A 50-year-old Tucson man had lost his job after a heart attack. He needed a new battery for his defibrillator, but had no access to health care.
As a childless adult, he was not eligible for a state-sponsored health-insurance program for low-income residents, said Tucson cardiologist Dr. Charles Katzenberg, recalling the recent case.
The Arizona Legislature froze childless adults from enrolling in the state's Medicaid program in 2011 because of $2.5 billion in annual budget cuts to the program. Since then, the number of Arizona childless adults with Medicaid has shrunk by more than 60 percent, from 220,000 people to about 80,000.
Katzenberg, who is president of the Pima County Medical Society, led a public plea this week in support of expanding Arizona's Medicaid program, which is called the Arizona Health Care Cost Containment System (AHCCCS).
Joining him in the campaign are the chiefs of staff of five Tucson-area hospitals. The physicians say their concerns are not Democratic or Republican - they are about getting patients the care they need.
There are also physicians campaigning against the Medicaid expansion, however. Some held a news conference in Phoenix earlier this week, arguing that AHCCCS is an inefficient program that should be overhauled.
Many of those against the expansion are also opposed to the new federal health law. The original law mandated states expand their Medicaid programs, but the U.S. Supreme Court ruled that the decision should be left to individual states, not the federal government.
The decision in Arizona will ultimately rest with the Legislature.
"If they are doing their job they would at least bring it up for discussion and a vote," Katzenberg said. "I'd call it not really doing their job if it doesn't get to the legislative level to discuss and vote upon. That's why they are there."
Gov. Jan Brewer, a longtime vocal critic of the federal health law, surprised many earlier this year when she said she supports Medicaid expansion. At least 15 states have said they will not expand Medicaid, including Texas, according to Avalere Health, a Washington, D.C.-based health consulting company. To date, 22 states plus the District of Columbia are expected to expand their programs, the company says.
Critical matching funds
Under Brewer's plan, AHCCCS would enroll people making up to 133 percent of the poverty level, rather than the current cap of 100 percent. The poverty level means an annual income of $11,490 or less for a single person. Taking the qualification up to 133 percent of the poverty level would work out to a maximum annual income of slightly more than $15,000 for a single person.
The expansion would cover an additional 57,000 Arizonans. But more significantly, the expansion would give what state officials say is enough federal matching funds to cover childless adults.
With the federal matching funds, the state would be able to restore coverage to 240,000 childless adults and continue coverage for 50,000 others.
So far, there's been no indication when the Legislature will consider the expansion, but Brewer spokesman Matt Benson said it will happen. It's undetermined whether it will be considered as an individual bill or as part of the governor's proposed budget, Benson said.
In a telephone interview, Phoenix surgeon Dr. Jeff Singer said many health-care officials are against the expansion but they can't speak out because they are employed by hospitals, who want the "corporate welfare" of Medicaid.
He said that putting a quarter of a million additional people, and likely more, on to AHCCCS will only increase a program already burdened with long waits.
The Indiana plan
"I am taking the unselfish position of being opposed to it. If I was like a lot of doctors supporting it I'd think, 'I will get paid more because more patients who show up will have insurance,' " Singer said.
But that would be short-sighted, said Singer, who says that while AHCCCS is one of the best Medicaid programs in the country, it is not serving patients well.
He cited an example of a man on AHCCCS who came to him with advanced rectal cancer - and it was so far advanced because it took the man nearly four months to get referred to a surgeon.
"AHCCCS is one of the better ones, but it is government-funded and on top of that it is a gatekeeper model," Singer said. "The Supreme Court handed a tremendous amount of responsibility to the states and it's up to them. It is very integral to the working of Obamacare that states expand Medicaid."
Singer said he'd rather see a model like the "Healthy Indiana Plan" in Arizona. The Indiana plan uses a cigarette tax to help low-income people purchase private insurance through a health savings account rather than putting them on government-run insurance. That encourages more personal responsibility, he said.
But the Tucson doctors campaigning for the expansion said that without Medicaid expansion, people without insurance will end up crowding emergency rooms because they didn't get preventive care.
"There are economists who have told us it's the right thing to do, but as physicians we are here to support the plan because for us it's really about people," said Dr. Andreas Theodorou, chief medical officer at the University of Arizona Medical Center. "People involved with the expansion are tens of thousands of folks around us - the working poor. They are not nameless, faceless people. They are regular people who are working and get sick. When they get sick they need care. If they don't have health-care coverage they get progressively sicker."
The other Tucson doctors who joined the campaign of support for Medicaid expansion are Dr. Manny Arreguin, chief of staff-elect at Tucson Medical Center; Dr. George Bradbury, chief of staff at Carondelet St. Joseph's Hospital; Dr. Herb McReynolds, chief of staff-elect at Carondelet St. Mary's Hospital; and Dr. Richard Chua, chief of staff of Northwest Hospital.
Supporters note that the state's share of the expansion would be funded by a hospital-bed tax. The federal government will provide $1.6 billion.
Katzenberg said the man who needed his defibrillator recharged got help through donations.
"To take care of him what we had to do was find a hospital that was willing to donate services, we had to find a physician who was willing to install it, we had to find a device company willing to donate the device and then we were able to accomplish this," Katzenberg said. "This is uncompensated care. We can't take care of people like that."
Contact reporter Stephanie Innes at email@example.com or 573-4134. On Twitter: @stephanieinnes