But while Daniel Scarpinato, the governor's spokesman, calls it a “significant reform to increase coverage and modernize [the Medicaid] program to better fit people's needs,” and Christina Corieri, Ducey's health and human services policy adviser, says the plan would help “individuals get healthy so they can get back to work,” critics blast the proposal — which some call “Ducey-care” — as just another right-wing, ideology-driven idea that would end up hurting the poor.
Medicaid in Arizona is provided through the Arizona Health Care Cost Containment System (referred to as AHCCCS, pronounced “access”). Every five years, states can apply for what's called a Section 1115 Waiver, which allows them to propose experimental and pilot programs “that promote the objectives of Medicaid.” Arizona's current waiver is set to expire in September 2016, and Ducey hopes his plan will go into effect the following month.
AHCCCS serves about 1.7 million people, about half of whom are children. Ducey's plan would not affect healthcare for children, the elderly, or the disabled. Only the up to 350,000 “able-bodied adults” enrolled in the program would be affected.
If approved by the federal government, the plan will cap Medicaid assistance at a five-year lifetime limit — the Ducey administration clarified Monday afternoon that men and women who are employed but still qualify for Medicaid because their wages are so low, will not be kicked off after five years, as had been suggested at a press conference earlier in the day. Also under the Program, Arizona would institute a new system of premiums and co-payments that charge individuals 5 percent of their annual income.
Any co-payments would go to the state to help offset costs, while monthly premiums would be deposited into individual Health Savings Accounts, a program Ducey calls AHCCCS CARE. The funds in the CARE account could be used for healthcare services not covered by the plan, like dental or vision, and would carry over with individuals who transition into the private healthcare system.
But not just anyone could access HSA money. Participants would have to make timely payments into the account, participate in the AHCCCS works program, and meet certain Healthy Arizona targets, like getting annual wellness exams and managing chronic diseases or substance-abuse problems. Failure to do so would result in consequences: Those whose annual income is above or equal to the federal poverty level would be “disenrolled from the AHCCCS program for a period of six months,” while those who fall below would see the charges counted as a debt to the state. (Ducey administration officials have said the details for collecting this debt have yet to be worked out.)
As noted by Corieri during a press conference Monday, the Centers for Medicare and Medicaid Services — the federal body in charge of approving state waiver proposals — never has approved a Medicaid plan that involved a work requirement. But, she adds, Arizona is doing something different.
"You won't be removed from the program" if you don't participate, she says. "You just won't have the ability to use your AHCCCS CARE account.” She calls accessing the account an incentive, not a penalty and says engagement throughout the program “unlocks” benefits.
The Governor's Office calls this plan “the right mix of requirements and incentives,” but critics such as Robert Grossfeld, a longtime political consultant for progressive groups, says the proposal is “an incomplete effort to dance around the Affordable Care Act and undo [former Governor Jan] Brewer's Medicaid legislation,” which expanded the program and made more people eligible.
“This is straight out of the ALEC playbook,” he says, referencing the American Legislative Exchange Council, a right-wing nonprofit that drafts model state legislation. “It's pure Koch brothers, [and] it doesn't surprise me at all” to see it from this administration.
“The Ducey folks keep saying 'more self reliance, more responsibility,' and are just completely oblivious to what life is like for someone living on $16,000 a year . . .There's all this stuff [in this proposal] about getting people healthy while a great many of these people are being challenged just to find a place to sleep and get food — let alone make co-payments. To someone making $16,000 a year, this isn't necessarily helping them; this is just throwing up more barriers.”
Amy McMullen, who runs PACH AZ, one of only three free healthcare clinics in the Phoenix area, also worries about the plan. She says Brewer's Medicaid expansion helped reduce the number of people who relied on free clinics like hers and better balanced the supply and demand for free or affordable healthcare. She expects that if this plan were to pass, her clinic would be overwhelmed by those who couldn't afford, or were no longer eligible for Medicaid and that her staff would once again have to start turning away clients because of capacity issues.
“Many of these people are living hand to mouth,” she says, “and that's not to mention the crises that come up in life, like car trouble or losing your job. So this idea that people have extra money lying around to put into a HSA is absurd.”
She says the modernization plan fits into the right-wing narrative that people are poor because of bad choices or laziness. “It's not going to make people go out and get work. People are just going to end up without healthcare.” As far as she's concerned, this proposal is simply code for “let's blame the poor and make sure there's no way they're ever going to get out of poverty.”
Representatives from the Governor's Office plan community meetings around the state this month to discuss public concerns before submitting the proposal to the federal government for approval later this year, and during Monday's press conference, Corieri and AHCCCS director Tom Betlach conceded that there are areas where they expect push-back from the government.
“When you enter into a negotiation, it's just that: a negotiation,” Corieri said, prompting one journalist to ask if the Ducey administration is "just throwing everything it can think of against the wall and hoping something sticks." After a long pause, Corieri responded by saying there are aspects of the plan “that will be hard to get approved . . . but no one is saying they absolutely won't approve it.”
McMullen and Grossfeld agree that the plan hurts the poor, and they bank on the federal government's rejecting it or at least to requiring that certain elements of it be modified. “I'd be very surprised if this got approved, so why are they even wasting their time? This is a bunch of nonsense,” she tells New Times. “Is it all just to make an ideological point?”
Schedule of community meetings
Governor's brochure about changes