Daniel Derksen and Will Humble | AZ We See It
Even if the governor vetoed it, Nevada's plan to allow anyone to buy Medicaid coverage may be the way forward for Arizona and the nation.
Last week, the Nevada state Legislature handed Gov. Brian Sandoval an innovative opportunity to replace the Affordable Care Act at the state level. Unfortunately, he didn’t take advantage of the opportunity.
The Nevada Legislature sent Sandoval a bill that would have allowed any Nevadan to “buy in” to their state’s Medicaid program. On Friday, he vetoed the legislation. Had he signed it, and the Centers for Medicare and Medicaid Services approved the plan, any Nevadan could buy Medicaid coverage — regardless of income.
Why we need 'Medicaid for Many'
Assembly Bill 374 would have directed the Nevada Department of Health and Human Services to ask for a CMS Waiver (called an 1115 waiver) to allow any Nevadan to buy a Medicaid managed care plan. Nevadans eligible for an Affordable Care Act tax credit (called an advance premium tax credit) or cost-sharing reductions based on income could have used them to help pay their share of the premium.
Polling shows that most Americans want reasonably priced health insurance regardless of having a pre-existing condition. Nevada’s Medicaid plan would have done that, avoided a complicated health-system overhaul and could be tailored to fit other state programs.
“Medicare for All” is getting a lot of national attention again these days. Perhaps it’s time to add “Medicaid for Many” to the discussion, as the U.S. Senate is poised to vote on a bill in the next few weeks. Medicaid infrastructure exists in all states.
How it could work in Arizona
Arizona’s Medicaid program, called AHCCCS, operates through a CMS-approved 1115 Medicaid waiver. Medicaid is re-channeled through private health insurers through a multiyear bid process. Insurers compete for the Medicaid business, and are assured of enrollees for several years. Consumers are not subjected to the yearly volatility of changes in price, plans and benefits.
Insurers have time to build a contractual network with participating clinics, physicians, hospitals and other health providers; consumers can make sure their provider is participating. Arizona’s Medicaid program has the eighth lowest per-person expenditures of the 50 states, with two million AHCCCS enrollees among our population of seven million.
To make Nevada’s approach work in Arizona, our Medicaid 1115 Waiver needs amendment and CMS approval. With ACA tax subsidies and cost-sharing reductions, the out-of-pocket costs per person would be less than plans currently offered in Arizona’s Marketplace, with far less year-to-year volatility in pricing.
Let's take this debate nationally
Medicaid payment to hospitals and physicians tends to be lower than even what Medicare pays. To assure that there are enough hospitals, clinics, physicians, dentists and other health providers in the network, insurance vendors offering Medicaid plans would have to negotiate more reasonable payment rates with providers.
Jun 14, 2017 | Mohave Dalily News
PHOENIX (AP) — The only two insurance companies offering individual health plans on federal exchanges in Arizona have filed paperwork to continue selling coverage in 2018, raising hopes that the state can avoid a repeat of last year’s crisis when one county was briefly left without a health insurance provider.
Grants to allow first responders and members of other key community sectors to administer a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose.
Geographic coverage: Nationwide
Application Deadline: Jul 31, 2017
The Georgetown University Center for Children and Families (CCF) Rural Health Policy Project released Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities. This report resulted from analysis by researchers from Georgetown and the University of North Carolina Rural Health Research Program and examined "how the role of Medicaid has changed over time in 46 states with small-town and rural populations."
The CCF also developed an interactive map that displays the percent of children in these areas covered by Medicaid in 2014-15.
- Applications Open May 16 – July 17
- 15% Minimum Match Required
- Awards Range from $50k to $500k
- Every State/Region has a General Field Rep who can answer more specific questions. This info is available on Grant Page.
By Stephanie Innes Arizona Daily Star | June 3, 2017
An AARP television advertisement airing in Arizona again this week takes aim at federal health reform and is targeted to U.S. Sen. Jeff Flake.
“As the number of opioid overdoses and deaths increase at an alarming rate, we must take action.”
PHOENIX — Governor Doug Ducey today signed an emergency declaration to address the growing number of opioid deaths in our state.
Newly released data from the Arizona Department of Health Services shows in 2016, 790 Arizonans died from opioid overdoses – an average of more than two people per day. The trend shows an alarming increase of 74 percent over the past four years. Today’s declaration by the Governor directs the Arizona Department of Health Services to rapidly respond to this public health emergency.
“As the number of opioid overdoses and deaths increase at an alarming rate, we must take action. It’s time to call this what it is — an emergency," said Governor Ducey. “Most of us know someone impacted by substance abuse – our family, our friends, our neighbors. Our hearts ache for them, but that isn’t enough. We must do more. I’m declaring a statewide health emergency, because we need to know more about the epidemic, including enhanced data that illustrates when and where these overdoses occur so that we can develop real, targeted solutions.”
The declaration gives the state the ability to coordinate public health efforts between state, local, and private sectors and allow the state to utilize all its public health resources and help put naloxone into the community to help prevent drug overdose deaths. The declaration and enhanced surveillance advisory will provide for enhanced reporting of overdose deaths from doctors and hospitals.
“The only way we will be able to make an impact in the opioid epidemic is to come together as a community and this declaration helps us move forward quickly,” said Dr. Cara Christ, director of the Arizona Department of Health Services. “We will look into helping improve prescribing practices, addressing poly drug use, and analyzing raw data on overdose deaths that occur to see where the problem areas are and learn how we can make changes to save lives.”
As part of this public health emergency the Arizona Department of Health Services will identify ways to:
- prevent prescription opioid drug abuse through appropriate prescribing practices,
- develop guidelines to educate healthcare providers on responsible prescribing practices,
- expand access to treatment, especially Medication Assisted Treatment (MAT), and
- reverse overdoses through the distribution of naloxone.
View a copy of today’s emergency declaration along with information and updates on our progress in turning the tide on the Arizona opioid epidemic here: http://azhealth.gov/opioid.
by Alexandria Bachert | Staff Writer, MedPage Today May 26, 2017
House Republicans and the White House have recently proposed massive reductions in the Medicaid program which could shave more than $1 trillion from projected expenditures over the next 10 years.
Much of the debate over these cuts has centered around the effects on children and the poor, but about 40% of the Medicaid budget pays for long-term care for the elderly, many of whom are poor only on paper. In this edition of “Friday Feedback,” experts discuss the critical role Medicaid plays in the healthcare system, particularly for America’s increasingly numerous seniors, and what might happen if funding is slashed.
…won't budget cuts simply deprive the poor of access to care?
Daniel Derksen, MD, Arizona Center for Rural Health: You don't save money by throwing millions off of coverage. That strategy shifts costs to states, to individuals and their families, and to physicians, hospitals, clinics and nurses through uncompensated and charity care. It strains credulity to cut almost a trillion dollars of federal funding to state Medicaid programs over the next 10 years, and claim that bill gives states more autonomy.
Wednesday, May 24th 2017, 9:54 pm Thursday, May 25th 2017, 8:53 am MST
TUCSON, AZ | Tucson News Now KOLD 13
More than 23 million Americans could be uninsured by 2026 if the GOP health bill goes through.
That statistic was released Wednesday, May 24, by the Congressional Budget Office.
Eric and Risa Cline are worried it could hurt their family. The Tucson couple purchased health insurance through the Affordable Care Act.
Right now, they pay about $500 a month for themselves and their three children, but they are worried that since Eric has a pre-existing condition, the price will go up.
“We won’t be able to afford it at all,” Risa said. “I don’t even know how we’re surviving now, to be honest.”
Eric is recovering from an aneurysm and has endured two brain surgeries since 2015. He needs continuing treatment.
“My whole left side was paralyzed, I had big speech issues,” he said.
Republicans supporting this bill say it would save the government $119 billion.
However, Dr. Daniel Derksen, U of A Professor of Public Health Policy argues that the long-term costs will be passed on in other ways.
“All you’re doing is shifting the cost of health care for that population to hospitals, to nurses, to physicians that take care of people regardless of their ability to pay,” he said.
Tucson News Now | Wednesday, May 24, 2017, 8:45 pm
The National Rural Health Association (NRHA) honored Copper Queen Community Hospital (CQCH) CEO, James Dickson earlier this month with the 2017 Louis Gorin Award for Outstanding Lifetime Achievement in Rural Health Care.
Award recipients are selected based on their creativity, unselfishness, compassion and cooperative attitude in seeking ways to make lasting contributions to rural health care.
“It is a rare opportunity for someone to be able to serve and help the community like I have for over 18 years, ” said James Dickson, “I would like to thank my staff, Board of Directors, and Physicians for believing in the vision and being able to provide access to primary healthcare in medically underserved communities.”
Jim Dickson, has an unwavering commitment to providing rural southern Arizonans with accessible, affordable, high-quality health care. His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.
Dickson has achieved this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.
In addition to his work in health care, Dickson identifies and addresses unmet community needs, creating the first library for middle school students in Bisbee and offering scholarships to Cochise County high school graduates for training to land well-paying local jobs.
“Jim Dickson’s work at the CQCH critical access hospital and affiliated RHCs, and most recently, to create one of the state’s first rural freestanding emergency departments (ED) at the Douglas Medical Complex, underscores his unwavering commitment to providing rural southern Arizonans with accessible, affordable, high quality health care.” stated Daniel Derksen, MD from the Arizona Center for Rural Health at The University of Arizona.
“For 20 years, Jim has led health care improvements in Cochise County that spans over 6,200 sq. miles, has a pop. density of 20 persons/sq.mi., and 17 percent poverty rate. For comparison, Connecticut is smaller at 5,500 sq.mi., has a pop. density of 650 persons/sq.mi. and 10.7 percent poverty rate.
His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.
He does this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.”
Summary: The AHCA cuts $1.5 trillion dollars in federal funding over 10 years by slashing state Medicaid (-$830B), eliminating Marketplace subsidies (-$665B) to individuals and families, and causing 23 million Americans to become uninsured over 10 years. The President’s budget cuts $2 trillion dollars in health spending over 10 years, disproportionately affecting low-income, elderly and rural Americans.
The American Health Care Act (AHCA) was passed by the U.S. House of Representatives on May 4, 2017 by a vote of 217 to 213. The Congressional Budget Office posted its costs and coverage estimates of that bill on 05/24/20171. If passed by the Senate then signed by the President, the CBO estimates it would:
- Increase U.S. uninsured by 14 million in year 2018, and 23 million uninsured by year 2026.
- Increase the uninsured total to 51 million Americans by year 2026, versus 28 million who would lack insurance in 2026 under the current Affordable Care Act (ACA) law.
- Decrease by almost $1.5 trillion dollars the federal funding of health coverage over 10 years (2017-2026) by cutting Medicaid funding to states ($830 billion) and eliminating ($665 billion) in marketplace subsidies to help low-income Americans buy health plans (page 39 CBO Report1).
- Disproportionately affect the frail elderly, blind, disabled and rural Medicaid enrollees.
- Cut by $830 billion dollars over 10 years in federal Medicaid funding to states, resulting in 14 million fewer Medicaid enrollees by 2026.
- Reduce by $665 billion dollars over 10 years in federal subsidies to help individuals buy health insurance (also known as the nongroup or individual health insurance market) by eliminating in year 2020 the ACA’s refundable tax credits and cost sharing reductions. These would be replaced by $275 billion in tax credits for nongroup insurance in year 2020.
- Allow insurers in 2018 to charge older enrollers five times more than younger enrollees, versus three times more under current law.
- Allow insurers to impose a 30% charge to individuals who did not maintain continuous coverage.
- Allow states to waive the Affordable Care Act’s consumer protections and thereby stop requiring insurers to include the 10 essential health benefits (such as preventive services, newborn care, and maternity coverage), and allow insurers to go back to charging people more for pre-existing conditions (eliminates the community rating) if a person had not maintained continuous coverage.
- Appropriate $8 billion dollars per year in 2018 in funding for states that obtain a waiver for a Patient and State Stability Fund starting in 2018 for those with pre-existing conditions.
- Provide $15 billion in funding to states choosing to waive the ACA requirements for community rating and essential health benefits for maternity coverage, newborn care, prevention, treatment, or recovery services for people with mental and/or substance use disorders.
- $610 billion in federal Medicaid funding to states. It is not clear how this relates to AHCA cuts.
- $193 billion for the Supplemental Nutrition Assistance Program (SNAP, aka food stamps).
- $72 billion in Supplemental Security Income (SSI) disability.
- $21 billion in Temporary Aid to Needy Families (TANF).
- $87 billion for the National Institutes of Health
- $18 billion for the Centers for Disease Control and Prevention
Payson Roundup | by Peter Aleshire roundup editor May 9, 2017
Most Gila County residents will likely face a much harder time getting health care if the U.S. Senate adopts the Affordable Care Act Repeal the U.S. House narrowly approved last week.
KJZZ | By Will Stone | May 4, 2017
Almost all of Arizona’s Republicans threw their support behind the replacement for the Affordable Care Act, which narrowly passed the U.S. House on Thursday.
Four of Arizona’s five House Republicans voted for the American Health Care Act. Republican Rep. Andy Biggs, who represents a conservative district in the East Valley, joined Arizona's Democrats in opposing the bill.
Before the vote, Biggs criticized the legislation for not being a "clean repeal of Obamacare" and said he was disappointed that two amendments he had submitted were not adopted.
Even the state's Republican members of the House who voted for the bill struck a measured tone.
Congressman Paul Gosar, part of the far-right House Freedom Caucus, acknowledged the bill was not a full repeal, but said there were enough "conservative, time-tested" changes to this version of the AHCA to win his vote.
"Millions of Americans are drowning right now under the tidal wave of Obamacare regulations and mandates that have destroyed our entire health-care system. The American Health Care Act is a life raft to those suffering and represents a down payment towards a true market-based solution," Gosar said in a statement following the vote.
Congresswoman Martha McSally echoed those sentiments, saying she faced a "binary decision" and that the AHCA wasn't a "perfect bill."
“I will continue to work with state and local stakeholders and closely monitor this bill throughout the legislative and implementation process to ensure that my constituents have access to the care they need, that the most vulnerable are protected, and that Southern Arizona is better off in the future,” McSally said in a statement.
Congressmen David Schweikert and Trent Franks were the other Republicans from Arizona to vote yes.
The bill passed without a full analysis from the Congressional Budget Office, but some in Arizona's health-care industry say the new version of the AHCA will dramatically scale back Medicaid funding and, in the short term, cause premiums to rise for certain groups.
As written, the AHCA would allow states to apply for a waiver to what's known as the "community rating" requirement, which protected people with expensive medical conditions from being charged more than others.
"By removing that, insurance plans could charge people with pre-existing conditions significantly more to the tune where they could no longer be able to afford health insurance," Marcus Johnson of Vitalyist Health Foundation, which helps enroll people in Arizona's marketplace, said.
The AHCA allocates billions of dollars to help cover those with pre-existing conditions, but an initial analysis from Avalere Health shows that funding would not be nearly enough to cover everyone. Arizona has about 48,000 people with pre-existing conditions in its marketplace.
If Arizona pursues a waiver to establish a high-risk pool, Johnson said it's unclear whether Arizona would have the funding to cover the "demand of our aging and low-income population."
Arizona could also request exemptions from the "essential health benefits" that the ACA requires every insurance plan to include.
The Republican legislation also has major implications for Medicaid. It phases out the extra federal funding that Arizona received to expand the program.
More than 400,000 people in Arizona have joined the rolls of the state's Medicaid program since the state restored and expanded it. The new legislation keeps that enhanced funding for those already enrolled so long as they don't fall off the program, which is common among that population.
"This increases uncompensated care and forces hospitals to cost shift to commercial payers and businesses. There really isn't any free lunch in all of this," Debbie Johnston with the Arizona Hospital and Healthcare Association told KJZZ.
Johnston said the hospitals that won't be able to cost shift because of their payer mix may become financially unviable.
"We are deeply disappointed with the passage because it will jeopardize coverage for hundreds and hundreds of thousands of Arizonans," Johnston said.
"When you shift the risk and the blame from the federal government to states, it is going to make state government much more challenging with much less resources to do it," Dr. Daniel Derksen, director of the University of Arizona's Center for Rural Health, said about the changes to Medicaid.
"This isn't increasing or preserving choices. This is really reducing choices," Derksen said.
Along with rolling back the expansion, the AHCA changes Medicaid from an open-ended federal program to one that's capped. That most likely means less money for a state like Arizona, which already has a low-cost program.
Dr. Jeffrey Singer, who’s a surgeon in the Valley and a fellow at the Cato Institute, said that’s a good thing.
“By freeing states from the shackles of Washington, that money can go a lot farther. States need to be able to control their budgets because the way Medicaid is growing, it’s not leaving room for anything else,” Singer said.
In response to the vote, a spokesperson for Governor Doug Ducey emphasized that the legislation is still a work in progress:
Health policy expert Dan Derksen, MD, the Walter H. Pearce Endowed Chair and professor of public health policy and management at the University of Arizona Mel and Enid Zuckerman College of Public Health, has been appointed President of the Arizona Academy of Family Physicians (AzAFP). AzAFP’s 1,600 members include allopathic and osteopathic family physicians, family medicine residents, and medical students. It is the state chapter of the American Academy of Family Physicians with 120,000 members.
As director of the Arizona Center for Rural Health (AzCRH), Derksen oversees the state Office of Rural Health, the Rural Hospital Flexibility Program, the Small Rural Hospital Improvement Program, and the AzCRH Navigator Consortium.
After graduating from the University of Arizona College of Medicine in 1984, Dr. Derksen completed his family medicine residency at the University of New Mexico where he worked as a faculty member for 25 years.
While working for Governor Susana Martinez as Director, New Mexico Office of Health Care Reform, Dr. Derksen wrote and was funded ($34.3 million) by the Centers for Medicare and Medicaid Services to establish New Mexico’s state health insurance Marketplace that currently covers over 50,000 New Mexicans.
Dr. Derksen completed a Robert Wood Johnson Health Policy Fellowship in 2008 with U.S. Senator Jeff Bingaman. He researched and drafted federal legislative provisions to improve the nation’s supply and distribution of the health workforce enacted in 2010.
As principal investigator of state, federal, private foundation, and grants in excess of $55 million over his academic career, Dr. Derksen works to improve health insurance coverage and access to high quality health care, emphasizing community-based service-learning models in rural areas.