Extravagant claims are made about the benefits of expanding the Arizona Health Care Cost Containment System (AHCCCS), the state's Medicaid program for lower-income residents.
But where is the evidence?
Arizona will purportedly get 15,000 new jobs. Really? Will some businesses please come forward and announce that once AHCCCS is expanded, they will put out "Hiring Now" signs? What kind of jobs, exactly? More people providing health care? It is asserted that care is already being provided, just not paid for by AHCCCS. More paper pushers?
Will we have a healthier workforce? AHCCCS has been around since the 1980s. There has been plenty of time to show that its formerly sickly beneficiaries got healthy and are now working. So where are the reports?
Hospitals are advocating for the expansion, purportedly to decrease the cost of uncompensated care. We need to see some numbers. If a hospital admits a patient without the ability to pay, it immediately tries to get that patient enrolled in AHCCCS. Nearly 50 percent of Arizonans who are eligible for AHCCCS have not bothered to enroll. If the patient is ineligible, that could be because he is not a citizen or a "qualified immigrant."
How much uncompensated care is for such patients? Arizonans need to know.
To help hospitals meet their federal obligation under the Emergency Medical Treatment and Active Labor Act, a statute that governs when and how a patient may be refused treatment or transferred from one hospital to another when he is in an unstable medical condition, they receive Disproportionate Share Hospital adjustment payments. Those help hospitals serving a substantially disproportionate number of low-income patients.
These will be slashed by Obamacare, but the reduction will be more severe if the state expands Medicaid than if it does not. The calculation of whether hospitals will be better off, especially considering the tax they are said to be eager to pay, is fairly complex.
The most obvious beneficiaries of the expansion would be the billion-dollar "program contractors," managed-care plans, which would get their per-person payments every month, even when the enrolled person ("covered life") gets no services.
Gov. Jan Brewer proposes a "circuit breaker" in case the federal government fails to come up with promised funding. Given the federal government's unsustainable deficit spending, this default is very likely, according to Medicare trustee Charles Blahous. What kind of compassion is that, to get people dependent on a program, only to kick them out?
There are many reasons why patients don't like AHCCCS, such as the estate-recovery program that can seize any assets they might have after they die to recoup the money the program paid the contractors (even if no care was received). Probably more important to patients is the restricted access to care. Many physicians limit the number of AHCCCS patients they will accept, and many will not accept any at all. The pay is poor, and the frustration of constantly having to fight to get patients what they need is often too great.
Arizona should resist the temptation to grab the money before somebody else does. It could end up costing much more than the hypothetical benefits.
Jane Orient, M.D., practices internal medicine in Tucson. Contact her at firstname.lastname@example.org