Republican Primary Voters Weigh In on Medicaid Expansion for Arizona

Round two of a recent poll is now out and there are some revealing numbers on how Republican primary voters feel about Governor Brewer’s push to expand Medicaid in Arizona Senator Jeff Flake and several legislative districts. Here are those results:

This memorandum is an executive summary of an automated voice recorded survey of 718 likely Republican primary voters in six legislative districts in Arizona. The legislative districts surveyed were 13, 17, 18, 20, 25 and 28. The interviews were conducted March 27th and 28th, 2013. This survey has a margin of error of +/-­‐ 3.65% at the 95 percent confidence interval. This survey was weighted based upon past Republican primary voter demographics. The focus of this survey was to measure Republican primary voter opinions regarding the expansion of Medicaid, the implementation of Obamacare, as well as voter reaction to their state legislator’s support or opposition to Medicaid expansion. The survey toplines are also included with this document.

GOVERNOR BREWER IMAGE RATING

Among Republican primary voters in the six legislative districts, Governor Brewer has a very strong image rating with 69% of voters having a favorable opinion of her, 23% having an unfavorable opinion of her, and 8% being undecided or not having an opinion.

SENATOR FLAKE IMAGE RATING

Senator Jeff Flake also has a very strong image rating among Republican primary voters in the six legislative districts, with 70% of voters having a favorable opinion of him, 18% having an unfavorable opinion of him, and 12% being undecided or not having an opinion.

GOP PRIMARY VOTER SUPPORT FOR THE EXPANSION OF MEDICAID

Republican primary voters in the six legislative districts were asked if they support Governor Brewer’s proposal to expand Medicaid in order to fully implement the federal government’s health care system in 2014. Among all respondents, 30% support the expansion of Medicaid, 51% oppose expansion, and 19% are either unsure or do not have an opinion about the issue. The following table shows responses by legislative district.

“As you may know, Governor Brewer has proposed the expansion of Medicaid in Arizona in order to fully implement the federal government’s health care system in 2014. Knowing this, do you support or oppose the expansion of Medicaid in order to implement the federal government’s health care system?”

Medicaid GOP Primary 1

 

VOTER OPPOSITION FOR LEGISLATORS WHO VOTE TO EXPAND MEDICAID

To measure voter reactions if their state legislator voted to expand Medicaid, the following question was asked:

“Would you be more or less likely to vote to reelect your state legislator if they voted for the expansion of Medicaid?”

Medicaid GOP Primary 2

 

Not surprisingly, among Republican primary voters in the six legislative districts a majority, or 53% are less likely to reelect their legislator if they voted to expand Medicaid and only 22% would be more likely to vote for their state legislator. When looking at the results by legislative district, the percentage of voters that are less likely to reelect their state legislator ranges from a low of 37% to a high of 69%.

GOP PRIMARY VOTER SUPPORT FOR TAX INCREASE TO FUND MEDICAID EXPANSION

In addition to measuring Republican primary voter’s reactions toward their state legislators if they voted to expand Medicaid, the survey tested voter reaction to a tax increase on hospitals to fund the expansion of Medicaid. Again, it is no surprise that Republican primary voters vigorously oppose this idea and do not want their legislators supporting a new tax on hospitals to fund the expansion of Medicaid. Among all respondents in the six legislative districts, only 11% would be more likely to vote to reelect their legislator, and two thirds, or 68%, would not vote to reelect their legislator. In short, if an incumbent voted for such a proposal it would be toxic for their reelection. The following table shows the question responses by legislative district.

“Would you be more or less likely to vote to reelect your state legislator if they voted for a new tax on hospitals to fund the expansion of Medicaid?”

Medicaid GOP Primary 3

 

CONCLUSION

Among the likely Republican primary voters surveyed in these six legislative districts, it is clear they oppose the expansion of Medicaid by varying degrees from a plurality of 42% to a large majority of 62%. Support for Medicaid expansion ranges from a high of 35% to a low of 26%. The survey also finds a plurality, or a majority, of Republican primary voters would be less likely to vote for their legislator if they voted to expand Medicaid in all six legislative districts. Finally, the information in this research should be of concern to incumbent legislators as they consider how to handle this issue.

View/Download the entire report including the topline results.

New Poll Reflects Voter Opinion on Governor Brewer, Legislators on Expanding Medicaid in Arizona

Sonoran Alliance has obtained a recent poll that was conducted in Arizona on the latest public policy issue being debated among Arizonans – Obamacare’s expansion of Medicaid in Arizona. This poll demonstrates the current attitude toward Governor Brewer, Legislators and the implementation of Obamacare. Magellan Strategies conducted the poll at the end of March. Here are the results of the poll:

ARIZONA MEDICAID EXPANSION SURVEY AMONG REGISTERED VOTERS

This memorandum is an executive summary of an automated voice recorded survey of 812 Arizona registered voters. The survey was conducted on March 27th and 28th and has a margin of error of 3.44% at the 95% confidence interval. The focus of this survey was to measure voter opinion regarding the expansion of Medicaid, the implementation of Obamacare, as well as voter reaction to their state legislator’s support or opposition to Medicaid expansion. The survey toplines are also included with this document.

GOVERNOR BREWER IMAGE RATING

Among all voters, Governor Brewer has a respectable net‐positive image rating with 49% of respondents having a favorable opinion of her, 40% having an unfavorable opinion of her, and 11% being undecided or not having an opinion. She is more popular among male voters than female voters, with 53% of men having a favorable opinion of her compared to 46% of women having a favorable opinion of her. Among senior voters aged 65 or older, 52% have a favorable opinion of her and 39% have an unfavorable opinion of her.

VOTER SUPPORT AND OPPOSITION FOR THE EXPANSION OF MEDICAID

When voters are asked if they support Governor Brewer’s proposal to expand Medicaid in order to fully implement the federal government’s health care system in 2014, we find opinion almost evenly split. Among all respondents, 41% support the expansion of Medicaid, 37% oppose expansion, and 22% are either unsure or have no opinion about the issue. There are significant differences in support for expansion by party, with only 25% of Republicans supporting expansion compared to 62% of Democrats supporting expansion. “Independent” voters are split on the issue with 37% supporting expansion, 35% opposing expansion, and 28% are either unsure or have no opinion about the issue. The following table shows Medicaid expansion support and opposition by voter subgroup.

“As you may know, Governor Brewer has proposed the expansion of Medicaid in Arizona in order to fully implement the federal government’s health care system in 2014. Knowing this, do you support or oppose the expansion of Medicaid in order to implement the federal government’s health care system?”

Arizona Medicaid Poll 1

ARIZONA VOTER SUPPORT FOR FULL IMPLEMENTATION OF OBAMACARE

When comparing voter support for Medicaid expansion to the full implementation of Obamacare, it is clear the full implementation of Obamacare has far less support than Medicaid expansion. While the issue of Medicaid expansion is nearly split among Arizona voters (41% support/37% oppose), 58% of all voters oppose the full implementation of Obamacare and a majority of those voters, 51%, strongly oppose the full implementation of Obamacare. Looking at the responses to this question by party, a whopping 87% of Republican voters oppose the full implementation of Obamacare and only 10% support it. Among Democrat voters, a plurality of 44% support full implementation of Obamacare and 35% oppose it. Among independent voters, two thirds, or 62%, oppose full implementation of Obamacare and 34% support full implementation.

VOTER SUPPORT FOR LEGISLATORS WHO VOTE TO EXPAND MEDICAID

To measure voter reactions if their state legislator voted to expand Medicaid, the following question was asked:

“Would you be more or less likely to vote to reelect your state legislator if they voted for the expansion of Medicaid?”

Arizona Medicaid Poll 2

Not surprisingly, 63% of Republican voters would be less likely to vote for their state legislator if they voted to expand Medicaid and only 17% would be more likely to vote for their state legislator. Among Democrat voters, a plurality, or 47%, would be more likely to vote for their legislator if their legislator voted to expand Medicaid, and 30% would be less likely. Among independent voters, 28% would be more likely to vote for their legislator, 34% would be less likely and 38% were either unsure or did not have an opinion.

VOTER SUPPORT FOR TAX INCREASE TO FUND MEDICAID EXPANSION

In addition to measuring voter’s reactions toward their state legislators if they voted to expand Medicaid, the survey tested voter reaction for a tax increase on hospitals to fund the expansion of Medicaid. As the data in the table below indicates, voters do not want their legislators supporting a new tax on hospitals to fund Medicaid. Among all respondents, 57% would be less likely to vote for their state legislator, and among Republican voters, 72% would be less likely to vote for their legislator.

“Would you be more or less likely to vote to reelect your state legislator if they voted for a new tax on hospitals to fund the expansion of  Medicaid?”

Arizona Medicaid Poll 3

CONCLUSION

Among all Arizona voters, 41% support Governor Brewer’s effort to expand Medicaid in order to implement the federal government’s health care system by 2014, and 37% of voters oppose it. Among Republican voters, 57% oppose expansion and only 25% support it. In addition, 63% of Republican respondents indicated that they would be less likely to vote for their state legislator if they voted to expand Medicaid. These two data points should be a cause for concern among Republican legislators when considering how to vote on this issue. Republican legislators that support Medicaid expansion could make themselves vulnerable to a primary challenge.

View/Download the entire report including the topline results.

 

Ten Reasons to Decline Medicaid Expansion in Arizona

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.”

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

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.

 

Maricopa GOP Votes Down Medicaid Expansion in Arizona

March, 2013

A RESOLUTION OF THE EXECUTIVE GUIDANCE COMMITTEE (EGC) OF THE MARICOPA COUNTY REPUBLICAN COMMITTEE (MCRC) MARICOPA COUNTY, STATE OF ARIZONA

IN OPPOSITION TO

THE ARIZONA GOVERNOR’S PROPOSED EXPANSION OF MEDICAID (AHCCCS) IN SUPPORT OF OBAMACARE

WHEREAS, Arizona voters clearly expressed their will to reject implementation of the Affordable Care Act (Obamacare) and the individual mandate by amending the Arizona Constitution in 2010 via the Arizona Health Insurance Reform Amendment, Proposition 106; and

WHEREAS, the “circuit breaker” clause is insufficient to prevent out of control escalation of enrollment and the long term costs will cause severe financial hardship on Arizona’s budget; and

WHEREAS, the “assessment” on hospitals is actually a tax and a disingenuous attempt to subvert Arizona’s Constitution and legislative process requiring tax increases receive supermajority approval in the legislature; and

WHEREAS, the United States Supreme Court ruled that each State may reject the expansion of Medicaid and Insurance Exchanges, the two cornerstones of Obamacare, without which it collapses; and

WHEREAS, the best method to honor Arizona voters’ wishes to reject Obamacare is for each State to refuse implementation and allow Obamacare to fail; and

WHEREAS, supporting a government takeover of Arizona’s health care system, even to secure large amounts of federal funds, does not reflect the values of the Republican Party or the interests of the taxpayers of Arizona.

NOW THEREFORE BE IT RESOLVED by the Executive Guidance Committee of the Maricopa County Republican Committee, Maricopa County, State of Arizona, does affirm and declare our opposition to the Governor’s plan to expand Medicaid; and

BE IT FURTHER RESOLVED by the Executive Guidance Committee of the Maricopa County Republican Committee, Maricopa County, State of Arizona, demands that the Arizona State Legislators uphold the rule of law set forth by Proposition 108 requiring a supermajority vote in this matter; and

BE IT FINALLY RESOLVED by the Executive Guidance Committee of the Maricopa County Republican Committee, Maricopa County, State of Arizona, demands that the Arizona State Legislators stand with the people of Arizona in opposition to the Governor’s plan to expand Medicaid by defeating any bill to such ends.

Author: Eric Morgan, Chairman, LD22 Republican Committee

PASSED & APPROVED this 7th day of March 2013, by a vote of 26 (ayes) to 2 (nays) to 0 (abstentions) of the Executive Guidance Committee of the Maricopa County Republican Committee, Maricopa County, State of Arizona.

MARICOPA COUNTY REPUBLICAN COMMITTEE

MARICOPA COUNTY, STATE OF ARIZONA:

A. J. LaFaro

________________________________________

by: A. J. LaFaro, Chairman

Maricopa County Republican Committee

[Download Resolution]

STOP Medicaid Expansion in Arizona!

Americans for Prosperity - Arizona

IMPORTANT ACTION ALERT!

To all Arizona Taxpayers and Health Care Consumers,

First, please register now for AFP-Arizona’s debate on the ObamaCare Medicaid expansion, which will take place from 11:30 am to 1:30 pm on Thursday, February 21 at the Goldwater Institute. To register, send an email here (For more info about the debate, scroll down.)

Gov. Jan Brewer and powerful lobbyists are pushing Arizona to impose statewide taxes, including a hospital bed tax, to fund an expansion of Medicaid (AHCCCS) under ObamaCare. It is vitally important for Arizona to stop the proposed Medicaid expansion, because the human and fiscal costs of that expansion would be enormous. TAKE ACTION NOW.

The most important issue in the Medicaid expansion is the human cost. If Arizona were to expand Medicaid, it would railroad at least 250,000 Arizonans into a low-quality, government-managed health insurance system. Medicaid patients not only have worse medical outcomes than patients with private insurance, but often have worse medical outcomes than low-income persons without insurance — even when they have the same medical conditions. Please go to http://tinyurl.com/gottliebwsj to learn more about this important issue.

But the proponents of the expansion are also trying to do an end-run around Prop 108, the most important taxpayer protection ever passed by Arizona voters. Thanks to Prop 108, the Arizona Constitution requires a two-thirds majority of the Legislature to raise taxes. But Medicaid expansion proponents want to allow unelected bureaucrats at AHCCCS to raise state taxes (mainly hospital bed taxes) by $369 million over the next three years — without a two-thirds vote of the Legislature! If Legislators use a simple majority to delegate to bureaucrats the authority to impose gigantic taxes on hospital patients, they will kill Prop 108 and destroy its protections for Arizona taxpayers. If that happens, we will blame those Legislators — not the lawyers and judges who help them carve out a gigantic loophole in Prop 108.

Gov. Brewer told Arizonans to “do the math” on the Medicaid expansion. With all due respect, she should do the same. According to Brewer’s projections, the Arizona Medicaid expansion would cause the (already bankrupt) federal government to spend $3.6 billion over the next three years alone. The people who will pay those taxes include most of the people of Arizona and — thanks to the federal debt — our children and grandchildren.

The current JLBC projection of $325 million per year in tax increases in 2016 (as bad as that is!) hides the actual future cost of the proposed taxes. By 2019, Arizona will have to pick up at least 10 percent of the cost of the expansion, which will be hundreds of millions of additional dollars annually. And the Obama Administration has already proposed several times to shift additional costs of the expansion to the States.

TAKE ACTION!

Please use this link to send a quick and easy email to your Legislators, asking them to resist the ObamaCare Medicaid expansion. At the very least, even if they are tempted to engage in short-term thinking and take a bunch of “free” money from Washington, legislators should comply with the voter-imposed constitutional requirement to raise taxes with a two-thirds majority.   

REGISTER FOR THE DEBATE!

Please register now for AFP-Arizona’s debate on the ObamaCare Medicaid expansion, which will take place from 11:30 am to 1:30 pm on Thursday, February 21 at the Goldwater Institute.

At the event, Michael Cannon of  the Cato Institute, Goldwater Institute health care policy analyst Christina Corieri, and Phoenix surgeon Jeff  Singer will take on any three pro-expansion advocates who want to debate these issues publicly. We have extended the invitation to debate to the Brewer Administration, to Brewer advisers Chuck Coughlin and Peter Burns, AHCCCS director Tom Betlach, Democratic Legislators, and members of the hospital and insurance lobbies. All concerned citizens who wish to attend the debate should RSVP here.

LEARN MORE!

For more about the problems with the proposed Medicaid expansion, read AFP-Arizona’s line-by-line refutation of Gov. Brewer’s pro-expansion arguments in her January 14 speech.

For Liberty,

Tom Jenney
Arizona Director, Americans for Prosperity

WSJ – Governor Brewer’s Spectacular Flip-Flop

The GOP’s ObamaCare Flippers

Reprinted from The Wall Street Journal

February 4, 2013

As D-Day looms for ObamaCare, one big question is how many states will sign up for its Medicaid expansion. The recent and spectacular flip-flop of Arizona Governor Jan Brewer is a case study in the political pressure and fiscal gimmicks designed to get states to succumb. It’s also a study in the arcane and perverse ObamaCare incentives that are intended to gather ever more health-care spending under federal control.

***

Arizona’s current Medicaid program is well run by the program’s standards—a low bar—but it is also too large. The program now finances one of every two in-state births and two of every three days seniors spend in nursing homes. Spending tripled in the last decade to $9 billion a year.

That’s despite $1.8 billion in cuts since 2009. The state fisc was such a mess that in 2010 Arizona Medicaid banned paying for several types of organ transplants. In March of that year, Ms. Brewer wrote to Mr. Obama calling the Affordable Care Act “a vast new entitlement program that our country does not have the resources to support” and also one that “makes our situation much worse, exacerbating our state’s fiscal woes by billions of dollars.”

Arizona argued before the Supreme Court that the Medicaid mandate was unconstitutional, anti-federalist commandeering—and seven Justices agreed it was “a gun to the head” and allowed states to opt out without penalty.

But so much for that. In her State of the State address last month, Ms. Brewer pulled a political 180°—or maybe 540°—and said expanding Medicaid would “inject $2 billion into our economy and “save and create thousands of jobs.” (Is Larry Summers moonlighting as a Brewer speechwriter?)

One secret of her switcheroo is Medicaid’s “matching rate” formula, in which the feds pick up 67% of Arizona’s existing spending and 100% (and later 90%) of the costs of ObamaCare’s newly eligible population. The state supposedly no longer needs to spend “billions” but merely an extra $154 million in 2014—then bank $1.6 billion from Washington, which her budget documents call “a return on investment of more than 10-to-1.”

Associated PressArizona Governor Jan Brewer

How can the state conjure such money from nothing? The answer is that Ms. Brewer and Arizona hospitals have cooked up a spending scheme to rip off national taxpayers to avoid even the $154 million the state would at first pay. The hospital lobby first floated this scheme in 2011 “for the specific purpose of generating matching federal Medicaid funds.”

Here’s how it works: Arizona will tax hospitals and insurers for the $154 million. Then it will return $154 million to the health industry via more Medicaid business that will cover the cost of the tax and then some. The money needs to make a round trip from providers to the state and back to providers to game that 67% federal matching rate.

So Arizona takes (say) $3 from a hospital and then turns around and pays the $3 back, using one of the hospital’s own dollars that Arizona converted to “revenue” plus two dollars courtesy of Washington for its 67% federal share of the $3 payment. Arizona can then use the hospital’s remaining $2 of the original $3 to pay for another $6 of Medicaid expansion.

Some 49 state now use this trick of so-called provider taxes to goose federal spending, up from 21 in 2003. (Alaska is the exception.) But the practice is so abusive that even Mr. Obama proposed new limits in his last two budgets.

This subsidy honeypot can’t last forever, which is why other Governors are more skeptical about this Obama Medicaid windfall. When the money inevitably runs out, states will retain permanently larger obligations and lose budget autonomy for a generation or two as health care crowds out other priorities like education and roads.

Ms. Brewer was nonetheless besieged by health-industry lobbying, especially from hospitals that want more government money and the insurers that administer Medicaid. The campaign is orchestrated by Chuck Coughlin, Ms. Brewer’s former political strategist, and Peter Burns, a former Brewer budget consultant.

Providers are especially powerful at the state and local level, and the goal now is to rush the Brewer-Obama condominium through the Phoenix legislature with little debate. A particular offender is the Arizona Hospital and Healthcare Association, a trade group whose 2012 agenda includes “Oppose Taxpayer Bill of Rights-style legislative referendums or bills that arbitrarily limit state spending.”

Ms. Brewer’s other rationale is that everybody else is doing it, and that if Arizona opts out of a larger Medicaid then “Arizona’s tax dollars would simply be passed to another state.” Well, no, Washington would simply spend less money that it doesn’t have. In any event Arizona is already a net tax beneficiary—pulling down $1.19 from the feds for every dollar it sends to D.C., according to the Tax Foundation.

Ten other GOP Governors have rejected Mr. Obama’s Medicaid bribe, with another 20, Democrats and Republicans, undecided. Twenty are expanding, including Republicans Brian Sandoval of Nevada, Susana Martinez of New Mexico, Jack Dalrymple of North Dakota and even, on Monday, Ohio’s John Kasich. Thus does modern government create the carrots and sticks of ever-larger government.

 

 

A Responsible Doctor Confirms: Obamacare Won’t Work — It’s Just Too Complicated

A few days ago, I posted an article titled “Obamacare’s Fatal Flaws: Complexity and Central Control.”  I argued that the whole Obamacare system was too complex to deliver on its promises, especially when operated by political appointees from a Washington-based central control bureaucracy.

I know virtually nothing about the practice of medicine.  I based my argument on four decades in the engineering business, where complex systems designed from scratch never work, especially when they are pressed into service under full load, with high expectations, much too soon.

And now from the US House of Representatives Oversight Committee comes the testimony of Richard A. Armstrong, MD, Chief Operating Officer of Docs4PatientCare.  His clear and compelling testimony, at this link, is worth reading in its entirety, but the key paragraphs for this brief post are (my emphasis added):

Although the ACA attempts to address many of the perceived problems with our health care system, it ignores the fact that enormously complex systems cannot be successfully centrally designed or controlled. We have been attempting that with Medicare and Medicaid for almost five decades. Any honest and objective appraisal would conclude that we are failing with those programs. The ACA will fail as well, for the same reasons.

[Some ACA supporters have claimed] that the ACA will remove the burdens of bureaucracy and overhead that currently plague our nation’s practicing physicians. How can we possibly take this seriously? It creates an estimated 159 new agencies, boards and committees governing in detail how physicians are to care for their patients and run their practices. In a time of decreasing reimbursement and the lack of an alternative for the Sustainable Growth Rate formula in Medicare, these claims of bureaucratic simplification ring hollow with experienced physicians.

Shifting to electronic medical records has been touted as a means to improve patient care. Even though the HITECH portion of the Stimulus Bill provides financial support for the adoption of electronic medical records and the ACA provides incentives for those who meet federally defined meaningful use, only a minority of physician practices have adopted EMR systems. A majority of those who have attempted have been met with major frustrations and financial burdens. This is because the existing systems are not designed to enhance patient care. They are business systems designed for medical coding and billing. They are cumbersome in design, difficult to use and detract from the already limited time most physicians have to spend with patients.

Quite apart from all the politics, the fatal flaw of the Affordable Care Act (ACA, Obamacare) is that it simply won’t work.  How many people will suffer and how many lives will be lost as Washington feeds our life savings into this bottomless sink hole, this mother of all white elephants?

Picture yourself pleading for a loved-one’s life with an uncaring bureaucracy of blame-shifters and formerly fine doctors who must now slavishly follow rules issued from Washington.  From those bureaucrats and hapless doctors, you can almost hear the responses now:

The voice mailbox for this department is full.  Please call back later.

I don’t make these rules, ma’am — I just follow them.

You’ll have to get in line like everyone else.  We’ll call you back when it’s your turn.

If I made an exception for you, I’d have to do it for everyone.  It’s illegal.  I could lose my job.

I’m sorry, I can’t help you … I could lose my license to practice medicine

I’m sorry, the doctor is not accepting new patients.

You’re yelling at the wrong person … try yelling at your Congressman!

In the meantime, you can be sure that Washington politicians will enjoy first-rate medical care with no waiting.

In the engineering business, when a system can no longer be patched or tuned, it has to be scrapped.  That’s where we are now with the whole gang in Washington that brought us to the edge of this national health care nightmare.

The Supreme Court has abdicated, and now there’s only We-the-People who can change things this November.  Surely America’s voters can be forgiven for being fooled once.  But to be blunt about it —

Anyone who votes again for Barack Obama or for any politician who has supported Obamacare should understand one thing:  the pending national disaster in healthcare is on YOU !