Rep Warren Petersen: Why Conservatives Oppose Expansion of Obamacare

Warren PetersenThe battle over the Arizona expansion of Obamacare resembles the fight between David and Goliath. The pro-expansion team has millions of dollars, powerful lobbyists, support from all Democratic legislators, most if not all of the media and a few Republicans who have defected to their cause.

You’ve probably heard radio ads, watched commercials on ESPN or received a full page glossy mailer promoting their “conservative plan.” The only problem is that conservative legislators do not support it.

Here are a few reasons why.

We don’t fall for optical illusions. When the pro-expansion team bused in 300 people to their last rally, we knew that their support was a charade. When they say 63,000 people will lose coverage, we knew that it was not true. Those currently on Medicaid will still have coverage with or without the expansion. Even if it was true, they could get insurance from exchanges with any minimum wage job. We know that it is money and not compassion that is driving this train. A train that Harry Reid (U.S. Senate majority leader) said will wreck without the appropriation of more federal funds.

We stick to the facts and know that the budget put forth by Arizona Senate President Andy Biggs will not drain the rainy day fund or kick people off Medicaid. It does, however, include a request to renew our federal waiver. The pro-expansion team has said the waiver has been denied when, in reality, it has not. Cutting and pasting a web FAQ directed to 50 states is not the same as formally submitting your plan and receiving a denial letter. Ironically, this is the same argument the Democrats made when we last requested a waiver. They said we couldn’t get it, but we did. Will they deny that the U.S. Supreme Court has ruled you can’t coerce people into expansion?

Another fact is that expansion doesn’t deal with health care of poor children. We are talking about a select group of adults of whom many have incomes above the poverty level. We are not talking about disabled people who cannot work. They have and will continue to have Medicaid coverage.

We have learned from history that we can afford to wait a year with or without the waiver as Arizona was the last state to implement Medicaid. We waited about 20 years and now it consumes one of every four dollars we spend. Obamacare is going to implode, which even the pro-expansion team admits. When it does, the expansion will go with it. It would be foolish to add onto something that is unraveling prior to implementation.

We know the numbers don’t add up. Conservatives don’t raise taxes on hospitals as a gimmick to draw down federal funds and they don’t put hundreds of thousands of people on a welfare program that will cost billions. Billions will be added to the national debt of which some will be used to fund abortions. Fortunately, half of the states have now refused the expansion. They took advantage of this rare opportunity to cut federal spending.

We believe in the American dream, which depends on every able bodied American to contribute and work. As mentioned before, a minimum wage job qualifies a person for health care exchange coverage. This will increase wealth and allow further contributions to society. Ours is a society that has been the most prosperous in the world because it promises that people can keep what they earn. Nations that guarantee benefits others have earned fail. Conservatives understand that and know that expansion is nothing more than massive growth of the welfare state and a direct threat to our long-term economic health.

Warren Petersen serves the citizens of Legislative District 12. He and his wife and children reside in the Town of Gilbert. For more information, visit his Facebook page.

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

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.

NFIB Poll: Small Business Strongly Opposes Expanding Medicaid

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.

Medicaid Expansion: Been There, Done That

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 weekthe 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

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

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.

Dr. Kelli Ward: Opposition to Medicaid Expansion is Real

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.