Gov. Doug Ducey

Gov. Doug Ducey said he wants a bill to give states “maximum flexibility.”

A.E. Araiza / Arizona Daily Star/

PHOENIX — Gov. Doug Ducey is defending his support for the latest bid to repeal the ACA although he has no idea how much federal aid it would cost the state and how many Arizonans might lose health care.

Ducey said Wednesday that his staff is analyzing the potential effects of the Graham-Cassidy bill on the Arizona Health Care Cost Containment System, the state’s Medicaid program, as Republican leaders in the U.S. Senate push for a vote before the end of the month.

“The numbers are important,” Ducey said.

But he remains convinced that what comes next will be better than the existing Affordable Care Act, he told reporters, even without yet knowing the effect on the state and its residents.

“Obamacare is a failure,” he said. “It’s time for it to go.”

Ducey sidestepped a question of whether he could guarantee that none of the 400,000 people who have been added to the rolls of Arizona’s Medicaid program because of the ACA would again find themselves without health insurance.

“Well, I haven’t seen the final bill,” he said of the legislation he has endorsed.

But Ducey said he believes the measure will provide Arizona with “the longest possible transition so that we can move people from Medicaid into a superior insurance product.” He did not say what that product would be.

The Republican governor also acknowledged that the proposal by GOP Sens. Lindsey Graham, S.C., and Bill Cassidy, La., would financially penalize states like Arizona which expanded Medicaid eligibility long before the Affordable Care Act. Arizona did so through voter approval in 2000 of a ballot proposition that guaranteed care for everyone up to the federal poverty level at a time when Medicaid eligibility was far less.

In fact, in a previous letter to Arizona Sen. John McCain, Ducey cited a similar penalty in earlier ACA-repeal bills as one of the “critical changes” needed in those now-failed attempts to make them acceptable.

“I don’t want a bill that is going to penalize Arizona,” Ducey said Wednesday, despite the provision that’s in the current version of the measure. But he said even if Graham-Cassidy does become law and the penalty is included, it won’t be the end of the discussion.

“It will take this bill and more to do and get our health care system in the right shape,” he said.

That’s assuming Senate Majority Leader Mitch McConnell can line up the votes, particularly that of McCain, whose opposition to the earlier “skinny repeal” helped to doom that measure.

As of Wednesday McCain was still undecided. But he repeated his statement that he wants the issue considered in “regular order,” meaning with full-blown hearings and the opportunity for amendment.

That’s not what McConnell is considering, with the latest proposal being a single hearing in the Homeland Security Committee and a Sept. 30 deadline for action.

Ducey’s strong and early support of the new federal legislation puts him at odds with some of his Republican colleagues.

In a letter Tuesday, John Kasich of Ohio, Charles Baker of Massachusetts, Phil Scott of Vermont and Brian Sandoval of Nevada urged McConnell to scrap the plan and instead support “bipartisan efforts to make health care more available and affordable for all Americans.”

All are from states that several studies conclude will be, like Arizona, financial losers under the Graham-Cassidy plan.

One study from the Center for Budget and Policy Priorities puts the annual loss to Arizona at $1.6 billion by 2026.

“The estimates you are referring to right now come from a left-wing or left-leaning organization that has a real stake in maintaining the status quo,” Ducey responded.

A separate report, from Avalere Health, which does consulting for the health- care industry, estimates cumulative Arizona losses between 2020 and 2026 at $11 billion. At least part of that is because the federal block grants to states for health care would grow at a set rate rather than based on the number of people who enroll. And after 2026, all the block grant dollars would go away.

The nonprofit Kaiser Family Foundation concluded the current legislative proposal “revamps and cuts Medicaid, redistributes federal funds across states, and eliminates coverage for millions of poor Americans.”

For Ducey, however, the touchstone is getting rid of the Affordable Care Act. “If anything, I think the deciding issue of the last eight years in terms of elections has been Obamacare,” he said.

Ducey said he wants a bill to give states “maximum flexibility,” not only for Medicaid but also in the private insurance market.

He was asked whether the new proposal will result in fewer dollars from Washington, as reducing federal expenditures has been one key goal of all the proposals to undo the ACA.

“There is no federal money,” Ducey responded. “All of the money is our money that is sent to Washington, D.C., and then comes back to us in a lower figure. Somewhere there must be some overhead.”

He provided no specifics on how Arizona, with fewer federal dollars, would be able to provide care to all who are in the Medicaid program now. In essence, the governor said he’s just convinced this replacement would be better and more efficient than the ACA.

“We know how to do things in the state of Arizona,” he said, noting that AHCCCS and its system of prepaid care on a per-capita basis has been cited by many as superior to fee-for-service Medicaid programs in other states.

Ducey took a shot of sorts at the Arizona Hospital and Healthcare Association and its national affiliate, which have come out against the Graham-Cassidy plan.

What’s in place now, “you can’t even call it a health-care system,” the governor said. “A system actually delivers a product or service. This is a system that begins in Washington, D.C., and then it takes care of the insurance providers, the pharmaceutical companies and the hospital organizations before it runs over the doctors and leaves the patients with an insurance card the health-care system won’t accept.”

Greg Vidor, president of the Arizona association, said the plan “falls short” on the goal of quality and affordable care.

“This proposal erodes critical protections for patients and consumers and would lead to costlier premiums for many individuals, especially those with preexisting conditions,” Vidor said in a prepared statement. “Millions would lose coverage altogether.”