Local hospitals and emergency rooms are at risk of closing if the Legislature doesn't expand a state-run health insurance program to include more people, Arizona Medicaid officials were told Thursday.

"The hospital in Douglas already filed for bankruptcy and that can have a domino effect," said Dr. Manny Arreguin, chief of staff -elect at Tucson Medical Center. Arreguin spoke during a Tucson forum organized by officials with the Arizona Health Care Cost Containment System (AHCCCS).

AHCCCS is the state's Medicaid program for lower-income residents. The aim of the session was to educate the public about what many say is the biggest health policy decision to face the Arizona Legislature since AHCCCS began.

If the Legislature decides against expanding the program, state officials say it will leave approximately 300,000 Arizonans without any health insurance in 2014 when most provisions of the federal healthcare law take effect.

Opponents of the expansion include many who would like to repeal President Obama's Patient Protection and Affordable Care Act.

Critics say AHCCCS needs to be reformed before it is expanded.

The Legislature must decide whether AHCCCS will enroll people making up to 133 percent of the poverty level, rather than the current cap of 100 percent. The poverty level means an annual income of $11,170 or less for a single person. Taking the qualification up to 133 percent of the poverty level would work out to a maximum annual income of $15,282 for a single person.

The expansion would cover an additional 57,000 Arizonans. But more significantly, the expansion would give what state officials say is enough federal matching funds to cover childless adults, who were frozen out of AHCCCS because of state budget slashing that made $2.5 billion in annual cuts to the program.

With the federal matching funds, the state would be able to restore coverage to 240,000 childless adults and continue coverage for 50,000 others, said AHCCCS spokeswoman Monica Coury. But restoring that coverage is contingent on the Medicaid expansion, she stressed.

The childless adults affected include people like 51-year-old Teresa Miller, a Tucson resident with severe health problems who says she needs medical care in order to be well enough to work again. Miller broke into tears as she spoke at Thursday's forum.

The U.S. Supreme Court's June decision on the health-care law gave states leeway on what to do with their Medicaid programs. So while the federal health law had called for states to expand their Medicaid programs, the individual state flexibility on Medicaid means some people could be without insurance.

State health exchanges will offer federal subsidies for purchasing insurance, but people living below the poverty level do not qualify for those subsidies. Some people are calling that glitch the "Medicaid doughnut hole."

Much of Thursday's testimony recounted the struggles of childless adults who have been frozen out of AHCCCS. One emailed comment was from a woman whose child died, leaving her unexpectedly childless and no longer eligible.

Earlier this year, Gov. Jan Brewer, a staunch opponent of the federal law, surprised many when she announced her support for Medicaid expansion. This week, she introduced a Medicaid expansion bill in the Legislature.

"Some will say she's senile. Others see it as a slap in the face to her party," TMC's Arreguin said. "It was absolutely wise."

The Tucson event was the fourth of five such forums that AHCCCS officials have held statewide. The agency says states that expand Medicaid have competitive advantage.

They note that everyone is paying for the high rates of uncompensated care that have soared in the last 12 months.

Critics of the expansion are organizing their own information sessions.

Last week the conservative policy group Americans for Prosperity held a forum at Tucson's Loft Cinema.

Tom Jenney of Americans for Prosperity outlined reasons why he believes Arizonans should be skeptical of the proposed expansion. Among other things, he said the state's share of paying for the Medicaid population will increase and burden the already strapped state coffers. He also said the expansion will not fix the problem of uncompensated care because it will not give insurance to undocumented immigrants.

Other critics of the plan said they oppose an assessment hospitals will pay to help finance the state's portion of the expansion.

AHCCCS director Tom Betlach and Don Hughes, who is Brewer's director of health-care policy, were in attendance at The Loft forum and defended Medicaid expansion as both fiscally and morally responsible.

"It's a matter of life and death," Betlach said. "The government has a solution. What is yours? Or do we just wait for them to die?"


More information about Medicaid expansion:

The Arizona Healthcare Cost Containment System: www.azahcccs.gov/

Critics of Medicaid expansion at Americans for Prosperity: americansforprosperity.org/arizona/