Gov. Brewer State of the State

Gov. Jan Brewer addresses the Arizona Legislature for the annual State of the State speech in the January 2013 file photo. Behind her is House Speaker Andy Tobin. Saying there are technical problems with the proposal, Gov. Jan Brewer vetoed legislation Friday which would have allowed individuals to shop around for the best price on health care needs.

Capitol Media Service/ Howard Fischer

PHOENIX — Saying there are technical problems with the proposal, Gov. Jan Brewer vetoed legislation Friday which would have allowed individuals to shop around for the best price on health care needs.

The legislation crafted by Sen. Nancy Barto, R-Phoenix, would essentially have put hospitals and doctors in the same position as retailers: They would have to give people an opportunity to learn what certain procedures will cost, before they show up in a waiting room.

That would have included both a requirement for online posting as well as making a price list available on site.

Barto promoted the legislation as a cost-containment measure, especially for patients without comprehensive health insurance who end up having to pay all or part of their medical bills.

In her veto, the third of the legislative session, Brewer said she supports the idea of transparency "which will provide useful information to help patients manage their health care needs.'' But the governor said there are "practical and potential legal implications of this bill.''

Some of what Brewer said makes the measure unacceptable is its breadth.

She said the language as approved covers not only traditional hospitals but facilities run by the Veterans Administration, Indian Health Services, tribal clinics, military hospitals and even the Arizona State Hospital. She said these facilities do not serve the general public and should be exempt.

Brewer also said the bill "contains a number of ambiguous terms and definitions that likely would cause unnecessary litigation and create conflict with both state and federal law.'' The governor, however, did not provide specifics in her veto message.

And she also said — again without providing details in her veto — the legislation could impede the ability of the Arizona Medical Board to effectively investigate complaints and discipline doctors for billing abuses and excessive fees.

The veto comes as Barto, who chairs the Senate Health Committee, has taken an active role in opposing Brewer's plan to expand the state's Medicaid program. And Barto has specifically been critical of the hospitals who have been the governor's allies in the battle.

But gubernatorial press aide Matthew Benson said Brewer's veto is totally unrelated to the fight over Medicaid. And he said that the governor supports the concept of what Barto wants to do and would have signed the measure had there not been ``technical concerns.''

Among those concerns, said Benson, is that hospitals do not have one flat rate they charge for procedures. He said different charges apply depending on whether the patient is paying his or her own bill, has coverage from an insurance company that has negotiated a discount or is a Medicaid patient.

And Benson said Brewer is willing to work with Barto to find an acceptable plan, though it is too late to do so this year.

Barto has been attacking the hospitals' contention that they need the Medicaid expansion to stop the losses from uncompensated care.

Those losses, Brewer has argued, are passed on in higher costs to uninsured individuals and insurers. Brewer has pegged this "hidden health tax'' at $2,000 per family.

"Most big hospital systems are not actually losing money,'' Barto argued in an online screed. The worst that has happened, she said, is that their profits are smaller.

She also noted the perennial argument by hospitals that what Medicaid reimburses them does not cover their actual costs. If that is the case, Barto said, "how will expansion of Obamacare solve the problem.''

Under the proposal, the Arizona Health Care Cost Containment System, the state's Medicaid program, would provide coverage to individuals and families below what amounts to 138 percent of the federal poverty level. That works out to about $26,000 a year for a family of three.

AHCCCS currently funds care for most individuals below the federal poverty level. Estimates are that Brewer's proposal, which would take effect in 2014 along with the federal Affordable Care Act, would add about 300,000 individuals during the next three years on top of the nearly 1.3 million now enrolled.

Barto also said she was not swayed by Brewer's argument that the plan will bring $1.6 billion federal dollars into Arizona, money the governor said if Arizona does not accept will go elsewhere. The senator said if Washington does not send the money to Arizona, it simply reduces the amount of money that the federal government, with its deficit budget, has to borrow.

Part of Barto's objection — other than philosophy of expanded government care — is how Arizona would pay its share: what Brewer calls a $240 million "assessment'' on hospitals.

Specifically, the legislation would give the AHCCCS director the power to levy what amounts to a "bed tax'' on each hospital. By calling it an assessment — and leaving the exact amount of the levy up to the agency — Brewer contends it is not a tax.

That distinction is politically important.

Authorization for an assessment requires only a simple majority of the Legislature. But the Arizona Constitution mandates a two-thirds vote of both the House and Senate, a goal that could be politically insurmountable for Brewer given the opposition by Barto and other Republicans.

The governor's office did not immediately respond to requests for comments about any link between the veto and the Medicaid fight.

But the governor's letter itself said more than her stated reasons were involved, saying those listed concerns were "among the primary reasons'' she vetoed the legislation.

In vetoing the measure, the Republican governor largely aligned herself with legislative Democrats. The measure was opposed by only three Republican lawmakers and supported by just two Democrats.

Senior Editor, News, Arizona Daily Star, Tucson, Az.