Transplant coverage for low-income Arizonans
By Mary Jo Pitzl
The Arizona Republic
November 22, 2010
WHAT WE’RE LOOKING AT: Gov. Jan Brewer has said the state can't afford to pay for certain transplant surgeries because of the constraints of the federal health-care-reform bill. Democrats say she's lying, and note Brewer could tap into federal stimulus dollars over which she has discretion to pay for the procedures. Alternatively, they argue she could call the Legislature into a special session to restore funding for the services. The rhetoric has been heated and impassioned: Incoming Senate Minority Leader David Schapira, D-Tempe, has called the governor a “one-person death panel” because she refuses to act.
THE FORUM: Dueling news statements from legislative Democrats and Brewer.
ANALYSIS: The Legislature in March approved a fiscal 2011 budget that cut funding for optional services provided by the Arizona Health Care Cost Containment System, the state's Medicaid alternative. That included coverage of certain transplant surgeries, including bone marrow, kidney, liver problems due to hepatitis C and others. Those cuts took effect Oct. 1.
The budget also eliminated 310,000 people from AHCCCS coverage as part of deficit-reduction moves. Those people would lose coverage as of Jan. 1.
Soon after the state budget was completed in March, President Barack Obama signed the federal health-care-reform bill into law. It locked the state into providing required Medicaid services at the level in place at the time. That meant Arizona had to continue covering the 310,000 people, or risk the loss of $7 billion in Medicaid dollars to services such as long-term-care centers. It did not have to continue optional services such as the transplants.
The state is obliged to continue the required coverage through fiscal 2014, when federal dollars would arrive to cover them. The state's estimated cost over the next three years is roughly $1 billion a year.
Although the state is part of a lawsuit seeking to overturn the federal health-care-reform law, lawmakers and Brewer so far have concluded the state can't afford to ignore its requirements since $7 billion in Medicaid payments hangs in the balance. Therefore, they say they need to save money where they can - for example, by not covering optional services such as some transplants. However, the decision to cut off some transplant funding was made before the effects of the federal health-care bill were known.
Brewer has said she would consider restoring the transplant funding if she were provided ideas on where to raise the money.
Democrats last week said the governor could tap into federal stimulus dollars that she controls. The latest available accounting of those dollars, from May, shows the governor had $46 million at her disposal. It would cost about $800,000 to restore transplant coverage through the June 30 end of this fiscal year; another $1.4 million for the following year.
Brewer's office did not respond to requests on whether she would consider using the stimulus dollars. Her office also did not immediately respond to a public-records request for the amount of stimulus money still unspent.
THE FINDING: Brewer is wrong to directly link the denial of transplant coverage to federal health-care reform; it was a decision lawmakers made before the federal bill became law. But she is correct in noting that the federal law puts pressure on the state budget, which is facing chronic deficits.