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Updated Apr 22, 2014 - 7:56 pm

Brewer vetoes bill limiting Medicaid to 5 years

PHOENIX — A bill that would have forced able-bodied Medicaid recipients to
get a job and would have limited some to a maximum of five years of insurance
was vetoed Tuesday by Gov. Jan Brewer.

Brewer said in a veto letter that the five-year cap could have meant throwing
more than 210,000 adults off the state’s Medicaid program, and an additional
253,000 children as soon as they reached their 18th birthday.

Brewer said her Medicaid expansion plan passed last year was designed to
address uncompensated care that was forcing hospitals to pass on hundreds of
millions of dollars’ worth of costs on to Arizona families and businesses
through higher rates.

House Bill 2367 by House Speaker Andy Tobin, R-Paulden, would have required the
state’s Medicaid program to apply for a waiver from federal regulators every
year to allow it to impose the new rules. Federal officials said after final
approval by the Legislature last week that they likely would not approve the
waivers. Tobin has said he believes Medicaid’s position could change.

Tobin’s bill also imposed copays on unneeded ambulance and emergency room use.
He said they’re needed to protect the state from excess expenses. Democrats
argue they would limit the effectiveness of the health system for poor
Arizonans.

Tobin said he had never received a rejection message from Brewer’s office, but
knows state agency directors don’t like the kind of requirements the bill would
have imposed. And while Republican governors like Brewer would be more likely to
make such requests on their own, he believes Democrats would not and a law needs
to be in place to force that.

“I’d hate to see Arizona stuck in the budget crisis we just left” because of
soaring Medicaid costs, Tobin said.

The bill passed both the Senate and the House on party-line votes, with
majority Republicans in support and Democrats opposed.

As originally introduced in February, the bill would have a hard limit of five
years for anyone getting Medicaid. After an outcry from Democrats over its
effect on the working poor, Tobin changed that provision so it would only affect
people who are able-bodied and don’t work. He also added exemptions for pregnant
women, those on disability and those caring for young children.

Tobin said the federal opposition could change and the requirements give the
state tools to cut enrollment if the government fails to fund the program as
promised.

Tobin’s proposal also included a requirement for a copay for unnecessary visits
to hospital emergency rooms or ambulance use. The federal government had been
allowing Arizona to charge $30 copays for unnecessary emergency room visits, but
that expired Dec. 31. Arizona is now asking federal officials for authority to
charge $200 for such visits for newly eligible people on the state’s Medicaid
plan, called the Arizona Health Care Cost Containment System, or AHCCCS.

Democrats accused Tobin of trying to limit the reach of the program for
political reasons. He is running for Congress in Arizona’s 1st District.

An analysis of the bill’s impact by the Legislature’s budget analysts estimated
that 141,000 current Medicaid recipients would lose coverage under Tobin’s
lifetime limit. That could save the state nearly $150 million a year. Only about
half of the 440,000 able-bodied adults now getting insurance meet the work
requirement. A total of more than 1.4 million Arizonans were enrolled in the
state’s health insurance plan for the poor as of April 1.

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