COMMENTARY: An increase in AHCCCS eligibility





The measure of a society is how it cares for its members…

Have you ever stopped to think what it’s like to be sick and not be able to see a doctor or go to the hospital because you don’t have insurance or sufficient finances to pay the bills ?

Many of our citizens not only think about this misfortune but actually experience it daily. According to the Kaiser Foundation, there are approximately 1.1 million Arizonans who do just that! 

In order to remedy this problem, a provision was enacted as part of the Patient Protection Affordable Care Act (PPACA) to provide federal matching funds to those states that want to extend the eligibility of individuals living at or below 133 percent of the Federal Poverty Level (FPL). For a family of four that’s an annual income of $31,000. Extending coverage was upheld by the Supreme Court, although the penalty for not doing so was rejected.

Gov. Brewer has proposed legislation that would extend the eligibility to 133 percent of the FPL and has started an active campaign with the legislature to get the measure passed.

According to information from Gov. Brewer’s executive budget recommendations, four of our neighboring states will also be expanding eligibility levels: California, Nevada, Colorado, and New Mexico.

Under the governor’s proposal, an estimated additional 57,000 individuals would now be able to have health insurance which is beneficial to their well-being, beneficial to commercial payers who won’t have to subsidize those without insurance, and reduce the amount of uncompensated care hospitals and other healthcare providers have had to absorb.

The executive budget recommendations calculated in fiscal year 2015, the first year of implementation of the new eligibility standards, the state will receive $1.6 billion in federal dollars for this new match, a 10-1 return on investment. Not a bad return for helping our indigent population! The proposal also will restore coverage to those who were declared ineligible because of legislative action, contrary to the will of the people who twice passed initiatives to provide coverage. The estimate of the matching funds for that is 85 percent. One caveat to the governor’s proposal: Reductions in reimbursement rates to hospitals and other providers must be rescinded and reimbursement for the additional individuals must also be at cost.

Unfortunately, the governor’s proposal is meeting with opposition from members of her own party, which is disappointing considering she is dealing with the welfare of our citizens who are in financial difficulties. These legislators who oppose the increase cite several reasons, none of which are not valid.

For example, one erroneous assertion is that under the expansion everyone will be on AHCCCS… wrong.

The expansion only adds 57,000 new individuals to the program and restores coverage to the 240,000 approved by the voters but removed by the state legislature.

Another mythical assertion by opponents is that undocumented immigrants will receive AHCCCS coverage… wrong. Undocumented immigrants are not eligible for AHCCCS, and a vigorous application process is followed by AHCCCS. The Arizona Auditor General found a 1.1 percent error rate in applications but with no errors placing an undocumented immigrant on the AHCCCS rolls.

Arizona’s hospitals that have been “bending the cost curve” to maintain financial stability are hoping that they will be reimbursed at least the costs for the AHCCCS program, which currently is not the case. According to the state hospital association 42 percent of Arizona’s hospitals reported an operating loss for the month of November.

For example, the Sierra Vista Regional Health Center has been continually underpaid for its health care services under the AHCCCS program…. an approximate underpayment of 30 percent. In terms of dollars. This translates to an underpayment by AHCCCS of $1.8 million in fiscal year 2011, and $2.7 million in fiscal year 2012… a total underpayment of $4.5 million in these last two years!

We have three state legislative officials: Sen. Griffin, Reps. Gowan, and Stevens… who, I am sure, are studying the matter very closely and who will hopefully conclude that the AHCCCS expansion plan being proposed by Gov. Brewer is in the best interest of our Cochise County citizens. 

The measure of a society is how it cares for its members…

 LANNY A. KOPE, EdDhas been a hospital trustee for more than 30 years, serving on urban and rural hospital boards. He is the past Board Chair of Sierra Vista Regional Health Center and has had a national responsibility as Chair of the American Hospital Association’s Committee on Governance.





Sumtingwong on Sun, 03/03/2013 - 4:09am

The hospitals are under paid, for their over charged billings. Two puffs of
an inhaler, cost as much as the inhaler, that has 200 doses in it.

Just The Three of Us on Sun, 03/03/2013 - 9:21am

The measure of a society is how much all members are willing to contribute
and not be a burden on their fellow citizens. Unfortunately, too many are
willing to live lifestyles that keep them in debt and wreck their health,
then they cry out for others to come to the rescue the the stuff hits the
fan. I don’t think it’s particularly noble to enable that behavior. Too bad
we can pick and choose which people get public health care. Don’t get me
wrong, I’m all for churches and other charities or individuals helping those
in need. I think we should. But ‘in need’ is way different than ‘I couldn’t
be bother and now I want a handout.’

highcynic on Sun, 04/07/2013 - 10:20am

This article is certainly a good cause and needs to be supported. Also much
of the revenue of the hospitals goes to CEOs and other managers who are
making huge salaries and many in the millions. What if they tried to find
administrative leaders who expected half of what the present leaders are
making? Have they tried? There are lots of talented people who recognize that
getting exceedingly rich off of peoples’ illnesses is not necessary. Yes,
sports/movie stars and others make a lot but they are not exploiting the sick
for their personal wealth.

Myron Jaworsky on Mon, 04/08/2013 - 8:15am

REF: highcynic, “This article is certainly…” You’re on the right track.
What people fail to mention when they talk about controlling health care
costs is that patient costs represent provider revenues, which increasingly
go to the high salaries and bonuses paid to CEOs and managers, many of whom
are specialists in law and finance, and who have no medical training.