(This article is from the Feb. 17 Arizona Republic.)
By Mary K. Reinhart
State lawmakers, poised to drop health-care coverage for thousands, say poor people who still qualify for the state's Medicaid program, including pregnant women, should take greater responsibility for their health care.
They want to impose co-payments for prenatal care, block care to those who don't pay a fee for missed appointments and require people to prove citizenship before hospitals will admit them.
The bills are moving through the Legislature as Gov. Jan Brewer and legislative leaders plan to eliminate at least 250,000 people from the Arizona Health Care Cost Containment System, the state's Medicaid program.
A half-dozen AHCCCS-related bills, at least one of which would violate federal regulations, illustrate the resentment among some Republican legislators toward the nearly 30-year-old program, its growing share of the state budget and the authority wielded by the federal government to oversee it.
"The federal government is passing laws that prevent us from doing what we need to do," said Sen. Sylvia Allen, R-Snowflake.
Senate Bill 1216 would require AHCCCS to develop a sliding-scale fee of $150 to $1,000 for prenatal care and childbirth. AHCCCS lobbyist Jennifer Carusetta told the Senate Appropriations Committee this week that federal rules ban co-payments for pregnant women.
That didn't dissuade Allen, the bill's sponsor, who called the federal rules "chains of bondage." Nor did it deter the committee, which passed the measure 7-4.
"I believe that children are the parents' responsibility, and they need to pay something towards this," Allen said.
Lawmakers also want to require a $25 fee for missed appointments and allow doctors and other health-care providers to refuse care to those AHCCCS patients who don't pay it.
Federal health officials, who must approve most changes to the program, have rejected attempts by AHCCCS to impose a no-show fee. But lawmakers are pushing forward in the name of states' rights, saying Arizona's fiscal health depends on challenging federal authority, particularly over the burgeoning health-care program.
"They are literally forcing us to throw the AHCCCS population under the bus or go bankrupt," said Sen. Frank Antenori, R-Vail, who sponsored Senate Bill 1357, the no-show bill. "I'm tired of coddling this population."
The Senate Healthcare and Medical Liability Reform Committee approved SB 1357 on a 4-1 vote Wednesday night.
With 1.3 million members, AHCCCS accounts for 30 percent of the state budget. Brewer and lawmakers have tried for two years to scale back the program to help close gaping budget holes, and Brewer's budget for fiscal 2012 proposes eliminating 280,000 people, effective Oct. 1.
In a letter to Brewer this week, Health and Human Services Secretary Kathleen Sebelius said the state can drop most of those people without losing federal matching funds. That's because Arizona's program is due for reauthorization on Sept. 30, and the law allows the state to renew its agreement without including childless adults, whose coverage is optional under Medicaid.
Opponents of the bills say people cannot afford fees. Federal rules prohibit such fees because they could discourage or prevent people from seeking care. Medicaid rules require minimum coverage for children, parents, the disabled and pregnant women.
"They just wouldn't be able to pay it," said Sen. Kyrsten Sinema, D-Phoenix. "These are very, very poor people."
AHCCCS provides health care for children, parents and the disabled. Under an expansion, approved in 2000 as Prop. 204, the state covers childless adults up to 100 percent of the federal poverty level, which is $10,830.
Sinema said the bills are intended to reduce the AHCCCS population.
The bills, including another to require AHCCCS and food-stamp recipients to carry bright-orange identification cards with large black lettering, demonize poor people, said Tim Schmaltz, who heads Protecting Arizona's Family Coalition.
"There are rampant stereotypes about poor people," Schmaltz said. "They don't have the faintest idea what people are going through."
By Mary K. Reinhart
State lawmakers, poised to drop health-care coverage for thousands, say poor people who still qualify for the state's Medicaid program, including pregnant women, should take greater responsibility for their health care.
They want to impose co-payments for prenatal care, block care to those who don't pay a fee for missed appointments and require people to prove citizenship before hospitals will admit them.
The bills are moving through the Legislature as Gov. Jan Brewer and legislative leaders plan to eliminate at least 250,000 people from the Arizona Health Care Cost Containment System, the state's Medicaid program.
One measure, sponsored by Senate Appropriations Committee Chairman Andy Biggs, R-Gilbert, would eliminate AHCCCS altogether. Senate Bill 1519 and the hospital citizenship bill, Senate Bill 1405, are scheduled for a hearing before Biggs' committee next week.
A half-dozen AHCCCS-related bills, at least one of which would violate federal regulations, illustrate the resentment among some Republican legislators toward the nearly 30-year-old program, its growing share of the state budget and the authority wielded by the federal government to oversee it.
"The federal government is passing laws that prevent us from doing what we need to do," said Sen. Sylvia Allen, R-Snowflake.
Senate Bill 1216 would require AHCCCS to develop a sliding-scale fee of $150 to $1,000 for prenatal care and childbirth. AHCCCS lobbyist Jennifer Carusetta told the Senate Appropriations Committee this week that federal rules ban co-payments for pregnant women.
That didn't dissuade Allen, the bill's sponsor, who called the federal rules "chains of bondage." Nor did it deter the committee, which passed the measure 7-4.
"I believe that children are the parents' responsibility, and they need to pay something towards this," Allen said.
Lawmakers also want to require a $25 fee for missed appointments and allow doctors and other health-care providers to refuse care to those AHCCCS patients who don't pay it.
Federal health officials, who must approve most changes to the program, have rejected attempts by AHCCCS to impose a no-show fee. But lawmakers are pushing forward in the name of states' rights, saying Arizona's fiscal health depends on challenging federal authority, particularly over the burgeoning health-care program.
"They are literally forcing us to throw the AHCCCS population under the bus or go bankrupt," said Sen. Frank Antenori, R-Vail, who sponsored Senate Bill 1357, the no-show bill. "I'm tired of coddling this population."
The Senate Healthcare and Medical Liability Reform Committee approved SB 1357 on a 4-1 vote Wednesday night.
With 1.3 million members, AHCCCS accounts for 30 percent of the state budget. Brewer and lawmakers have tried for two years to scale back the program to help close gaping budget holes, and Brewer's budget for fiscal 2012 proposes eliminating 280,000 people, effective Oct. 1.
In a letter to Brewer this week, Health and Human Services Secretary Kathleen Sebelius said the state can drop most of those people without losing federal matching funds. That's because Arizona's program is due for reauthorization on Sept. 30, and the law allows the state to renew its agreement without including childless adults, whose coverage is optional under Medicaid.
Opponents of the bills say people cannot afford fees. Federal rules prohibit such fees because they could discourage or prevent people from seeking care. Medicaid rules require minimum coverage for children, parents, the disabled and pregnant women.
"They just wouldn't be able to pay it," said Sen. Kyrsten Sinema, D-Phoenix. "These are very, very poor people."
AHCCCS provides health care for children, parents and the disabled. Under an expansion, approved in 2000 as Prop. 204, the state covers childless adults up to 100 percent of the federal poverty level, which is $10,830.
Sinema said the bills are intended to reduce the AHCCCS population.
The bills, including another to require AHCCCS and food-stamp recipients to carry bright-orange identification cards with large black lettering, demonize poor people, said Tim Schmaltz, who heads Protecting Arizona's Family Coalition.
"There are rampant stereotypes about poor people," Schmaltz said. "They don't have the faintest idea what people are going through."
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It is always on the backs of the less fortunate, that the fortunate, or the perceived fortunate, move forward. Once again, the state of Arizona has embarrassed itself. For those of you that do not live here, I would argue the problems of this state have not been caused by ACHHS, they have not been caused by the poor; they have been caused by the arrogance of a political party who would put the needs of the few way ahead of the needs of the many! A true abomination of greed and corrupt political power! Shame to the Republicraps and democraps as well; and shame to us (you and me) for allowing this to get to this point!
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