PHOENIX — Gov. Doug Ducey is defending his support for the latest bid to repeal the Affordable Care Act even though he has no idea how much federal aid that would cost the state and how many Arizonans would lose health care.
“The numbers are important,” the governor said Wednesday. Ducey said his staff is analyzing the elements of the Graham-Cassidy bill on the Arizona Health Care Cost Containment System, the state’s Medicaid program, which U.S. Senate Republican leaders are trying to get voted on before the end of the month. But the governor said he remains convinced that what comes next will be better than what exists now, even without yet knowing the effect on the state and its residents.
“Obamacare is a failure,” he said. “It’s time for it to go.”
Yet Ducey sidestepped a question of whether he could guarantee that none of the 400,000 people who have been added to the rolls of the state’s Medicaid program because of the Affordable Care Act would again find themselves without health insurance.
“Well, I haven’t seen the final bill,” the governor said of the legislation he has endorsed. Anyway, Ducey said he believes the measure will provide Arizona with “the longest possible transition so that we can move people from Medicaid into a superior insurance product.”
He did not say what that would be.
Ducey also acknowledged that the proposal by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would financially penalize states like Arizona that expanded Medicaid eligibility long before there was an Affordable Care Act. That’s the result of voter approval in 2000 of Proposition 204, which guaranteed care for everyone up to the federal poverty level at a time when Medicaid eligibility was far less.
In fact, the governor cited a similar provision in earlier bills in a letter to Arizona Sen. John McCain as one of the “critical changes” that needed to be made to those now-failed attempts to make them acceptable.
“I don’t want a bill that is going to penalize Arizona,” Ducey said Wednesday despite what is in the current version of the measure. But the governor said he believes that even if Graham-Cassidy does become law and the penalty is in it, it won’t be the end of the discussion.
“It will take this bill and more to do and get our health care system in the right shape,” the governor said.
That’s assuming Senate Majority Leader Mitch McConnell can line up the votes, particularly that of McCain, whose opposition to the earlier “skinny repeal” helped to doom that measure.
As of Wednesday the state’s senior senator was still undecided. But he repeated his statement that he wants the issue considered in “regular order,” meaning full-blown hearings and the opportunity for amendment.
That’s not what McConnell is considering, with the latest proposal being a single hearing in the Homeland Security Committee and a Sept. 30 deadline for action.
Ducey’s strong and early support of the new federal legislation puts him at odds with some of his Republican colleagues.
In a letter Tuesday, Kasich of Ohio, Charles Baker of Massachusetts, Phil Scott of Vermont and Brian Sandoval of Nevada all urged McConnell to scrap the plan and instead support “bipartisan efforts to make health care more available and affordable for all Americans.”
All are from states that several studies have shown will be, like Arizona, financial losers under the Graham-Cassidy plan.
One study from the Center for Budget and Policy Priorities puts the annual loss to Arizona at $1.6 billion by 2026.
“The estimates you are referring to right now come from a left-wing or left-leaning organization that has a real stake in maintaining the status quo,” Ducey responded.
A separate report from Avalere Health, which does consulting for the health care industry, has cumulative losses between 2020 and 2026 at $11 billion. At least part of that is because the federal block grants to states would grow at a set rate rather than based on the number of people who enroll.
And after 2026, all the block grant dollars would go away.
Even the nonprofit Kaiser Family Foundation concluded what’s in the federal bill “revamps and cuts Medicaid, redistributes federal funds across states, and eliminates coverage for millions of poor Americans.”
For Ducey, however, the touchstone is getting rid of the Affordable Care Act.
“If anything, I think the deciding issue of the last eight years in terms of elections has been Obamacare,” the governor said. “It’s time for it to go.”
Ducey said he wants a bill to give states “maximum flexibility,” not only for Medicaid but also in the private insurance market. And he sniffed at the idea that what’s being proposed will result in fewer dollars from Washington, even as reducing federal expenditures has been one of the key goals of all of the proposals to undo the Affordable Care Act.
“There is no federal money,” Ducey said.
“All of the money is our money that is sent to Washington, D.C. and then comes back to us in a lower figure,” he said. “Somewhere there must be some overhead.”
But Ducey provided no specifics on how Arizona will be able provide care to as many people who are in the Medicaid program now with fewer federal dollars. In essence, the governor said he’s just convinced it would be better and more efficient.
“We know how to do things in the state of Arizona,” he said, noting that AHCCCS and its system of prepaid care on a per-capita basis has been cited by many as superior to fee-for-service Medicaid programs in other states.
Ducey also took a slap of sorts at the Arizona Hospital and Healthcare Association and its national affiliate, both of who have come out against the Graham-Cassidy plan. He said what’s in place now “you can’t even call it a health care system.”
“A system actually delivers a product or service,” the governor said. “This is a system that begins in Washington. D.C. and then it takes care of the insurance providers, the pharmaceutical companies and the hospital organizations before it runs over the doctors and leaves the patients with an insurance card the health care system won’t accept.”
In a statement Tuesday, Greg Vidor, president of the Arizona group said the plan “falls short” on the goal of quality and affordable care.
“This proposal erodes critical protections for patients and consumers, and would lead to costlier premiums for many individuals, especially those with preexisting conditions,” he said in a prepared statement. “Millions would lose coverage altogether.”
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