Arizona's Medicaid Expansion, 5 Years Later
Five years ago, Arizona’s legislative session came to be dominated by one surprise issue. An issue that was revealed in Gov. Jan Brewer’s State of the State speech.
"By agreeing to expand our Medicaid program just slightly beyond what Arizona voters have twice mandated, we will protect rural and safety-net hospitals from being pushed to the brink, by growing their cost and caring for the uninsured, take advantage of an enormous economic benefit, inject $2 billion into our economy, save and create thousands of jobs and provide health care to hundreds of thousands of low-income Arizonans," she said in her address.
Her call to expand Medicaid under the Affordable Care Act led to a contentious special session in which legislative Democrats and a handful of Republicans, agreed to the plan. Forecasts at the time projected the rolls to add 300,000 low-income residents. At the time of the expansion, there were roughly 1.5 million Arizonans enrolled in the state’s Medicaid program, known as AHCCCS. Now, there more than 1.8 million.
The Show has a few perspectives on this five-year anniversary, starting with Greg Vigdor.
Vigdor is president and CEO of the Arizona Hospital and Healthcare Association, which was one of the biggest advocates of the expansion plan. The Show asked him, from his and his members' perspectives, what’s happened over the course of the past five years.
During the debate over Medicaid expansion, supporters talked about helping keep rural hospitals open by reducing the number of patients coming into their emergency rooms who didn’t have any insurance.
Ron McArthur, CEO at Summit Healthcare Regional Medical Center in Show Low, said uncompensated care at his hospital has dropped substantially since the Medicaid expansion.
"We’ve seen our bad debt write-offs, five years ago they were running around $22-23 million a year and they have been reduced now to $11-12 million a year, so a $10 million decrease in the amount of bad debt write-off," he said.
McArthur said his is the safety-net hospital in two low-income Arizona counties: Navajo and Apache. He estimated a little less than half of the patients that come into his emergency room are covered by Medicaid, and overall, there’s been a four percent increase in patients covered by the program, up to 26 percent. But he acknowledges the region could still use more physicians who accept Medicaid patients.
"Prior to Medicaid expansion, people without insurance were using our ER for primary care, and that’s where we had our biggest bad debt write-off," he said. "We’ve reduced the write-off coming from our ER, but it’s showing up in Medicaid contractuals in our physician clinics in some of the other areas. But doctors’ visits are a lot cheaper than hospital ER visits.
In other words, McArthur said, while the system is still losing some money, it’s better for that to happen in a doctor’s office than the emergency room.
But critics of the Medicaid expansion say adding new enrollees hasn’t had the positive benefits advocates envisioned. Naomi Lopez Baumanm, director of Health Care Policy at the Goldwater Institute, which opposed the expansion five years ago, has been looking into the effects of that decision now.
She calls it a “cautionary tale” and joined The Show to talk more about that.