Ted Simons: Good evening. Welcome to "Arizona Horizon." I'm Ted Simons. How much progress is being made on the question of accepting federal funds for expanding Arizona's Medicaid program? Is any progress being made? We turn to Jim Small of the Arizona Capitol Times. Good to see you. Give us an update.
Jim Small: I think you're not seeing a whole lot of progress but behind the scenes we keep hearing that the votes are definitely there in the Senate for whenever this goes to the floor they will have the votes in the Senate. In the house more people say they have the roads than that they don't but that one is still up in the air. While there seems to be a path to getting to the floor in the Senate which is Republicans siding with Democrats to use procedural moves to override Senate president Andy Biggs. There's an attempt to try to find a way to convince House Speaker Andy Tobin to get this to the floor. So I think there's a lot of wheeling and dealing behind the scenes in terms of what needs -- what does the governor's office need to give up in terms of policy on this issue or other issues to allow this to happen. I suspect we'll see more coming up this next week. I'm hearing some rumblings that perhaps in the next week or two we may see some forward movement on this in one way or another.
Ted Simons: Interesting. Reports out of the Arizona Capitol Times where the governor may be working on individual lawmakers.
Jim Small: There were some meetings she had couple weeks ago she called up small groups of lawmakers, some who were on the fence, some really perceived to be opponents. It was essentially a two to three hour meeting where they sat down with the governor with her chief of staff, with all of her top policy advisors on this health care issue and the director of AHCCCS was in the room. Her budget folks were in the room. They basically went through, “Here's how we got to our decision. Here's why we made the decision we made. What kind of questions do you have?” It was essentially a robust Q and A with the governor's office trying to defend their decision to push for the expansion and get this federal money.
Ted Simons: Just to reiterate here, we're talking about expanding those who would be covered by Medicaid to up to 133% of the poverty level. That would kick in massive federal funding matches. You don't do that expansion and what happens?
Jim Small: If you don't the state is left with a couple options. During the tight of the budget process we put a freeze on childless adult enrollment which is something approved by the voters more than a decade ago. The federal government said they will still continue to give us matching dollars, two for every one we spend on that population. At the end of the year the federal government has indicated that will go away, if we do not restore that entire population, 150,000 people that have been removed, the state won't get matching funds so we have to pay for it out of the state's pocket.
Ted Simons: You have that so again the governor and those who look at the matching funds if you go up to 133% of the poverty level, which raises this, means more people covered, paying for it by way of a hospital assessment so not much out of the general fund, what is the argument against this? We have done programs on this. I understand the philosophical kind of aspect. But in the real world, that seems like a tough thing to argue against.
Jim Small: The biggest is that it's an unsustainable federal program that federal government is promising all this money now but in three years it will evaporate. The federal government is committed to paying this enhanced matching funds through 2016. When that money goes away the state is going to be left holding the bag is their argument. We have added, say, 300,000 or 400,000 people on to AHCCCS and the government says all that money is going away. We're going back to the 2-1 match. The state will have billions of dollars that -- a billion that it will have to come up with or face kicking a quarter of a million or more people off AHCCCS.
Ted Simons: Yet the governor's proposal calls for a circuit breaker if they don't match 80% of what they are supposed to do.
Jim Small: Correct 80%. Right now the match is about 90%. If it drops off more than that, the way she's proposed designing this is that it would go away. Arizona would opt out of the program, would no longer be beholden to this program.
Jim Small: So you're thinking that again Democrats are -- we have talked about this as well. There seems to be a hint that abortion language could muck things up if you will. What's this all about?
Jim Small: This is an issue that Pro-life advocates raised, they didn't like the idea min would go to Planned Parenthood. It also does a wide range of other health services for women. Some of the patients are Medicaid patients. It stands to reason they would get more money, probably have more patients because of this expansion. So they have looked, raised the specter that is essentially indirectly funding abortions. In turn the governor's office has worked with them to try to find if there's some language they can put in to kind of soothe their concerns, but it becomes difficult because a law passed last year basically said, aimed at Planned Parenthood, said they can't receive any Medicaid money and the courts blocked that saying it's against federal law. Politically if the governor moves forward with this there are some Democrats who say even though we don't think it will have a practical effect we can't in good conscience sign off on it. So you’re looking at two, three, four, five democrats falling off. When you talk these narrow margins, that becomes a problem.
Ted Simons: The goal posts move again. Before you go, a judge ruled on a casino in unincorporated land in Glendale and once again we have a court ruling that seems to side with the tribe that it's okay to build the casino.
Jim Small: Yet another ruling where the courts have said that according to the federal law the way this is set up and the way the Arizona gaming compact was set up the tribe can use this land for a casino even though it wasn't tribal land when the gaming compact was passed in 2000.
Ted Simons: Basically the state and two other tribes are arguing that there was an agreement. We won't build any more of these in the Phoenix metro area. But the judge said that's an agreement, not in the compact.
Jim Small: The judge said even if they did acknowledge it at the time they are a sovereign nation. I don't have the ability to say you need to keep your word.
Ted Simons: So is this still moving through the courts?
Jim Small: I think it is.
Ted Simons: Thanks for joining us.