Arizona media misleads on restoration of organ transplant funds

Posted by AzBlueMeanie:

Last week all the newspapers carried headlines about how Gov. Jan Brewer was fighting to restore funding to organ transplant patients in the budget finally adopted last week (leaving out the fact that she had terminated the coverage on October 1, 2010, and her office blocked consideration of any bills to retore the funding in legislative committees). Those headlines were misleading.

Upon closer examination of what is actually in the budget adopted last week, the Arizona Capitol Times has corrected this misleading reporting in two reports, the first from Luige del Puerto, Transplant services are not restored in GOP budget:

Despite perceptions they did, the Republican-led Legislature did not restore funding for certain transplant services in the $8.3 billion budget plan they submitted to the governor last Friday. [empasis added] If there were any confusion, it’s because the budget bill that deals with the transplant issue is, well, a little bit confusing.

Legislators inserted an “intent clause” in the measure, SB1619, saying they wanted the transplant services, which were discontinued by a law adopted last year, to be funded. But they provided no money to back up their intent. Neither did they authorize the Arizona Health Care Cost Containment System to find the money within the agency for those services.

In fact, the bill did not lift language in statute that specifically disallows the transplant services, a decision that drove home the severity of Arizona’s festering fiscal crisis.

So what you have is a bill that orders AHCCCS to still not provide those medical services and then also says legislators wanted them funded.

This report now contains an Editor's Note:

Editor's Note: After this blog was published, the Governor’s Office explained that the money for transplants was included in the budget. In addition to the legislative intent language, the budget includes a clause that authorizes AHCCCS to fund the transplants using money appropriated by the Legislature. However, instead of restoring the funding in a direct manner, the budget uses a more round-about way, and only allows for the transplant program to be fully funded through June 30, 2013.

The second follow-up report by Jeremy Duda comes to the same conclusion. Budget language sparks confusion, accusations over transplant coverage (subscription required):

Confusing and roundabout language in the 2012 budget led to several days of Democratic sniping at Gov. Jan Brewer, who said the Arizona Health Care Cost Containment System is on its way to restoring transplant coverage that was eliminated last year.

The budget, which awaits Brewer’s signature, does not actually reinstate the transplant coverage or provide the funding to do so. But it does authorize AHCCCS to restore the program itself, “within available appropriations,” and it gives permission for an agency rulemaking that will temporarily reinstate seven kinds of organ transplants.

A big problem:

Brewer’s plan faces two potential pitfalls. The U.S. Centers for Medicare and Medicaid Services could reject portions of the plan, which could leave Arizona’s Medicaid program facing a deficit of tens of millions of dollars. Or the courts could rule that the cuts violate Proposition 204, a 2000 ballot measure that drastically expanded Medicaid eligibility.

So what is really going on here? House Minority Leader Chad Campbell explains:

Campbell said the legislation is overly complicated, and questioned why Brewer and the Legislature didn’t simply restore the funding.

“They’re going to come back and blame the feds. This is all a big shell game they’re playing,” he said. “Are they going to then come back and say, ‘It’s not our fault. The feds or the courts rejected our plan, so our hands are tied and we can’t fund the organ transplant program.’”

E.J. Montini at the Arizona Republic adds his skepticism here Are transplants in or out? They're IN, governor says and here Is Brewer trying to 'transplant' blame?

This morning I received this missive from the Democratic Legislative Campaign Committee, Arizona GOP to fix transplant disaster by cutting off health care for 140,000:

Arizona Republicans have finally admitted that their unconscionable and deadly decision to rescind payment for organ transplants to patients who’d already been approved for them was a mistake. (They’ll never say it out loud, but Governor Brewer’s weekend proposal to reinstate transplants says everything Republicans won’t.)

But the Republican “solution” isn't just illegal; it would also kick an estimated 140,000 poor and working Arizonans off of Medicaid.

How bad is the GOP proposal? Arizona business advocacy groups are practically jumping up and down screaming “Tax me, tax me!” as an alternative:

Brewer’s move comes despite a proposal by the Arizona Hospital and Healthcare Association to tax its members to raise enough money to much more sharply limit the number of people who would need to be cut from the program to balance the budget. The hospitals say that, aside from increasing the number of uninsured in Arizona, Brewer’s plan would force layoffs at hospitals.

It also is going to trigger a lawsuit if and when Sebelius approves the change.

That is because Brewer hopes to phase in her plan by immediately refusing to enroll any childless adults and some parents with children. But attorney Tim Hogan of the Center for Law in the Public Interest said these people remain eligible for AHCCCS coverage under a 2000 ballot initiative that requires the state to provide care for anyone below the federal poverty level, about $18,310 a year for a family of three. And a state constitutional provision generally bars lawmakers from altering or repealing voter-approved measures.

The hospitals’ stance appears counter-intuitive at first, but it makes perfect sense once you delve into the numbers. As a joint federal-state program, 76.1% of Arizona’s Medicaid expenses are paid for by the Federal Government in 2011. Therefore, for every dollar Arizona hospitals are taxed (at their own request) to pay the state’s share of the program this year, the health care industry can expect up to four dollars in revenue from Medicaid services. In addition, when some of the 140,000 kicked off the program need emergency care and are unable to pay for it, heath care providers would absorb much of the cost themselves.

But for ordinary Arizonans, of course, the calculation is much simpler: Should the State of Arizona save more lives, with someone else offering to relieve taxpayers of the costs? Or should Arizona toe the national Republican Party line?

Because right now they can’t do both.

Our Tea-Publican legislature made up of "Birthers, Birchers and Secessionists" wanted to pick a "states rights" fight with the federal government over Medicaid and rejected all reasonable alternatives to their deeply flawed ideological plan, including the hospital association's plan. Governor Grim Reaper and her GOP death panels did not merit the misleading headlines from newspapers last week giving her undeserved credit for fighting to restore funding to transplant patients. She is using these patients as a pawn in her "states rights" posturing with the federal government.

As E.J. Montini said in an earlier post, After dropping hints, Brewer MUST restore funding: "It was inhumane and unnecessary to have cut off transplant funding to begin with. It would be grotesque and unspeakably cruel to dangle a possible solution in front of those gravely-ill patients and their families and then to snatch it away."