Coalition for expanded Medicaid (AHCCCS) in Arizona is forming

Posted by AzBlueMeanie:

It appears that Governor Jan Brewer, who once cast herself as a fierce opponent of the Affordable Care Act ("ObamaCare") and made heartless cuts to the state Medicaid (AHCCCS) program for transplant recipients and imposed a freeze on childless adults and KidsCare enrollment, may now be hedging her bets on the success of the Ryan-Romney plan to repeal "ObamaCare" and to adopt the GOP Medicaid "let them die!' healthcare plan.

Governor Brewer's top advisers are attempting to create a coalition of hospitals, insurance plans, providers and other players to push Arizona to expand Medicaid under federal health-care reform. Brewer advisers form health pact to push to expand Medicaid:

Last week, the board of a statewide group of human-services providers agreed to hire Chuck Coughlin and Peter Burns, and the state's largest hospitals and health plans are considering signing on.

The pair would bring political and technical savvy to the complex realm of health care, with the goal of marshaling a united front of heavy-hitting businesses to push Medicaid expansion through the Legislature next session.

Brewer, whose spokesman was unable to say whether the governor was aware of Coughlin and Burns' coalition efforts, has been a vocal opponent of the federal health-care law, and she led efforts to cut state Medicaid programs in prior years. But she has recently indicated a willingness to consider expansion.

The stakes are high for health-care groups, businesses and Arizonans. If Brewer and state lawmakers agree to expand Medicaid, an additional 300,000 low-income Arizonans might get health coverage during the first year. If they don't, hospitals, doctors and health-care providers will continue to lose patients and lose money caring for the uninsured.

In June, the U.S. Supreme Court ruled that states could reject the ACA's Medicaid expansion without being penalized with the loss of their base Medicaid federal funds.

[Governor] Brewer has said she wants to hear from Arizona stakeholders and get more information about federal requirements and the potential impact before making her decision.

Medicaid is a state-federal program for low-income and disabled people. Federal funds would cover most of the cost of expanding the program.

The governor's staff said last week that Brewer's decision will be part of her budget proposal for fiscal 2014, which she'll release in early January.

But Burns and Coughlin aren't waiting. Their idea is to bring together those with a stake in Medicaid expansion to show Brewer they are behind her and to provide the financial data and other background information to support Medicaid expansion.

Coughlin and Burns already have Brewer's ear on health, budget and political matters. Coughlin ran the governor's re-election campaign. And Burns, a former state budget director, has a contract with Brewer's office to provide an analysis of the federal heath-care overhaul's impact on Arizona.

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Burns said he's concerned that there's a general sense, both here and nationally, that Medicaid is broken. He said that while it may be broken in Texas and Florida, where governors have turned down the expansion, Arizona's Medicaid program, the Arizona Health Care Cost Containment System, is different.

"AHCCCS has been breaking ground since it was started in 1982," Burns said. "We don't believe it's broken at all. … We just don't want to get painted with that brush."

Health-care officials are listening. In the coming weeks, several entities could decide to hire Burns, who would likely subcontract with Coughlin's firm, High Ground, to put together a coalition with a common goal.

Health and welfare groups traditionally have taken separate, if related, approaches to public policy and legislative lobbying. That backfired last year when the Arizona Hospital and Healthcare Association approached Brewer to support a tax on their facilities in exchange for backing off her proposal to freeze the AHCCCS program for childless adults. Their pitch failed. The freeze took effect in July 2011, and some of the state's largest hospital systems quit the association months later.

Since Brewer and lawmakers imposed the freeze and other budget cuts, including a freeze on the KidsCare health program, more than 160,000 Arizonans have lost health insurance and an untold number have become ineligible. Some hospitals have seen their budgets for uncompensated care quadruple during that time.

Emily Jenkins, CEO of the Arizona Council of Human Service Providers, said her board decided recently to join Coughlin and Burns' effort and is hopeful it will expand beyond health-care organizations to include the business community, which she said also has a lot at stake if Arizona rejects Medicaid expansion. The council represents 80 mental-health, child-welfare and juvenile-justice agencies.

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Coughlin and Burns have been meeting with various groups over the past few weeks. At the same time, Brewer's chief of staff, Eileen Klein, health-policy adviser Don Hughes, AHCCCS Director Tom Betlach and other administration officials have been briefing many of the same players on how federal health-care reform will affect the state, particularly the potential for expanding Medicaid and running the health-insurance exchange, a marketplace of coverage plans for individuals and small businesses.

Betsey Bayless, CEO of Maricopa Integrated Health Systems, set up a meeting late last month at Maricopa Medical Center with other hospital executives, including the CEOs of Banner Health, Abrazo HealthCare and Dignity Health, the parent company of St. Joseph's Hospital and Medical Center. Burns and Coughlin also took part.

The group met in advance of a Governor's Office briefing, she said, to craft a unified message and avoid the debacle of last year's hospital-tax proposal. Brewer has indicated that the health-care lobby was "not unified, was dysfunctional," Bayless said.

"We met here and just very bluntly talked about the fact that we need to be together. We can't be fighting," she said. "Whatever is going to happen, the governor is going to lead this and we need to support her."

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A large coalition in support of expanding Medicaid to more low-income Arizonans would give the governor political cover to move forward with broadening eligibility for the program. It also would provide the lobbying muscle many predict will be needed to get an expansion through the Republican-led Legislature.

Every Democrat running for the state legislature should be making expanded Medicaid coverage an integral part of their campaign.