September 1, 2009
Host: Ted Simons
- At the end of September, thousands of working Arizonans will lose their health insurance. That’s because lawmakers did not reauthorize funding for KidsCare Parents, a low-cost health insurance program for working parents whose income is below 200% of the federal poverty level. Dana Wolfe Naimark of Children’s Action Alliance and Brenda Cardenas of Healthcare Connect talk about the limited options available to these families.
- Dana Wolfe Naimark - Children’s Action Alliance
- Brenda Cardenas - Healthcare Connect
Ted Simons: At the end of September, about 10,000 working parents in Arizona will lose their health insurance because state lawmakers did not appropriate funding for Kidscare Parents. The program offers low cost health insurance to parents with incomes below 200% of the federal poverty level, or about $44,000 for a family of four. More on the program and options for parents in a moment. First, David Majure shows us one place people can turn to for low-cost health care when they don't have access to insurance.
Catherine Amiot: More and more people who have never sought reduced cost or free medical services are now finding their way to our doors. I think this is a direct result of the economy, the loss of jobs.
David Majure: Three days a week Mission of Mercy takes its mobile clinic to different parts of the Valley. Wednesdays it's here at shepherd of the Valley Church, 15th avenue and Maryland.
Catherine Amiot: We're stretched to the seams as far as being able to handle the increase in patient care.
David Majure: Director Catherine Amiot says patient visits at this location are up 41% compared to last year, and the clinic is simply not able to see every patient who shows up.
Catherine Amiot: No, we're not. Last Wednesday I was here conducting a tour, and before 9:00 we had turned away 32 people. Most of our patients, for most of them Mission of Mercy is their last hope. When we turn away patients, it's not just saying please come back next week. We're booked two months out. We're saying we can't help you and we're not sure where we can tell you to go.
David Majure: Mission of Mercy is funded entirely by private donations. It provides free primary medical care and prescriptions to people who are uninsured. Doctors and medical staff donate their time, as do many other volunteers.
Catherine Amiot: Well, they're the heart and soul of Mission of Mercy. We could not be open for one minute of one day without our volunteers.
David Majure: People like Ana Berlanga-Nabozny, a volunteer interpreter for the last five years.
Ana Berlanga-Nabozny :I volunteer because I can.
David Majure: She helps non-English-speaking patients communicate with their caregivers. By doing so, she knows she’s helped save lives.
Ana Berlanga-Nabozny: Many people may think they don't have much to give, oh, but they do, they do. And the old cliche about you get so much back, you do get so much back. The best days for me -- and I think any volunteer will say the same thing -- are the busiest days. If I can hop or run or skate from table to table, helping people, that's my best day. That's my best day.
David Majure: It appears Ana has many good days ahead of her because the Mission of Mercy clinic is busier than ever and shows no sign of slowing down.
Ted Simons: Joining me now to talk about health insurance for the working poor is Dana Wolfe Naimark, president and CEO of Children's Action Alliance, and Brenda Cardenas the eligibility coordinator for Healthcare Connect, the medical discount program in Maricopa County. Thank you both for joining us on "Horizon."
Dana Wolfe Naimark: Thank you.
Ted Simons: Let's talk about Kidscare Parents. What exactly is it?
Dana Wolfe Naimark: It's affordable health care coverage for working parents in our state. It covers just under 10,000 parents. It's very cost-effective and affordable and provides comprehensive coverage for parents.
Ted Simons: We're talking about 200% of poverty level, $44,000 for a family of four. What kind of premium is involved here?
Dana Wolfe Naimark: Parents pay premiums ranging from $40 to $100 per month, and then there are additional premiums for their kids' coverage.
Ted Simons: It is funded how?
Dana Wolfe Naimark : Three quarters of the funding is from federal funds, so it's very cost-effective for the State. If we were doing it for a full year, there's about $8 million of state funding. There are premiums paid of about $6 million.
Ted Simons: What is the status of the program right now?
Dana Wolfe Naimark: The status is it ends at the end of this month, September 30th is the last day. As of October 1 no more Kidscare Parents coverage. Parents have received letters in the mail telling them about this. They are now looking for alternatives.
Ted Simons: The Governor has a budget she's looking over probably as we speak.If she signs that budget right now, Kidscare Parents still doesn't exist?
Dana Wolfe Naimark : Right. As of October 1, it is gone. That's the budget on her desk.
Ted Simons: What happens to 10,000 parents depending on Kidscare Parents?
Dana Wolfe Naimark: That's the scary part. There are very few alternatives for most of these parents. Many of them have preexisting health care conditions. To find coverage on the private market is impossible or extremely expensive.
Ted Simons: Community health care centers, are they an option?
Dana Wolfe Naimark: They are an option. As you know, they don't provide health insurance. They provide primary and preventative health care services on a per-visit basis. That's certainly a good option. They are very strained as well, they have suffered budget cuts. There are waiting times and sometimes it's hard to get services there. But that is an option for people.
Ted Simons: We are talking about parents, many of whom have jobs and there are employers in the picture. Whatever happened to employer insurance?
Dana Wolfe Naimark: As you know, employer coverage has been dropping not only in Arizona but across the nation. For small employers in particular, it's extremely hard for them to offer coverage because it's not affordable. Even if they do offer it, the premiums the parents would have to pay are beyond what they can afford.
Ted Simons: Is it a hardship situation or is it simply impossible for them to afford?
Dana Wolfe Naimark: Well, it's some of both. For many parents it is impossible. They could not make ends meet, pay their rent, take care of their families if they had to pay those premiums.
Ted Simons: Brenda, you're with Healthcare Connect. Tell us about that program.
Brenda Cardenas: It's an alternative for parents losing Kidscare. We help anyone throughout Maricopa County who doesn't qualify for any kind of a State program or can't afford a private insurance that you could receive discounts on services like primary care doctors, specialists, hospitals and services like that.
Ted Simons: Status of the program right now?
Brenda Cardenas: Just like any other nonprofit program, we're struggling financially, but we're still okay for now.
Ted Simons: And funding comes -- again, your funding doesn't come from the state directly, correct?
Brenda Cardenas: No, not at all, no state or federal funding. With the program, if you qualify, There's an enrollment fee, so that helps us a little bit with our funding and we apply for different grants.
Ted Simons: What happens to your program when Kidscare Parents goes away?
Brenda Cardenas: Right now the parents have already received their letters, we are one of the resources. We're getting calls left and right from parents throughout all of Arizona trying to look for something. For people who live within Maricopa County, Healthcare Connect is a pretty good alternative for them.
Ted Simons: What are you hearing in these calls?
Brenda Cardenas: There's a lot of upset parents. For example, parents who pay premiums of over $100 including their children feel it's unfair because they are paying for their medical. A lot of people who have chronic conditions really don't have a way out. Even if they make okay money with their employers, because with preexisting conditions they don't even qualify for any insurance. It's really scary.
Ted Simons: Dana, what are you hearing as far as parents who may be out of luck in the next month?
Dana Wolfe Naimark: We're hearing desperation, pure desperation. Healthcare Connect is only available in Maricopa County. For parents in greater Arizona, there are very few alternatives. One thing we're hearing, some may be forced to quit their jobs or spend down their savings to qualify for access Medicaid. It's the opposite of what we all want for the community. Parents want to keep working, we want them to keep working. That would be a negative outcome for everybody.
Ted Simons: Explain the tumble, the landslide that could happen when one aspect of coverage in a safety net falls through?
Dana Wolfe Naimark: Exactly. If parents lose their affordable coverage and they have health problems that have to be addressed, bills pile up and they fall behind, they could lose any savings they have and what's called spending down to qualify for Medicaid. At which point they pay no premiums, they may not be working or paying taxes and we get less federal dollars for that. That's a lose, lose, lose proposition for Arizona and we should be doing everything we can to prevent that.
Ted Simons: Spend X over here for Kidscare Parents, or don't spend X, but spend X, Y and Z, the repercussions of not having Kidscare Parents. Is that what you're saying?
Dana Wolfe Naimark: That's exactly what I'm saying. If parents are forced to turn to emergency rooms as their only source of care, we know how expensive that is and what a strain that is on hospitals and that raises the cost of health care throughout the system. It's a really costly decision on the part of the legislature.
Ted Simons: Brenda, this hits home for you, talk to us about your parents and your situation.
Brenda Cardenas: My parents are one of the people who depend on Kidscare Parents. They are eligible through my youngest siblings in the household. Unfortunately for them, the week KidsCare broke out the news, my mom ended up in the hospital and now they told her she needs to follow up with certain specialists and taking certain tests. The cash pay is just completely unaffordable. She's fortunate to have Healthcare Connect afterwards, but the fact is either way for everything that she's going to need, it's too much money. So it's really difficult.
Ted Simons: I was going to say, and her situation is that she's raising grandkids.
Brenda Cardenas: Right.
Ted Simons: But how does she become eligible for Kidscare?
Brenda Cardenas: She's eligible because I have a younger sibling eligible for Kidscare right now. They are eligible for Kidscare, the family of three, because they have to take care of other kids. Only one of my parents is able to work because they have four younger grandchildren they have to take care of. It makes it a little difficult, it's more cost-effective for my mother to stay home versus paying a baby-sitter or day care. It makes everything financially even worse. You not only worry about feeding a family of six, you have to worry about paying bills and medical bills that are for sure going to come up.
Ted Simons: What about the parents? They are out of the picture right now, correct?
Brenda Cardenas: Right.
Ted Simons: What are you telling your parents as far as what they need to do?
Brenda Cardenas: When they heard the news of the Kidscare, they broke down. It's unfortunate because medical is expensive and there is no insurance. Both of my parents have preexisting conditions, so there's no way insurance will touch them. My dad only has a part-time job, that's all he's able to get right now. His employer won't offer him insurance because they are a small household, only my mom, dad and youngest brother. It's so difficult. Medical is expensive and there is really no way out. They will have Healthcare Connect which will help them a lot, but that's just going to be another bill on top of all of their other services.
Dana Wolfe Naimark: Ted, what's so heartbreaking is this is exactly what we shouldn't be doing right now. We should be expanding options for people. At this time when the economy is so tight and more people need health care coverage, we're going in absolutely the wrong direction.
Ted Simons: What do you say to lawmakers -- and we've had lawmakers on the program. When I bring up certain programs it all boils down to we don't have the money. We simply can't afford it. In this time, for this state, it's unaffordable. What do you say to that?
Dana Wolfe Naimark: Well, two things. Certainly with the current budget, revenue that's coming in, we can't afford it. But there have been many proposals put forward, as you know since the legislative session began, and going back 10 years, proposals to create a more responsible budget and a healthier budget for Arizona moving forward. And also, Ted, the budget on the Governor's desk right now includes $250 million in permanent tax cuts. Somehow we can afford $250 million in tax cuts, but we're kicking 10,000 working parents out of health care coverage. It doesn't add up.
Ted Simons: Is this an ideological viewpoint that basically says, we'll take care of those folks but we've got to get the economy up to speed, so that there is money flowing through the system to take care of everyone. Why is that not right?
Dana Wolfe Naimark: Well, we're not taking care of those folks. What we're doing is shrinking the options for hard-working families and forcing families into very desperate situations. What we really expect from our elected leaders is helping families cope through these hard times, not making it even harder.
Ted Simons: Are you at all optimistic that eventually Kidscare Parents is going to be back up in operation in some way, shape or form?
Dana Wolfe Naimark: Well, I am hopeful. I think it very important for lawmakers to hear the real-life consequences of their decisions. So many of these things were numbers on a page for all of these months while they are debating the budget. Now it's real, with real people, men and women, parents, calling all around the state, desperately. It's important for lawmakers to realize those consequences.
Ted Simons: And are you at all optimistic that your parents will find a way to figure this out? 18
Brenda Cardenas: Yeah, I have hope, I have hope that there will be a better way.
Ted Simons: Okay. Well, thank you for joining us on "Horizon."
State Budget Politics
- Senator Jay Tibshraeny, a Chandler Republican, talks about the politics of what’s been a painful process to pass a state budget.
- Jay Tibshraeny - State Senator
Ted Simons: Governor Jan Brewer has until Saturday to sign the eight budget bills remaining on her desk. None of them contain the temporary sales tax referral she's fought for all year along. Here to talk about the politics of what’s been a painful budget process is Senator Jay Tibshraeny, a Chandler Republican. Glad to have you back on the show.
Sen. Jay Tibshraeny: Glad to be here.
Ted Simons: What is the latest? What's new as of 30 minutes ago?
Sen. Jay Tibshraeny: Kind of a soap opera. Today was kind of an up and down day. I woke up, talked to a few people on both sides of the equation that were working on it. The early rumor was that she was throwing her hands up, the Democrats were being unreasonable, she was going to sign the budget sent to her and be done with it. That was the rumor but it was pulled back. They continue to meet, they being the Governor, Republican leadership from the House and Senate, Democratic leadership from the House and the Senate. Before we went on to tape the show, they were meeting and exchanging proposals and talking about the budget and what they could do to maybe get this done and get her her sales tax referral.
Ted Simons: We've heard the bipartisan talks are on, then off, and on and off, and now it sounds like they are on.
Sen. Jay Tibshraeny: Right now they are on.
Ted Simons: Is anything coming out of these talks?
Sen. Jay Tibshraeny: I think they are defining some issues. Whether that gets us to a point that they can agree on issues is a different thing. There are some big stumbling blocks that make it hard to get it done in a short time. Negotiations like this, my prior experience, it's hard to do them in two weeks, kind of the time frame that it has to happen. Usually it takes a lot longer, a lot of give and take and hand-wringing. The time for hand-wringing is past because we're so late in the budget process or early in the budget year.
Ted Simons: Would you have liked to have seen these bipartisan talks happen earlier in the process?
Sen. Jay Tibshraeny: Because of what happened in the Senate, with our inability -- because of mainly two recalcitrant Republicans to get the sales tax referral out -- because of that, I would have -- in the Senate, I think we could have maybe got this done better in the Senate with a bipartisan approach. I think once the budget was vetoed on June 30th, July 1, start it then and get her sales tax referral. We had a budget out, but not a budget that the Executive Branch could support, because the Executive Branch, Governor Brewer's been very clear from Day 1, she wants the sales tax referral to be part of this. When you send her a budget without that -- she does have to sign that budget. So it would have probably been better for us in the Senate to start working July 1 with a bipartisan approach, because it takes time.
Ted Simons: We keep hearing from capitol reporters and those at the capitol, lawmakers and such, lobbyists, they have never seen anything like this. Do you agree?
Sen. Jay Tibshraeny: A lot of them have a lot more years in the process. I've followed politics a long time and this is my seventh year in the legislature. It's the craziest time I've seen in my seven years. To be into September and have this much uncertainty surrounding the budget process is unusual, to say the least.
Ted Simons: Do you consider yourself a moderate?
Sen. Jay Tibshraeny: I'm a pragmatic person and a centrist. I don't know what they refer to me as. In my caucus, I don’t know what they refer to me as. I used to be in the middle of my caucus and kept getting lopped off. I like to get things done and see when you have to negotiate and when you don't. You have to get things done, you have to get a budget done.
Ted Simons: Let's stick to the sales tax referral. How much is that splitting the Republican Party, from what you've seen in caucus and the general attitude down there? How much is that hurting the G.O.P.?
Sen. Jay Tibshraeny: It’s hurting the G.O.P because it's stopping the whole budget process from moving forward. We'll go to the people in charge with the blame, which is us the Republicans. When you say it's hurting or splitting the caucus of the G.O.P., when you look the House got it out with 32 Republican votes. The Senate had 15 Republican votes. If we would have had the two Republicans support it who served them, because it was a conservative tax referral bill, we wouldn't be here. We had 15 out of 18 Republicans supporting it. Unfortunately, you need 16 votes to get anything done, so we split. But Randy Pullen came out supporting the package. A lot of the conservative think tanks came out supporting the package. It's not split in that point. But it's been divisive with those that have split from supporting the package.
Ted Simons: The Governor says egos are at play from keeping her referral from going any farther to this point. Does she have a point there?
Sen. Jay Tibshraeny: I don't know. She's looking at it probably from her perspective. I don't know if it's necessarily egos, but it's certainly causing a lot of consternation right now.
Ted Simons: Why do you think and why have you heard that there is such hesitation to allow -- the Governor's not saying you will pass this temporary sales tax. She's just asking for it to be on the ballot for a later vote. Now, of course, deals have been made, but there are still some holdouts. What's going on? Why not let people vote on this?
Sen. Jay Tibshraeny: I think the ones that don't support the sales tax, the sales tax referral on that particular bill had significant income tax cuts down the road where it was revenue neutral or even a revenue deficit bill, because of the income tax cuts down the road. The few that didn't support it had an ideological vent that they were voting for a tax increase, although really they weren’t, they were voting to refer it to the ballot and let the public have a say. Do I want this and do I want the programs? The governor’s point is it's going to offend the voters to say that, it's going to be very difficult to balance the budget. We've already cut the budget significantly, and we'll have to do it more. Without a revenue enhancement we'll see more cuts. Her point was, can the public maybe have a say in this. I don't think there's a problem with this. I, like most every Republican down there, supported this referral.
Ted Simons: Is it fair when the critics say the G.O.P, lawmakers at the Capitol are beholden to the ideology, Grover Norquist, no tax increase at any time. Is that a fair assessment?
Sen. Jay Tibshraeny:I think there is a small segment that are, but again when you are dealing with trying to do a budget within your caucus, even a small number of people will keep that from happening. I think there is a small number of people that feel that way. Yeah, there are some that are like that.
Ted Simons: Do you think voters will approve a temporary sales tax increase?
Sen. Jay Tibshraeny: Those things are difficult to pass. I saw what happened in California, it went down. I wouldn't predict. I've seen at the city level some of those issues have passed. But I think in this climate it's 50/50 at best.
Ted Simons: You mentioned the climate. Again, critics are saying that you've got a Republican governor, you've got a Republican-dominated legislature, and you've got what most are saying is craziness going on that they have never seen before. They say this proves the G.O.P. as it stands right now in Arizona can't govern. Your response?
Sen. Jay Tibshraeny: Well, I think we can govern, but we have these philosophical differences stopping this one issue from moving forward. Again, that one issue is stopping the whole budget from being finalized. Yeah, I don't think it bodes well that we’re at this gridlock. Hopefully in the next week or so the gridlock will be over. I don't think anybody would dispute that it's hurting us in the public's eyes. I would like to see it come to a successful resolution.
Ted Simons: When it comes to a resolution, successful or otherwise, what do Republicans need to do to get people to start thinking of the party, in perhaps different ways than they are thinking right now?
Sen. Jay Tibshraeny: Well, with the few votes we needed to pick up in the Senate, they are not going to change their mind, the two senators that didn't support it the day we voted on the tax. They are not going to change their mind for whatever reason. So that's the work with the Democrats. Again, working with the Democrats, to bring them in now, which I think is good, maybe we should have been doing this before, at least after the first veto. It just takes time, so whether that can happen or not, I don't know. I don't see the Republicans that didn't support the referral -- I don't see any of them changing their minds.
Ted Simons: All right, very good. Thanks for being on the program.
Sen. Jay Tibshraeny: Thanks for having me.