One outcome of the Supreme Court decision on the Affordable Care Act was to allow the states the choice of expanding Medicaid to 133 percent of the federal poverty level without risking the loss of federal funds.
Let's review what that means for Arizona and the ramifications of the decision to participate or not that the state will have to make.
Currently, Arizona Medicaid, or AHCCCS, covers people up to about 100 percent of federal poverty level, or FPL (an annual income of about $26,000 for a family of four) except for childless adults, for whom AHCCCS enrollment has been frozen.
For the latter group, only those making below about 33 percent of FPL, about $4,000, are eligible, due to the state's decision to suspend Proposition 204.
What has this meant in the year since the freeze has been in effect? More than 100,000 people are no longer eligible for health insurance coverage, decreasing their access to care. Hospitals are unable to get compensation for these patients, and are seeing huge losses, especially in rural areas.
Health providers see anecdotally the difference health insurance makes in people's lives, but until recently, there has not been good evidence to prove that having insurance improved people's health and general well-being.
A recent natural experiment did just that. Due to limited funds, Oregon decided to hold a lottery to determine who of the poor would get health insurance and then followed people with and without insurance.
The study found that there were increases in hospital, outpatient and drug utilization, increases in compliance with recommended preventive care, and declines in out-of-pocket medical expenses and medical debts for those with coverage. People with insurance also had improvement in mental- and physical-health measures and overall well-being.
Another recent study found that high rates of uninsured residents within a community pulled down the quality of care for insured and uninsured residents alike.
Given this evidence, what should Arizona do?
For at least the next two years, the Affordable Care Act will pay 100 percent of the cost for insurance for those patients between 100 and 133 percent of FPL.
After that time, 90 percent of the cost will be covered.
Given the nature of the health-care system and the way a decision in one area impacts us all, it would seem to be obvious that turning down the federal funds is, in effect, harming the most vulnerable Arizonans with possible lethal consequences.
In other words, our governor and legislators would be condemning up to 100,000 people to poorer health and well-being for what? To make a point?
In addition, if Medicaid is not expanded, what will happen to those patients caught between 33 and 100 percent of FPL? Would they have to pay a penalty for not purchasing insurance? They are some of the least able to afford it, and that was not the intent of the Affordable Care Act.
It is vital that we convey in the strongest language possible how important it is that Arizona use federal funds, worth billions of dollars, to improve the lives and health of Arizonans and bring job- creating money to the state.
Let's expand Medicaid to 133 percent and restore the coverage of the Prop. 204 population. Our future depends on it.
Eve Shapiro is a Tucson physician. Email her at evecshapiro@gmail.com
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