Thousands of Arizonans are at risk of losing health coverage if Trump cuts Medicaid
Dr Derksen quoted
Congressman Greg Stanton and Congresswoman-elect Yassamin Ansari hold a roundtable discussion on the importance of protecting the Affordable Care Act at Valleywise Health Piper Pavilion. Rob Schumacher/The Republic
Republican efforts to target health care could take away coverage for thousands of Arizonans and return hospitals to an era when emergency departments were filled with very sick, uninsured patients, some providers say.
Changes to Medicaid are expected when President-elect Donald Trump takes office with a Republican-controlled Congress, and a potential target for spending cuts is the Medicaid expansion that was allowed through the federal Affordable Care Act, according to a Nov. 27 analysis by KFF, an independent health policy research and information organization.
Arizona is one of nine states with a so-called “trigger law” that would automatically repeal its Medicaid expansion program if enhanced federal funding drops below 90%, research by the KFF and the Georgetown Center for Children and Families says.
In Arizona, the trigger for the Medicaid expansion population activates when federal matching funds dip below 80%, which would be a significant blow to the Arizona program and could remove coverage for thousands of enrollees.
Other potentially affected states are Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia, KFF reporter Phil Galewitz wrote on Dec. 4.
Arizona Gov. Katie Hobbs is aware of various proposals “threatening jobs and access to health care for everyday Arizonans,” a spokesperson wrote Friday in an email.
“While we won’t engage in hypotheticals, the Governor’s Office is working with stakeholders to ensure they are aware of the ramifications of the various proposals and the devastating impact they could have on Arizona families and our economy,” Christian Slater wrote.
Officials with Arizona’s Medicaid program told The Arizona Republic in an email that the agency is aware of a potential funding cut and is in the process of analyzing the possible impacts on AHCCCS members and funding.
“It’s difficult to predict what a potential decrease in enrollment and funding may look like without knowing for certain if there will be a cut and if so, to what extent,” the agency’s statement says.
When people can’t get health insurance, hospitals and providers pay
Medicaid is health insurance for primarily low-income people. In Arizona it enrolls 2.1 million people and known as the Arizona Health Care Cost Containment System (AHCCCS). Medicaid expansion allowed more people to qualify for the government-funded program by expanding the qualifications to those earning up to 138% of the federal poverty level, or $20,783 per year for an individual.
It’s unclear how many more state Medicaid enrollees would be affected by a reduction in enhanced federal funding but it could be more than a half million people. The adult Medicaid expansion population in Arizona is 70,866 people. An additional population of 448,592 childless adults is likely to be affected by a drop in enhanced federal funding because of a hospital assessment that the federal funding drop would eliminate.
If 70,866 or more Arizonans lose AHCCCS coverage and can’t afford to purchase their own health insurance, the result would be what’s known as “cost shifting,” where health care expenses shift from the government program to the hospital and provider system that will have to give uncompensated care to uninsured people, said Dr. Daniel Derksen, a health policy expert who is director of the Arizona Center for Rural Health at the University of Arizona.
“If you price people out of the market, guess what happens. They go without and when they do get sick, you are talking about the hospitals, the physicians and others shouldering a higher burden of charity care and uncompensated care,” Derksen said. “So you are not really saving money. You are just shifting who has to pay for the cost of that care to the providers and the hospitals.”
When Arizona passed Medicaid expansion in 2013 under then-Republican Gov. Jan Brewer, it not only increased the AHCCCS income limit, but also restored coverage for childless adults who had lost their coverage during state budget cuts in 2011, which resulted in hundreds of thousands more Arizonans gaining coverage.
A potential drop in enhanced federal funding for Medicaid expansion would also repeal the Arizona Hospital Assessment, which is the primary source of funding for the childless adult population, AHCCCS officials say. The childless adults on Medicaid are often known as the Proposition 204 population, in reference to a 2000 voter mandate that the state provide health care for everyone below the federal poverty level.
‘We're going to need the Senator John McCains of 2025 and 2026’
Medicaid is not the only health care program that could be on the chopping block when Congress reconvenes and a new presidential administration assumes control of federal agencies. Federal subsidies that have significantly reduced monthly premiums for health insurance marketplace plans offered through the Affordable Care Act, known as the ACA, are set to expire at the end of 2025. ACA health plans are also sometimes called Obamacare.
Without enhanced ACA subsidies and with Medicaid cuts, Derksen said, Arizona’s rate of uninsured people would likely end up “pretty close to where we were before the Affordable Care Act. I think we'd be at between 18% and 20% uninsured, potentially one in five Arizonans being uninsured (versus an uninsured rate of between 9% and 11% now),” he said. “That’s the kind of math that closes our rural and critical access hospitals.”
Health providers and some politicians are braced for a challenge to the entire 2010 Affordable Care Act, which offers benefits that many Americans may not even realize, including allowing young adults to stay on their parents’ health insurance until they are 26, and not allowing health insurance companies to refuse to cover people because of pre-existing conditions.
Promising to “fight like heck to protect the Affordable Care Act,” U.S. Rep. Greg Stanton, D-Ariz., and Rep.-elect Yassamin Ansari on Friday held a roundtable about upcoming threats to health care with a group of Arizona medical leaders. The group included chief clinical officer Dr. Michael White, at Valleywise Health Medical Center, 2601 E. Roosevelt St., which is in Ansari's 3rd Congressional District.
“It’s our responsibility to make sure the people of Arizona, the people of this country, know what is actually at stake for people’s lives and their health care if they push through with the elimination of the ACA,” Stanton said. “When the ACA was signed into law in 2010 as the people at this roundtable know, it was a game changer for American health care.”
U.S. House Speaker Mike Johnson said in the fall that House Republicans would propose “massive reform” to the ACA if they ended up controlling both chambers in Congress and the presidency, Stanton noted. He also pointed out that the Republican Study Committee's fiscal year 2025 budget proposes to cut total federal Medicaid, Children’s Health Insurance Program (KidsCare in Arizona) and Affordable Care Act marketplace subsidy spending.
Providers say expanded access to health care that happened with the Affordable Care Act, including Medicaid expansion, has made a huge improvement in the health of state residents, allowing more people to access preventive health care before their chronic conditions progress into more serious health problems.
Prior to Medicaid expansion, health outcomes at Valleywise Health, which is Maricopa County’s public health system, “were some of the worst in the nation,” White said Friday at the roundtable discussion.
“As we’ve seen our expansion in coverage, we’ve seen folks who are now able to access preventive health care. They are able to see us in our primary care clinics. They are able to see us in our specialty clinics and treat these conditions prior to them becoming a significant health problem leading to disability and an inability to work,” White said.
“We’ve actually seen improvement in our emergency department. We’re not seeing these chronic, severe presentations of relatively common illnesses come in at end stages. We’re able to intervene earlier.”
Dr. Nadeem Kazi, president of Arizona Medical Association and a practicing gastroenterologist in Casa Grande, noted that the ACA’s full name is the Patient Protection and Affordable Care Act. Without it, patient protection will be gone, he said, recalling a time before the ACA in Casa Grande, when its hospital emergency room was filled with uninsured patients.
“If we take the ACA away, it's going to be a disaster,” Kazi said.
In an interview after the roundtable, Stanton said that educating the general public and elected officials about potential impacts of health care funding cuts will be critical, and it will also be important for Democrats to reaffirm their support for the ACA and Medicaid. With enough awareness, bipartisan support could preserve the ACA and Medicaid funding, he said, noting the late Arizona Republican U.S. Sen. John McCain's vote against repealing portions of the ACA in July 2017.
“It will be unacceptable to the American people, it will be unacceptable to the people of Arizona, if we eliminate the ACA,” Stanton said. “We’re going to need the Senator John McCains of 2025 and 2026 who are willing to buck the vast majority of their party that are proposing to significantly cut back support for the ACA.”