Local leaders pushing for changes to GOP health bill

Arizona health-care and business leaders warn that Senate Republicans’ bill to replace the Affordable Care Act would trigger deep cuts to the healthcare system that could ripple through the state’s budget and economy.

Hospital leaders said the Senate bill, called the Better Care Reconciliation Act, would eliminate coverage for lowincome families on Medicaid and would significantly increase uncompensated care at hospitals.

On Monday, the top executive of the Arizona Chamber of Commerce predicted in a letter to U.S. Sens. John McCain and Jeff Flake that the Senate bill would harm the state’s economy and “blow a hole” in the state budget.

The letter from the Arizona Chamber was delivered the same day the nonpartisan Congressional Budget Office estimated the Senate Republicans’ bill would increase the number of uninsured Americans by 22 million. That is 1 million fewer than the version that

House Republicans approved in May.

Senate leaders are hopeful for a vote before the end of this week on the legislation to replace “Obamacare,” the sweeping 2010 law that expanded Medicaid coverage for low-income families and remade the private insurance market for individuals who directly purchased coverage.

While Republican leaders have been critical of President Barack Obama’s signature health bill, the heated chatter over the GOP’s health-reform bills in the House and now Senate show how difficult and divisive health-care reform can be.

The largest reduction would cut $772 billion from Medicaid, the federal-state program that provides coverage to low-income families and the disabled. The CBO forecast that the Senate bill would result in a net reduction in federal spending of $321 billion through 2026.

In Arizona, hospital and health leaders are particularly worried about the proposed reductions to the Medicaid program, which provides coverage for about one in five people in this state.

“One of our tenets has been, if you are going to replace the ACA, you cannot increase the number of uninsured,” said Steve Purves, CEO of Maricopa Integrated Health System.

Purves said Maricopa, which serves as the region’s main safety-net hospital system, would see a direct increase of $55 million to $75 million in uncompensated care should the Senate bill pass Congress.

Purves said Obamacare’s Medicaid expansion has allowed his health system and other hospitals to emphasize preventive care, in which insured patients get regular care to better manage chronic health conditions. If the Medicaid expansion is rolled back, Purves predicts more patients will lose their health insurance, delay preventive health care and seek emergency care when their health worsens.

The state’s Medicaid program, called the Arizona Health Care Cost Containment System, estimated that the rollback of the Medicaid expansion could jeopardize coverage to nearly 400,000 adults who gained coverage under the expansion.

That includes 28,900 adults with cancer, 80,800 with a mental-health diagnosis and 47,100 with a substance-abuse disorder.

AHCCCS estimated the Senate bill would cost the state $7.1 billion through 2026 due to a loss of federal match funding, the elimination of a local hospital assessment and inflationary factors.

The direct impact to the state’s budget would be $2.9 billion under the Senate bill — slightly less than House bill’s $3.3 billion tab for Arizona.

Either way, business leaders fear the prospects of such a large cost shift from the federal to state government.

Glenn Hamer, president and CEO of the Arizona Chamber of Commerce, applauded the Senate bill’s efforts to reduce taxes and replace parts of the Affordable Care Act.

But he said the Senate bill would place a large burden on states.

“The proposed cuts to (Medicaid) would negatively impact Arizona’s economy and blow a hole in the state budget that would result in the state’s inability to meet core government responsibilities,” Hamer wrote in a letter to McCain and Flake, citing a possible ripple effect to education and transportation.

Gov. Doug Ducey, a longtime critic of the Affordable Care Act, expressed similar concerns in a letter last week to McCain.

Among other items, Ducey highlighted an “early expander penalty” that punished Arizona and other states that expanded Medicaid eligibility before the Affordable Care Act. Arizona’s expansion came in 2000 with the voter-approved Proposition 204, which extended coverage to adults earning up to 100 percent of the federal poverty level.

Ducey wrote his critique Wednesday, a day before the Senate detailed the bill. A spokesman said his staff is assessing the Senate bill.

McCain and Flake have both signaled that they will take a cautious approach to the bill. Neither has publicly disclosed a position.