PHOENIX -- Arizona won't be asking the federal government to let it drop some people from the state's Medicaid program.
Gov. Jan Brewer this afternoon vetoed legislation that would have required the Arizona Health Care Cost Containment System to seek ways of cutting future costs by limiting who gets care. Brewer said kicking people out of the Medicaid program -- potentially close to half a million -- would not only harm them but bring the state's health care system "to a breaking point.'
"As we all know, their medical needs will still exist,' Brewer wrote in her veto message. And she said those who are not getting health insurance through Medicaid will instead will show up in hospital emergency rooms, get care -- and then be unable to pay their bills.
The legislation would have asked the U.S. Department of Health and Human Services, which provides the majority of the state's Medicaid funding, to place a five-year lifetime limit on benefits for adults. HB 2367 also would have required those who can work to have a job, be looking for one or be in a job-training program.
Federal Medicaid regulations currently do not allow such limits. But they have permitted states to seek waivers from their rules to find better ways to provide care.
This legislation would have required state officials to seek those waivers every year.
The legislation, crafted by House Speaker Andy Tobin, did have some exceptions to the five-year lifetime limit, including if the person is pregnant or the sole caregiver for a family member younger than 5. It also would have waived the five-year limit if someone remains employed full-time but in a low-wage job where the earnings still qualify them for Medicaid benefits.
Tobin's voted against Brewer's plan last year to expand eligibility for the state's Medicaid program by using cash from the federal Affordable Care Act. And he has made several statements opposing what has become known as "Obamacare.'
But Tobin said it became obvious that both the federal program and the state expansion are here to stay, at least for the time being.
His concern is the cost down the road for the state.
The Affordable Care Act currently picks up virtually all of the cost of Arizona expanding eligibility from the federal poverty level to a figure 38 percent above that. But Tobin said it will be impossible for Washington to keep enough money flowing to the states to do that forever, meaning some of the new costs of an expanded program eventually would be shifted back to the state.
Tobin said the waivers he sought would have given Arizona a chance to scale back the program if the federal funds dry up.
Brewer, in vetoing the legislation, said she shares his concerns about relying on the federal government. But she said his alternative of denying care is not an option.
She said a 5-year lifetime enrollment cap could mean kicking more than 212,000 people out of the program. And she said another 253,000 children would lose coverage when they turn 18 "as the bill makes no exception for enrollment during childhood when determining the five-year limit.'
Separate from the lifetime limit and the work requirement, Tobin's legislation also would have required AHCCCS officials to try to get federal permission to impose "meaningful copayments' to deter the use of hospital emergency rooms for non-emergency medical conditions and the use of ambulance services where it is not medically necessary.