expenses of the newly eligible enrollees, not the additional administrative costs. Additionally, the 100% reimbursement rate does not apply to those new enrollees who were previously eligible but either did not know it or otherwise failed to enroll.

The true costs to Arizona have been hidden by projections that reflect only the first three years of the expansion, not the later years when the state’s share increases. The Kaiser Family Foundation estimates that the total cost to Arizona for 2014-2019 could be as high as $739 million depending on how many newly eligible people enroll.

2. A supermajority vote is required to authorize new taxes.

In 1992, Arizona voters passed Proposition 108, which requires approval of 2/3 of both chambers of the Legislature to impose a new tax or fee or to increase an existing tax or fee. There is a narrow exception for “fees and assessments that are authorized by statute, but are not prescribed by formula, amount, or limit, and are set by a state officer or agency.”

The proposed Medicaid expansion disregards the spirit and letter of the law. Because the Governor’s office has explicitly prescribed the assessment amount in the proposed budget, the tax increase doesn’t fall within the exception in the law.

If legislators authorize a provider tax by a simple majority vote, they will circumvent the will of the voters and will be vulnerable to a lawsuit that, if successful, will leave the legislature with an expensive Medicaid expansion that lacks a funding mechanism.

3. The federal government is unlikely to maintain promised funding rates.

President Obama has already proposed cutting the promised reimbursement rate to states in his last two budgets.

The Governor’s office has acknowledged that Washington will likely cut its promised funding level. A publication released from the Governor’s office in January entitled Difficult Choice: Expanding Adult Medicaid Coverage states “it is probable that, at some point, the federal government will choose to reduce reimbursements to the states as a consequence of its own fiscal challenges.” In fact, the circuit breaker, which is intended to protect Arizona from additional costs, is not activated until the federal government cuts the reimbursement rate for the newly eligible enrollees to less than 80% – effectively allowing the federal government to double Arizona’s share of the costs before the state would react.

4. The provider tax, which is the proposed funding mechanism for the expansion, could be limited or eliminated.

A provider tax is a scheme by which states tax healthcare providers in order to draw down additional federal matching dollars. The tax paid by healthcare providers is returned to them via increased Medicaid spending in the state or increased Medicaid reimbursement rates to providers.

There are growing calls from both sides of the aisle in Washington to limit or eliminate the ability to assess a provider tax. Attacks have come from President Obama, Majority Whip Durbin (D-IL), Senator Corker (R-TN), House Republicans, and the Simpson Bowles Commission. If the provider tax is limited or eliminated, Arizona will be left holding the bill.

Eliminating or limiting the provider tax will not trigger the circuit breaker despite the fact that it would leave the expansion in place with no funding source besides the general fund.

5. The circuit breaker may not be enforced by a future governor and future legislature.

The circuit breaker is designed to automatically abolish the Medicaid expansion if the federal reimbursement rate for the newly eligible enrollees ever falls below 80%.

If circuit breaker is triggered, the sitting governor and legislature would face a media storm as thousands of people who had become dependent on free government health care were removed from the Medicaid rolls. Arizona has already experienced such a media storm when the state did not drop coverage, but merely froze enrollment for childless adults up to 100% of the federal poverty level in 2011.

6. The Woodwork Effect is likely to be much larger than anticipated.

The federal health care law’s higher reimbursement rate does not apply to the costs associated with those individuals who are newly enrolled but who were previously eligible – this is referred to as the “woodwork effect.”

When Arizona passed Prop 204, it was estimated that roughly 129,000 people would fall into this category. But by 2003 it was approximately 250,000 – almost double the original estimate, costing the state hundreds of millions in unexpected money.

7. Uncompensated care is unlikely to decrease.

The Governor’s office has stated that uncompensated care results in a hidden tax of $2,000 per family per year that is reflected in the family’s insurance premium. Proponents of the expansion claim that it will solve the problem of uncompensated care and eliminate this hidden tax.

The same claims were made by proponents of Prop 204, but neither claim proved true. Uncompensated care increased by an average of 9% a year during the first seven years of the Prop 204 expansion according to a study by the Lewin Group. And the average family premium increased from $8,972 in 2003 to $14,854 in 2011 – a 66% increase. There is no reason to believe the results will be different this time.

8. Cost projections are likely incorrect, as Arizona’s last Medicaid expansion illustrates.

The Prop 204 expansion was four times more expensive than the projected cost each year. For example, in 2008, the cost of covering the Prop 204 population was projected to be $389 million, but the cost was actually $1.623 billion.

9. There is no rush because a state can choose to expand Medicaid at any time.

The Centers for Medicare and Medicaid have made it clear that states may opt into the Medicaid expansion at any time. It would be wise for Arizona to wait and see how the expansion plays out in other states before committing Arizona to an expansion that will be incredibly expensive and difficult to roll back.

10.There is no such thing as free federal money.

This “free federal money” is borrowed money which taxpayers must pay back.

By agreeing to the Medicaid expansion, Arizona legislators would be committing current and future Arizona taxpayers to billions of dollars in new federal debt, and each Arizona legislator who votes for the expansion will be complicit in Washington’s spending problem.

Click here to download “Ten Reasons to Decline Medicaid Expansion in Arizona.”

Filed Under: Economics, Entitlements, Federal Government, Government Reform, Health Care, Legislation, State Government Tagged With: , ,

Congressman Matt Salmon: Medicaid Needs Reform, Not Expansion

March 26, 2013 by Leave a Comment

Matt Salmon

First bill repeals Obamacare’s Medicaid expansion, gives states more flexibility 

WASHINGTON—Today, Congressman Matt Salmon (AZ-05) introduced his first piece of legislation in the 113th Congress. Salmon released the following statement regarding H.R. 1404, The Medicaid Expansion Repeal and State Flexibility Act:

“Today, I’m honoring my pledge to fight with everything I have to eliminate Obamacare before it causes more damage to our economy. 

“My first step in this fight addresses Medicaid expansion at the federal level. 

“One of the big-ticket items included in Obamacare was a provision that essentially bribed states to expand their Medicaid eligibility requirements to 138% of the poverty level, and to have the Federal government pay for 100% of the expansion.  As with most other aspects of Obamacare, unwanted strings are attached. 

Obamacare only covers the full cost of this expansion for the initial years, but leaves the onerous federal mandates to stay.”  

“Medicaid needs reform, not expansion.” 

“Instead of more federal mandates, I support giving States the maximum flexibility to provide services to their most vulnerable populations.  My bill strikes the Medicaid expansion from Obamacare, and provides this flexibility without the strings attached. 

“I look forward to working with my colleagues in the House to repeal this and more of Obamacare’s harmful federal policies.”

Additional Information:

  • Since the creation of Medicaid in 1965, the focus of this program has been on providing health care to vulnerable low-income individuals.
  • Under current law, the Medicaid expansion is expected to cost Federal and State governments over $500 billion dollars from 2014-2019.
  • Currently, Medicaid provides health care to over 60 million Americans and consumes a growing portion of State and Federal budgets.
  • By adopting the Medicaid expansion to cover up to 138% of the federal poverty level provided in the Patient Protection and Affordable Care Act (PPACA), states will be expanding Medicaid to a different population of able-bodied adults, the vast majority of whom are single and without dependents.
  • Adding more people to the already distressed system only further exacerbates Medicaid’s underlying problems.

Click here to read the text of H.R. 1404

Click here to view a video message from Rep. Salmon on H.R. 1404.

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Filed Under: Conservatives, Economics, Elected Officials, Federal Budget, Federal Government, Government Reform, Health Care, State Government Tagged With: , , ,

The Actual Costs of Expanding Medicaid in Arizona – What Really Happened

March 21, 2013 by Leave a Comment

The main argument being made to expand Medicaid dependency in Arizona is “to do the math.” Well the Texas Public Policy Foundation did the  math for what really happened in Arizona the last time Medicaid was expanded and here is the graph depicting the cost to Arizona. These numbers cover a six-year period beginning in 2002 and ending in 2008.

Medicaid Expansion

The actual cost of expanding Medicaid in Arizona

Here is the article posted on the Texas Public Policy Foundation website:

This article originally appeared in The Daily Caller on 3/21/2013. 

If state lawmakers really want a clear picture of what Medicaid expansion under Obamacare will look like, they should start with Arizona, where expansion was tried more than a decade ago — with disastrous results.

In 2000, Arizona received a federal waiver to extend Medicaid to all childless adults and parents earning less than 100 percent of the federal poverty level. This is nearly the same group that would be eligible for Medicaid under the federal health care law, except that Obamacare would include those earning up to 138 percent of the federal poverty level, a slightly larger group.

At the time, Arizona lawmakers and expansion advocates promised that expanding Medicaid would lower the uninsured rate, reduce uncompensated care costs, decrease the “hidden tax” on private insurance for uncompensated care, and save about $30 million a year in state funds.

These same promises — lower uninsured rate and reduced uncompensated care costs — are being made by those calling for Medicaid expansion in other states.

None of the promises came true. In fact, the opposite happened. Enrollment of parents was more than triple what was forecast, while enrollment of childless adults was more than double.

As a result, costs skyrocketed. Spending per enrollee was much higher than anticipated, especially among childless adults, who proved to be twice as expensive to cover as parents. By 2008, Arizona had spent $8.4 billion on Medicaid expansion — more than four times what had been forecast.

What about the promise that expansion would lower the uninsured rate? In 2002, about 18.7 percent of Arizona’s non-elderly population was uninsured. By 2011, that group had actually increased to 19.4 percent. Meanwhile, the percentage of Arizonans with private insurance dropped from 61.8 percent to 55.5 percent, while Medicaid enrollment grew far beyond what had been predicted.

When the recession hit in 2008, Arizona faced a budget shortfall and scaled back Medicaid benefits for childless adults, including organ transplantation. It later froze enrollment for that group, which dropped from 227,000 to 86,000.

Arizona Gov. Jan Brewer’s January announcement that she will support the Obamacare Medicaid expansion should not have come as a surprise. Arizona’s waiver expires in 2013, and the state had no choice but to go along with expansion. If it did not, the feds would likely not renew the state’s waiver, which would force some 86,000 people out of the Medicaid program and into the ranks of the uninsured.

The Arizona experience is not unique. In 2002, Maine implemented an almost identical Medicaid expansion — with almost identical results. Within two years, enrollment was more than double what had been forecast, with childless adults costing more than four times as much as parents. Between 2002 and 2011, the uninsured rate remained the same, while the share of those with private insurance shrank, from 66 percent to 59 percent.

Proponents of Medicaid expansion claim it will reduce the uninsured rate and therefore reduce uncompensated care costs. The hope and expectation is that federal expansion dollars will free up state funds and relieve taxpayers, much like advocates of expansion hoped for Arizona and Maine.

Earlier this month, Methodist Health Care Ministries and Texas Impact published an estimate of Medicaid expansion savings. At first glance the figures are impressive; some $900 million in state funds could be freed up for the upcoming biennium, according to the report. The groups’ earlier study claimed counties and local taxpayers could expect relief from having to pay for uncompensated care costs, which the report said would decrease dramatically with Medicaid expansion.

But these projections are in fact nothing more than thin hopes. In Arizona, uncompensated care costs increased by an average of nine percent each year after expansion, and in Maine charity care rose from $40 million in 2000 to $215 million 2011.

Other states that have toyed with expansion — Delaware, Oregon, Michigan, Utah — have all had similar experiences: costs and enrollment exceeded expectations, uninsured rates stayed the same or increased, and the number of people on private insurance shrank.

If states are the incubators and laboratories of public policy, then the results of decade-long experiments with Medicaid expansion are in. In Arizona, Maine, and everywhere expansion was tried, none of the promised benefits materialized.

If lawmakers in other states choose to go down the road of expansion, they now know what to expect: skyrocketing costs, huge enrollment growth, a static uninsured rate, and more — not fewer — uncompensated care costs. Just ask Arizona.

 

Filed Under: Economics, Health Care, Spending, State Budget, State Economy, State Government Tagged With: ,
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