Horizon, Host: Ted Simons

March 22, 2010


Host: Ted Simons

AHCCCS


  • State lawmakers have voted to cut $310,000 from the Arizona Health Care Cost Containment System, Arizona’s health care plan for the poor. John Rivers of the Arizona Hospital and Healthcare Association will address the ramifications of the cuts.
Guests:
  • John Rivers - Arizona Hospital and Healthcare Association
Category: Government

View Transcript
Ted Simons:
Tonight on "Horizon," the House passes health care reform. We'll talk about the impact on Arizona. And hear the pros and cons on a proposed one-cent increase in the state sales tax. That's next on "Horizon." Good evening and welcome to "Horizon." I'm Ted Simons. An investigation is underway into a reported act of vandalism at the Tucson office of democratic representative Gabrielle Giffords. The glass front door at the office and a side glass panel were shattered. No rocks or bricks were found and police are now looking to see if a pellet gun may have been used. U.S. capitol police and Tucson police are investigating. The House passed a historic health care reform bill last night. How will the changes impact Arizona residents and the state's Medicaid program? Here to talk about it is John Rivers, president of the Arizona hospital and healthcare association. Good to see you. Thanks for joining us.

John Rivers:
Thank you, Ted.

Ted Simons:
The health care reform bill. First of all, your thoughts, immediate thoughts.

John Rivers:
Some good, some not so good. It's going to affect people very differently depending on their circumstances. I think if you're uninsured right now, you'll have a different view of this bill as somebody that's insured. If you've ever been denied health coverage because of a pre-existing condition, you're going to view this as somebody that hasn’t. It depends on where you sit and your individual circumstances.

Ted Simons:
For those right now who have health insurance in one way, shape, or form, not much changes?

John Rivers:
I don't think too much is going to change for them, regardless of whether you have Medicare or whether you have private insurance. You're still going to be able to have coverage through your employer, paid for in the same way it is right now with whatever cost-sharing features are in there. How people who are insured right now are going to feel it the most, frankly, is in the tax increases that are going to occur in future years to pay for the reform that's being implemented and phased in, you know, very gradually.

Ted Simons:
They may feel that, but proponents of the plan say if health care costs do indeed come down the next few years, that would be a balancing act.

John Rivers:
I think that's fair to say. I think it's also fair to say there's a lot of skepticism whether that will happen or not. We've all heard the rhetoric on both sides of this issue and there's plenty of it on both sides of the issue. My sense is people intuitively are having a hard time getting their arms around the notion that you can insure 32 million more people and actually spend less money. And we're not partisan in our view of this. We actually favor reform as an association, but I have to tell you I'm as skeptical about that as anybody. I think there are some areas where it's going to cost more, some areas where it's going to cost less, and my guess is 20 years from now your kids and mine are going to be debating who is right in that argument.

Ted Simons:
And the argument includes some rhetoric, as you mentioned. Some are calling this as a government takeover. Do you see this as a government takeover?

John Rivers:
No. I'll be honest with you, I don't know what that phrase means. I think it's a phrase some people use to scare people. I think Republicans are a lot better at scaring people than the Democrats are. I think that is a -- well, I don't know what it means. We have a Medicare program right now, we have a Medicaid program right now, we have a V.A. health system. I guess those are government-run health systems. I don't see anything like that coming out of what Congress has just approved.

Ted Simons:
When Congressman Franks released a statement today saying that this bill, this plan, this reform fundamentally diminishes the best health care system in the world, how do you respond to that?

John Rivers:
I'd like to know how that happens. That would be my response to it. I think from a healthcare provider's point of view, we would probably answer that question would be, well, there are a lot of cuts to health care providers that are going to take place as a part of this reform package. Now, the democratic leadership in Washington rationalized this on the basis, hey, we're sending you 32 million more paying customers, so there has to be a little pain felt on your part. It wasn't quite that crass but almost. I think from our standpoint, okay, there are more paying customers, if you will, in the system, but is there enough money in the system to pay for the care that those 32 million people are going to require? And that's where nobody really knows the answer, in my opinion.

Ted Simons:
Let's get now to Arizona. How does this bill, this plan impact Arizona?

John Rivers:
It’s going to impact us I'd say on the plus side and on the negative side. You know, on the plus side, we presently got about a million and a half people who are uninsured in Arizona. If you're one of those uninsured, there's a really good chance that you're going to have adequate health care coverage in the future as a result of this bill. Where the challenge is going to come in is that the federal government is only -- is basically only paying for this expansion and the programs that we have right now up until the middle of 2011. There's a maintenance of effort requirement that kicks in as a part of the new expanded Medicaid program. We've heard our governor and other officials say we can't afford the Medicaid system now. They've got a point. They have a real problem figuring out how to pay for the Medicaid program that we now have between June of 2011 and January of 2014 when the new Medicaid expansion kicks in.

Ted Simons:
When you say the Medicaid program we now have, that does not include the cuts that were passed by the legislature?

John Rivers:
That does not include the cuts.

Ted Simons:
That's basically locked in by the federal bill, correct? At least if you want to get the maintenance of effort going.

John Rivers:
The cuts by the legislature said a couple of things. Number one, we're not going to have kids care anymore as of June 15th and we're going to have a rollback on what's called a prop 204 population, 310,000 childless adults currently covered by the access program. With the health care reform legislation, pardon me, it now says that if you want to continue to have a Medicaid program or an access program in Arizona, you're going to have to fund that kids care program and you're going to have to fund that prop 204 population. You're not going to be able to cut back eligibility for either one or you won't be able to participate in the federal Medicaid program. So if you're an Arizona lawmaker or governor or whatever, that's going to present you with a big challenge.

Ted Simons:
I was going to say, and now this is not the Senate bill that was passed but will be tinkered with by the Senate to reflect the House Bill. This is the House Bill you're referring to here as far as that Kidscare mandate.

John Rivers:
Yes. And it was I think what's called the sidecar bill or trailer bill that was fixing the bill, the one in the past and didn't. I think the main point, Ted, is we do expect that maintenance of effort requirement to be in the final version that gets signed into law by President Obama. So, you know, I think its good news for a lot of people in Arizona, but there isn't any question that it's going to present our lawmakers with a big, big challenge.

Ted Simons:
In terms of getting that money.

John Rivers:
Finding the money, right.

Ted Simons:
I know that the plan to up the eligibility as far as access is concerned and getting rid of kids care and all sorts of things meant a loss of matching funds. You did a study; your group did a study --

John Rivers:
Yes, we did.

Ted Simons:
That showed the economic impact. Talk to folks about what you're saying the people are going to be hurt by the jobs they won't have.

John Rivers:
There's going to be a wide variety of impact. We asked the ASU business school to do a study for us on what is the impact on Arizona's economy if you shrink health care by $2.7 billion, which is what was in the budget that was approved by the legislature about a month ago or three weeks ago. And the answer that came back was that is the equivalent of a loss of 42,000 jobs. That is the equivalent of shrinking the state's gross domestic product by 3.3 billion. Here we're at a time when we're trying to figure out how to attract more business into the state, how to create more jobs and our policies are having exactly the opposite effect.

Ted Simons:
Again, the governor will say and most lawmakers will say we simply don't have the money.

John Rivers:
Yes. That's what she would say. You know, when we would ask a legislator or the governor, why would you turn down a three-for-one federal match? That's a very highly leveraged expenditure of the state federal dollar. The answer is we don't have the dollar to give you. So, you know, economists have been debating for at least a year about why Arizona doesn't have the dollar, and there are some economists that say, you know, if we had the tax structure in place that we had in 1986 or 1996 even, we wouldn't have the economic crisis that we have today.

Ted Simons:
Last question. The governor and others, you know, they don't necessarily want this to happen, but, again, they say there's no money. And she's been quoted as saying, that if people are in need of emergency care, they'll just go to the emergency rooms. Are hospitals prepared for the onslaught of folks that will hit the emergency rooms?

John Rivers:
No. The governor has said we want people to get primary care so they don't have to go to the emergency room. What will happen now is that our hospital emergency rooms are going to be flooded with people who don't need to be there and they're going to be flooded with people who don't need to be there because they have no other place to go because they've lost their primary, you know, health insurance and access to their primary care doctor. That has an implication that goes way beyond the people that lost their health insurance coverage. It means people like you or me or family or friends having to go to an emergency room, they're going to find instead of getting seen by a physician in 30 or 45 minutes, it might be three or four or five or six hours. This will be something that has an impact on Arizona way beyond the people that have lost their health insurance.

Ted Simons:
John, good to have you here.

John Rivers:
Thanks, Ted.

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