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home : opinions : opinions May 24, 2016

3/21/2013 1:05:00 PM
My Turn: Serious questions about Gov. Brewer’s Medicaid expansion
Rep. Brenda Barton

Recently I have been asked by many for my thoughts on the Governor’s Medicaid Expansion proposal. This is a complex issue and there isn’t a simplistic or short form answer.

Until a week ago, any comments I could have made regarding the Governor’s Medicaid Expansion proposal would have been speculation, because the Governor had not released her proposal.

A week ago, against a backdrop of white coats and hospital scrubs on the House lawn reminiscent of President Obama’s Affordable Health Care Act announcement, Governor Brewer announced her intention to expand Medicaid in Arizona. There are two required steps to the full implementation of what is termed “Obamacare” in Arizona; one is the full expansion of Medicaid and the other is the establishment of a health care insurance exchange. The Governor has opted for a federally managed exchange.

Voters approved of Prop. 106 two years ago, which essentially was a referendum against a federally imposed health care program. But now in 2013 the mood of the voters appears to have changed.

As of this report to you, I have not received a copy of the Governor’s lengthy proposal; and as they say, the devil’s in the details. As much as I would like to insure the health care coverage of every resident of Arizona, there are some serious concerns with the Governor’s current proposal and the program overall.

I understand that to raise the funds necessary to pay for Arizona’s portion of the Medicaid Expansion, the Governor in union with the state’s health care insurance lobby, has proposed what amounts to something akin to a hospital bed tax, much like funding tourism and the local chamber through a hotel bed tax.

Additionally, I have been advised by several members of Congress that the federal funds for the first year of the Medicaid Expansion are no longer available, and funding for years 2 and 3 is in doubt. This should be of considerable concern to your readers; Arizona will enact a new tax to fund its share of this program while simultaneously the federal funds to cover the bulk of the funding may not be available.

This is in stark contrast to the $8 billion the Governor is asserting Arizona will receive from the federal government. Is this simply more borrowing from overseas creditor nations? I honestly do not know the source of this federal windfall.

Another concern to your readers should be the fact that the state has identified about 400,000 persons who will be eligible initially for coverage under the Medicaid Expansion. Here’s the rub, however; this does not include those persons who will become eligible once their employers cease their employer-assisted health care insurance and encourage their employees to apply for Medicaid. This also does not include our residents who are here without legal status; they too will qualify for the Medicaid Expansion. It is easy to see that 400,000 can climb abruptly to over 600,000. The cost estimates for the Medicaid Expansion are only calculated for a maximum of 400,000. There is no provision for funding the potential additional persons who may apply that are not currently factored into the present proposal by the Governor.

Finally there is the federal phase out of support beginning in year three. The federal government has committed to paying for 100 percent of the Medicaid Expansion for the first 3 years, but by 2016 will reduce their share by 5 percent and eventually the federal funds will cover only 90 percent. This will leave Arizona taxpayers to cover 10 percent of the health care costs for perhaps over half a million new Medicaid accounts.

As revenues are currently projected, our state budget choice may be simple: educate; incarcerate or medicate. I invite your readers to a community discussion of this issue and urge them to put aside simplistic partisan talking points and evaluate the hard evidence when deciding their thoughts on the Governor’s Medicaid Expansion. And, as you elected Representative, please let me know what your thoughts are.

Let me leave you with one of the most used opening newspaper paragraphs for the Week of March 11, 2013: “Some Americans could see their insurance bills double next year as the healthcare overhaul law expands coverage to millions of people. The nation’s big health insurers say they expect premiums — or the cost for insurance coverage — to rise from 20 to 100 percent for millions of people due to changes that will occur when key provisions of the Affordable Care Act roll out in January 2014.”

Rep. Brenda Barton, (R-Payson), represents Legislative District 6, which includes the Verde Valley.

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Reader Comments

Posted: Wednesday, April 17, 2013
Article comment by: Maybe I missed something

My bad . . . happy to oblige!

From Rachel Maddow in simple language.

"I imagine some folks see the phrase "medical loss ratio" and their eyes glaze over, but you don't need to be a wonk to appreciate the policy. Obamacare forces insurers to spend 80% of the premiums they receive from consumers on actual health care -- not advertising, lobbying, or giving executives huge salaries. When insurers fall short, they're required to -- you guessed it -- send you a check for the difference."


From the government web site on healthcare.

"More Affordable Care: Today, we have the new 80/20 rule: insurance companies must spend at least 80 cents of your premium dollar on your health care or improvements to care. And insurance companies must publicly justify their actions if they want to raise premiums by 10 percent or more. And States have more power to block them."


Now could you please post a credible link to your "small print" comment? I want to actually see what you are talking about.

Posted: Wednesday, April 17, 2013
Article comment by: @ Maybe you missed something

It's your argument that needs support. You're the one that claimed your healthcare insurer would be using $8000 of your money for a year, interest free.

Posted: Wednesday, April 17, 2013
Article comment by: Maybe you missed something

It is not my job to find support for your argument.

Not going to waste my time looking for something that does not exist. If you actually had any proof of your claims, I would think that you would be happy to offer it up.

You obviously can't do your own homework.

Posted: Tuesday, April 16, 2013
Article comment by: What sour grapes you have, grandma!

Sorry you didn't find what you were looking for.

Posted: Tuesday, April 16, 2013
Article comment by: Maybe you missed something

@ What a deal

We are talking about HEALTHCARE insurance.

Did you miss that?

Tell you what, you keep your premiums. I guarantee you are not going to get rich on the interest. Pay a small fine $300 and you can pay cash when you are sick.

Works for me.

Hope you never get in an accident.

Where is this small print you speak of? Show us. You can't do math, so how are we supposed to believe that you can comprehend?

Posted: Tuesday, April 16, 2013
Article comment by: @ ZD

I'm not scoffing, I'm snickering at the Grand Canyon Institute's UNSUPPORTED PROJECTIONS in FAVOR of JAN BREWER's proposal.

You mean the "expanded insurance pools" the Obama Administration will NOT have in place next year? (Google "Delays in Affordable Care Act implementation") I was referring to the premiums that are SOARING right now and are not expected to stop SOARING in 2014.

Who besides the Obama Administration is PROTECTING INSURANCE COMPANIES from anything? That's the only thing keeping people from dropping their INFLATED insurance.

Not yet it isn't reducing costs, much less saving lives.

Posted: Tuesday, April 16, 2013
Article comment by: Z D

@@zD: You scoff at 30,000 new jobs because you do not work in a medically related field. Perhaps you work at a restaurant or laundry or food service or uniform supplier or any other non-healthcare job that benefits from the increase in spendable income earned by these new additions to the work force. A rising tide lifts all boats.

What "soaring" premiums are you talking about? Insurance premiums will go down as a function of expanded insurance pools and the requirement in Obamacare that insurance companies spend no more than 15 percent of their earnings on administrative costs.

Why do you care so much about protecting insurance companies from taxes? Those businesses are already raking in billions in profits every year. Until Obamacare, much of those profits were simply going into the pockets of health insurance CEOs instead back to providing care for their members.

Obamacare is saving lives and reducing health care costs already.

Posted: Monday, April 15, 2013
Article comment by: What a deal!

Just this year I got a permanent premium reduction from my auto insurer for safe driving. And next year I'll get another if don't get any tickets or have an accident. When was the last time your health insurance premium went down?

Also, why would you want to lend your health insurer $8000 per year, without interest, if the actual cost of insuring your good health is $2000? Besides, you'd better go read those sections more carefully. You've got it turned around, and you're missing the fine print.

Posted: Monday, April 15, 2013
Article comment by: Maybe you missed something

@ What a deal

I will use a round number that is more realistic.

If you pay $10,000 in premiums for a year, and because of good health, you do not go to the doctor that year, you will get a $8000 refund because of Obamacare.

When was the last time you got a refund from an insurance company on premiums?

Posted: Sunday, March 31, 2013
Article comment by: itsy bitsy Spider

It's been truly amusing to watch Obamacare enthusiasts dance around the fact Governor Jan Brewer is out stumping for something they want.

But truly, people, you should be considering Jan Brewer's proposal to expand Medicaid to everyone under 138% of the poverty level before Arizona's economy can even support the federal co-pay. And rather than relying on partisan non-profits like the Grand Canyon Institute, you should be researching what Jan Brewer's judgment could do to other state priorities, other government programs, and to your budgets and your health care.

I realize this is difficult because Jan Brewer's presentation is rather vague. But if you start with the Verde Independent's "Governor explains details of expanding Medicaid" and "Brewer on stump to expand the state's Medicaid program," you can at least check her figures and see if they add up the same way twice.

Posted: Wednesday, March 27, 2013
Article comment by: Mary Heartman

@ @zD:
That's a good point. Where will the additional medical professionals be coming from? According to Wikipedia, that's tiny little Israel's biggest problem, and this will be happening all over the U.S. at the same time.

If, as Rep. Barton says, Arizona will have to reduce educational spending to cover the increase in medical spending, how will we expand the medical programs to cover the increased demand?

Posted: Tuesday, March 26, 2013
Article comment by: @ z D

@ zD
Re: "That means more doctors, nurses, medical transcriptions, billing specialists, medical technicians, psychologists and many other health care jobs for you and me."

For you, maybe. Not for those who don't work in the healthcare field. And I sort of wonder where all these MDs and RNs and medical technicians and psychologists will be coming from. Last I looked, the U.S. has a dearth of all four and jobs were going begging even in 2010. Why else do you think organizations like VVMC are hiring them out of private practices?

Re: "according to the Congressional Budget Office"

Better read that report again. FICA is before exemptions, deductions, and credits--at .9%, it's a hefty increase for families and businesses from someone who wasn't going to raise taxes on lower or middle class workers and the small businesses that are just barely able to employ them now. It's also 1.8% on self-employed. All this on top of soaring premiums. And we're going to reduce insurance premiums by charging a surtax? We're going to reduce medical costs by "taxes on the healthcare industry including, a tax on companies who manufacturer non-generic drugs and some medical device manufacturers"?

Posted: Tuesday, March 26, 2013
Article comment by: @ Peter, Yavapai County

@ Peter, Yavapai County
Re: "if you want access to the best health care, you must pay more and more for health insurance"
Not necessarily. The best health care for some people is minimal intrusion, low medication, and good advice. That happens to run in my family. My great grandmother lived into her 90's with no health insurance and no medical problems. Those of her twelve children who lived past early childhood and accidental deaths (nine) all lived nearly as long, also without insurance. My mother had insurance and died in her early 60's (from greater stress, not insurance per se). I decided to follow great grandmother's route and shopped around for medical professionals who had the same philosophy. Obamacare will put my doctor out of business. But at 74, with no medical problems, I figure when something does catch me, it will be time to pass on--not run to ER.

Posted: Monday, March 25, 2013
Article comment by: @Gaia Gurl

Oh I got the use of the word reject. Your posts are not over my head at all. It is you who has issues with things going over your head. You missed the whole point of my post. I was trying to politely point out that while I agree with you on some issues, your delivery will turn people away in droves because of your delivery, which is angry and insulting. It scares me that a person such as yourself is a school teacher because the childish manner that you behave in should not be set as an example for our young people. People like you are the problem in this country, they talk, talk, talk and don't ever stop to listen and think about someone's opposing view. I feel very sorry for you because your rage is so evident that it makes it apparent that you are a very unhappy person.

Posted: Monday, March 25, 2013
Article comment by: @ @ Gaia Gurl

It's a perversion of Teddy Roosevelt's foreign policy.

Scream loudly, and carry a big shtick.

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