Medicaid (AHCCCS) Elimination in Arizona

from former Maricopa County Health Officer Jonathan B. Weisbuch, MD, MPH (jbweisbuch@mac.com)

February 28, 2011

The Arizona legislative plan to kill our Health Care Cost Containment System (AHCCCS), is wrong, not only because it would add 280,000 (if only the Governor’s waiver is enacted), or 1.3 million Arizona residents (if SB 1519 passes) to the 1.1 million currently uninsured. It is wrong, not only because it denies poor children the prevention and medical care they need to become healthy adults. It is wrong, not only because it eliminates money that sick and poor elderly need to cover the costs of Medicare. And it is wrong, not only because many disabled, chronically ill, poor adults will be prevented from receiving the care they need to continue working, or caring for their family. These are important humanistic reasons for not killing AHCCCS. But the primary reason for not eliminating AHCCCS is that doing so will not just hurt the poor; it will harm all residents, regardless of their income, their current insurance status, their age, their ethnic background, or their political party.

The money Arizona spends on care for the medically indigent protects all of us from infectious diseases, it supports health providers and the health system; and it is a major contributor to the economy. For every dollar Arizona spends in the program, we receive over two dollars from the Federal Medicaid program. What other state investment yields a 200% immediate return? These three dollars support our hospitals, compensate our physicians and nurses, buy pharmaceuticals, reimburse nursing homes, ambulance services, and help to educate medical professionals. AHCCCS dollars keep the medical system functional so that when any of us needs care, the resources are available. These billions of dollars also go a long way to add wealth to the Arizona economy.

AHCCCS serves the poorest and often the sickest in society; a group subject to infectious diseases, which, if untreated, produce significant morbidity and mortality and a high probability of transmission to others. AHCCCS doctors identify and treat these illnesses; than report them to local health departments, as required by state law. If not managed early, tuberculosis, hepatitis, typhoid fever, infectious meningitis, encephalitis and a host of childhood illnesses can all become a threat to the community. If AHCCCS is killed, two million, one third of our population, will no longer have early access to medical care. Their treatment will be delayed, raising the chance for disease outbreaks. Infectious diseases do not just attack the poor, or immigrants; everyone is at risk. If we have children in our schools, shop in the malls, use public transportation, walk the streets, we cannot insulate ourselves from the diseases of the uninsured.

The elimination of AHCCCS will do more than place all of us at risk to infectious disease. Every dollar spent caring for Medicaid patients strengthens the Arizona health care infrastructure. When the medically indigent enrolled in AHCCCS use health services, provider groups, doctors, hospitals, long term care facilities, and pharmacies all benefit. In rural areas the medically indigent may be a majority of a physician’s practice, and a large proportion of rural hospital admissions. If Medicaid money is eliminated, rural and urban hospitals will be hurt. Some rural facilities may not survive, leaving the community bereft of emergency services, doctors, nurses, and pharmacies. Every rural resident will have difficulty finding comparable sources of care. The urban teaching hospitals, serving large numbers of AHCCCS patients, are also at risk if Medicaid funds vanish. These funds support the ER, pay for certain specialty care, and support post-graduate medical education, all of which would be reduced or eliminated.

But this is not all. The extinguishing of AHCCCS, will devastate the $200 billion Arizona economy. The state Health system is a $40 billion enterprise, nearly 20% of the total economy. The system includes 87 hospitals, numerous outpatient centers, emergency rooms and trauma centers, over 12,000 physicians, 100,000 nurses, thousands of technicians, aides, druggists, administrators and clerks. AHCCCS constitutes 25% of this industry, receiving revenue from the general fund ($3 billion including several hundreds of millions from the tobacco tax and settlement funds), and $7.2 billion from the US Treasury in Medicaid matching funds. Eliminating $10 billion from our economy will hurt every resident of the state. Our individual contribution of $500 to the program, seems a small price to pay to assure protection against epidemic disease, support of the state’s health care system, and preserving our economy and hundreds of thousands of health care jobs.

Ronald Reagan made the point that “A rising tide raises all boats.” It is also true, however, that an ebbing tide leaves all boats stranded. Let us hope that the Legislature and the Government do not eliminate a vital support system for our poor and ourselves.