- U.S. Sen. Ruben Gallego, D-Ariz., is raising awareness about the potential consequences of Republican-proposed Medicaid cuts in Arizona.
- Community health-care leaders warn that cuts could lead to increased medical debt, homelessness and untreated illnesses.
- Arizona’s Medicaid program, AHCCCS, covers a significant portion of the state’s population, including low-income individuals, children, and people with disabilities.
U.S. Sen. Ruben Gallego said he will be working to make Arizona residents and congressional leaders aware of the human suffering that Republicans’ proposed Medicaid cuts could cause.
Gallego, a Democrat who began his six-year Senate term in January, heard from more than a half-dozen community health leaders on Saturday about the toll that cuts to the federal Medicaid program could take in Arizona, where the program enrolls 2 million people.
Among the worries were increased medical debt, a rise in homelessness, a rise in incarceration, rural hospital closures and a rise in the number of Arizonans who don’t get the health care that they need, including cancer screening and treatment.
Gallego pledged, after hearing the comments, to do more outreach about the issue, including in rural Arizona where funding reductions to the government health insurance program could hit especially hard. It’s important for Arizonans to know what’s at stake, he said.
Medicaid in Arizona is a $21 billion program called the Arizona Health Care Cost Containment System, or AHCCCS, pronounced “access,” for short.
It is government health insurance that primarily covers low-income people, including nearly half of all births in the state, about one-third of the Arizonans who have a disability, and about 38% of the state’s children.
“We do have a very delicate balance here that we’ve put together in a very Arizona way,” Gallego said. “AHCCCS is unique to Arizona and it is one of the best-run programs in the country. But even if you are not on AHCCCS, you benefit from AHCCCS. … If you start pulling the strings away to our health-care network, it will affect everyone.”
‘With enough public push, we can limit the damage’
The proposed spending cuts are part of a Republican budget resolution to decrease the federal deficit by $4.5 trillion through 2034.
President Donald Trump has said he supports the resolution as part of an agenda to rein in what he calls wasteful spending, but critics of the cuts, including Gallego, emphasize that some of the savings from slashing Medicaid would go to tax breaks for the wealthiest Americans.
“It’s a very narrow majority in the House and a very narrow majority in the Senate, and I think that with enough public push, we can limit the damage that they could potentially do to Arizona’s families,” Gallego said.
“Right now, it looks like this is first going to go through the House of Representatives; it’s been made very clear that they are going to go with a House approach. That budget resolution says they are going to cut $880 billion, and the only way they can really cut is from Medicaid.”
House Republicans took a first step toward cutting Medicaid last week when they passed a budget resolution that does not specifically mention Medicaid but is considered by many as a blueprint for making drastic cuts to the federal program over the next nine years.
‘It will increase human suffering, homelessness’
While many elected officials look at potential Medicaid cuts from an economic standpoint, an enormous potential human cost needs to be considered, including job loss, unpaid medical bills and untreated illnesses, Kathy Busby of the Arizona Nurses Association told Gallego.
“You probably will have even less access to specialists in particular who diagnose things like Alzheimer’s, dementia. You have populations with issues like mental health problems that will not be treated or diagnosed,” Busby said. “It will increase human suffering, homelessness. It just kind of ripples out through the communities, particularly in vulnerable communities and rural areas.”
Busby was among a range of Arizona community health-care leaders, including Garrick Taylor of the Arizona Association of Health Plans, Brian Hummel of the American Cancer Society and Candy Espino, president and CEO of the Arizona Council of Human Service Providers, who told Gallego about multiple bleak scenarios that drastic cuts to Medicaid could cause for Arizonans and Arizona health-care providers.
She cited the likelihood of untreated mental illness and untreated substance use disorders.
“It’s kind of like, do you want to pay now or do you want to pay later? Because we will see an increase in homelessness. We will see an increase in emergency room visits and a huge increase in folks going to jails,” Espino said.
A rise in uncompensated care results in ‘cost shifting’ to others
Taylor said when medical debt rises, hospitals and other providers see higher costs for uncompensated care, which means they have “got to make up that fiscal hole somehow,” which results in higher health insurance premiums for people with private insurance.
“That drives up premium costs to commercial insurers, and commercial insurers then raise their rates with employers and their employees,” he said. “If anything, it creates what you might refer to as a hidden health care tax, economywide. That creates a drag on the overall economy.”
Federal Medicaid cuts would end up shifting costs to the state, Taylor predicted.
“Whether you are a state that has a Democrat governor or a Republican governor, they are going to be in a real pinch,” Taylor said. “Forty-one states in this country made the decision to expand their Medicaid eligibility, which comes with a higher federal match. If that goes away, it creates all sorts of effects economywide.”
If Republicans were concerned about people taking advantage of Medicaid benefits, Taylor reminded Gallego that Arizona was about to submit a proposal to the federal government to add work requirements for “able-bodied” people as an AHCCCS eligibility requirement.
Jessica Yanow, president and CEO of the Arizona Alliance for Community Health Centers, said if people were healthy, they could get and retain jobs. One of the biggest problems with Medicaid cuts is that the reduced funding could hinder important access to preventive care, she said.
“What that means is that people either go without care, or they wait until circumstances are dire and then they seek more expensive care at hospital emergency rooms,” she told Gallego. “It really is shifting costs. People are still going to need the care, and by the time they get it, it’s going to be a lot more expensive. To us, it makes a lot more sense that we would invest in primary care.”
Medicaid expansion, passed by a GOP Arizona governor, is now a target
One of the potential targets of federal Medicaid cuts is Medicaid expansion populations. States get a 90% federal match rate for their adult Medicaid expansion population. Arizona has a law that if funding for its adult Medicaid expansion population drops below a federal match rate of 80%, the program goes away.
The adult Medicaid expansion population in Arizona is 70,866 people. An additional population of 448,592 childless adults would be affected if the funding match drops below 80%.
Former Republican Arizona Gov. Jan Brewer fought members of her own party in 2013 when she was governor and decided to expand Medicaid under the Affordable Care Act, a measure that included raising income limits for adults on AHCCCS and a hospital assessment that restored eligibility to childless adults.
Medicaid expansion allowed more people to qualify for the government-funded program by expanding the qualifications to those earning up to 138% of the federal poverty level, or what now amounts to $21,597 per year in income for an individual.
Brewer said at the time that she was a “deficit hawk” but that federal money was needed to protect rural and safety-net hospitals from being pushed to the brink by caring for uninsured people, CQ HealthBeat reported on Jan. 15, 2013.
“With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the state budget,” the publication quoted Brewer as saying.
What to know:What is Medicaid and how does it work in Arizona?
Reach health-care reporter Stephanie Innes at Stephanie.Innes@gannett.com or follow her on X, formerly Twitter: @stephanieinnes.
