COVID-19 & Healthcare

Fate of Arizona’s Medicaid expansion now in the hands of the AZ Supreme Court

by

The Arizona Supreme Court on Thursday heard oral arguments on Republican lawmakers’ challenge of a hospital assessment that funds the state’s Medicaid expansion. Fate of GOP’s challenge to Medicaid expansion now in hands of the Arizona Supreme Court:

An attorney for three dozen current and former lawmakers argued that the hospital assessment is a tax that requires a two-thirds legislative majority to enact. The assessment was narrowly approved by the Legislature in 2013.

The lawsuit was rejected by a Maricopa County Superior Court judge in 2015, and the Arizona Court of Appeals upheld that decision in March.

The appellate court in its opinion (.pdf) said the law imposed an assessment that is exempt from the requirement that any act by lawmakers increasing state revenues, such a tax hike, must get a two-thirds vote in the Legislature [the “Two-Thirds for Taxes” amendment, Prop. 108 (1992)].

The “Kochtopus” Death Star, the Goldwater Institute attorney representing the lawmakers, pressed ahead with an argument before the seven-member Arizona Supreme Court that the assessment is a tax that required the vote of a two-thirds majority of the Legislature under Proposition 108, which was passed by voters in 1992.

“It is clear under Proposition 108, a supermajority is needed for the Legislature to authorize what they did here,” said Christina Sandefur, a Goldwater Institute attorney who represented the lawmakers. “That is what the voters wanted. They wanted the supermajority to apply any time the Legislature acts to raise revenue.”

Timothy Berg, an attorney representing Arizona and the state’s Medicaid program, said the voter-approved initiative included an exception that allows fees and assessments imposed by state agencies.

Berg argued that voters passed Proposition 108 with the intent of limiting the Legislature’s ability to raise taxes with a simple majority, not restrict fee increases that are a routine part of state government.

Read more

Healthcare Forum: We Want to Hear Your Stories

by

 

Banner University Medical Center
High-tech medical care at Banner University Medical Center

For the past 30 years, my career has focused on health promotion, disease prevention, behavioral research, and communications. I have seen, photographed, and written about the good, the bad and the ugly parts of our country’s healthcare “system”.

I saw the rise of HMOs (health maintenance organizations) in the 1980s. I cheered the Clintons for at least trying to fix the overly complicated mess in the early 1990s. I saw costs going up every year and service going down. I saw a health insurance system that was creaking under the weight of its own complexity, while big insurance and big pharma collected huge profits. As managing editor of the American Journal of Medicine, I stood proudly by the Editor-in-Chief when he and the Editorial Board called for Medicare for All on multiple occasions.

Along the way, I have heard stories about huge medical bills, uncompensated hospital care, outrageously expensive drugs, limited or delayed access to medical care, premature death and disease, medical bankruptcy, and the medical consequences of poverty.

Now, as a member of the Arizona House and the ranking Democrat on the Health Committee, I want to hear your stories.

Do you have concerns about the future of the Affordable Care Act, Medicare, Medicaid and Kids Care? Is the cost of medical care or prescription drugs a worry for your family? How would dramatic cuts to these programs impact you? Come to the 200 Stories: Tucson Healthcare Forum on Oct 29.

Read more

So how’s that trickle-down working out for Arizona?

by

The Arizona Capitol Times (subscription required) reports that Arizona Legislature’s budget analysts predict 2018 shortfall:

The Arizona Legislature’s budget analysts last Thursday predicted a budget shortfall that could top $100 million in the current and coming year as the impact of corporate tax cuts continues to overwhelm increases in sales, insurance premium and personal income tax collections.

Whaaa? You mean tax cuts don’t pay for themselves and are revenue neutral? (sarcasm).

Chief budget analyst Richard Stavneak told economists and state officials who make up the Legislature’s Finance Advisory Committee that the shortfall will hit $104 million. That’s out of an expected $10 billion in spending for the budget year that begins next July 1. A panel of state lawmakers also attended the meeting.

Excluded from that projection is $90 million in current spending that is labeled one-time but appears to be an ongoing commitment by the Legislature and Gov. Doug Ducey, Stavneak said. That puts the expected shortfall next year close to $200 million if that spending isn’t cut. The revenue picture could also brighten, but signals are mixed, he said.

Phased-in corporate tax cuts enacted under former Gov. Jan Brewer in 2011 have cut more than $600 million in yearly revenue since 2014. Rep. Don Shooter, R-Yuma, said it may be time to revisit the corporate tax cuts and predicted a budget battle next year.

“It’s going to be a free-for-all. We’re back to the cutting, I don’t see any other way,” Shooter said. “It’s going to come down to who’s going to bleed the least, what’s going to be the least painful, I guess.”

Read more

President Trump sabotages ‘Obamacare,’ will blow up health care markets out of spite

by

President Donald Trump, who promised to repeal and replace “Obamacare” on day one in office — “it will be easy” — suffered humiliating deafeats after several failed attempts by Congress. For a man fixated on erasing any legacy of Barack Obama out of jealousy and spite, he has been stewing about ways he can sabotage “Obamacare,” and with it the health care of millions of Americans, outside of congressional action. It is purposeful, malicious and amoral.

The New York Times reports that, as I predicted, Trump has gone nuclear in House v. Price, ending the Cost Sharing Reduction subsidies (CSRs) to insurers for low income Americans. Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again:

President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers.

The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own.

Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums and may pull out of the insurance exchanges created under the Affordable Care Act if the subsidies were cut off. Known as cost-sharing reduction payments, the subsidies were expected to total $9 billion in the coming year and nearly $100 billion in the coming decade.

Read more

Twitter-troll-in-chief threatens to abandon Americans in Puerto Rico

by

This is worse than George W. Bush’s clueless neglect of New Orleans after Hurricane Katrina. This is purposeful, intentional abandonment of Americans out of pure spite for having criticized the “Dear Leader” and his relief efforts in Puerto Rico and the U.S. Virgin Islands. Who does this? Trump threatens to abandon Puerto Rico recovery effort:

President Trump served notice Thursday that he may pull back federal relief workers from Puerto Rico, effectively threatening to abandon the U.S. territory amid a staggering humanitarian crisis in the aftermath of Hurricane Maria.

Declaring the U.S. territory’s electrical grid and infrastructure to have been a “disaster before hurricanes,” Trump wrote Thursday that it will be up to Congress how much federal money to appropriate to the island for its recovery efforts and that recovery workers will not stay “forever.”

In a trio of tweets, Trump wrote” “We cannot keep FEMA, the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!”

Screen Shot 2017-10-12 at 6.10.57 AM

Read more