Take Action & Make A Difference

Human side of Arizona debate over Medicaid

April 9, 2013
The Republic | azcentral.com
Mary K. Reinhart

John Froneberger has been without medication to treat his depression and high blood pressure since last fall, when a cost-of-living increase in his disability benefit, to $970 a month, put him just above the poverty level and cost him his health insurance.

Froneberger’s monthly disability check helps pay for rent and food, but, as with hundreds of other Arizonans, it disqualifies him from the Arizona Health Care Cost Containment System, the state’s Medicaid program.

“I was barely making it as it was,” he said during a recent interview. “I lost a psychiatrist. I lost all of my health care.”

Ryan Ragan struggled for years with severe pain from a digestive disorder that led to panic attacks and an addiction to pain medication. He figures he made at least two dozen trips to hospital emergency rooms because he didn’t have health insurance, but he eventually qualified for AHCCCS before lawmakers froze a program that covered childless adults like him.

“I never thought I would be better,” said Ragan, who has been taking anti-anxiety medication and is now a health instructor at the Mesa Marc Center, which he began attending under AHCCCS to improve his health. “If I hadn’t come here, there’s no way mentally or physically I would be where I am.”

But AHCCCS denied Ragan’s renewal application, and he lost coverage last week, temporarily throwing him back among the uninsured before the Marc Center, which serves the mentally ill, offered to increase his hours so he’ll be able to qualify for benefits.

Ragan was lucky, but Froneberger and thousands of other uninsured Arizonans with serious mental illnesses are still waiting to see whether they will gain health-insurance coverage under Gov. Jan Brewer’s proposal to broaden Medicaid eligibility through federal health reform.

But that’s not a sure thing. A number of key Republican legislators are lining up against Brewer’s plan, which would bring $1.6 billion in federal funding by fiscal 2015. The money would cover roughly 350,000 uninsured Arizonans and maintain health care for about 50,000 childless adults who would otherwise be dropped when a waiver expires Dec. 31.

The infusion of federal funding would ease the cuts that Arizonans with serious mental illness have weathered over the past few years. About 12,000 people lost $50 million worth of services when Brewer and lawmakers made budget-balancing reductions in 2010, and an estimated 5,000 people with serious mental illness lost coverage when AHCCCS coverage for childless adults was frozen in 2011, according to state data.

Brewer and legislators restored some of the funding last year, providing additional housing, counseling and other services for people with serious mental illnesses who earn too much to qualify for AHCCCS. People diagnosed with serious mental illnesses, regardless of income, also qualify for medication and crisis services.

The governor continues her high-profile push for Medicaid expansion, joining area hospital and business leaders Tuesday in Lake Havasu City and holding a state Capitol news conference on Thursday to publicize the impact it would have on Arizonans with mental illness.

Mental-health experts say expanding Medicaid to insure more people with chronic mental illness is both cost-effective and humane because it keeps people healthy rather than treating them in emergency rooms and jails.

“We are already paying for the health care for this population. We’re paying for it in our jails, in our prisons,” said Dr. Daniel Derksen, professor of public health policy at the University of Arizona’s Mel and Enid Zuckerman College of Public Health. “We’ve already proven that the most expensive method is to do nothing.”

But opponents of expanding the state-federal health-care program for the poor and disabled, including Republican legislative leaders, say it simply goes too far, beefing up an already unaffordable, unsustainable government entitlement program that goes against GOP principles and discourages people from taking responsibility for their own health care.

There’s room in the state budget to help people with chronic conditions, including mental illness, without providing insurance to cover every ailment for hundreds of thousands more people, said House Appropriations Committee Chairman John Kavanagh, R-Fountain Hills.

“We need a system that focuses on providing a safety net for people like this instead of a hammock for everybody,” Kavanagh said. “We’re committed to giving coverage to people who have serious mental illnesses. To suggest that we’re abandoning them by not taking care of everybody for everything is not fair.”

Brewer’s office estimates that 2,000 seriously mentally ill Arizonans will lose health coverage when a program that covers childless adults expires Dec. 31. But Kavanagh and other expansion opponents say federal health officials have not yet been asked whether Arizona could continue the program that voters first approved in 2000 as Proposition 204, which broadened AHCCCS eligibility to everyone earning below the federal poverty level, or about $11,200 a year.

Under Medicaid expansion, eligibility would increase to 133 percent of the poverty level, or slightly less than $15,000 a year. Federal funding would cover up to 90 percent of the newly insured, but Brewer’s proposal includes a “circuit breaker” that eliminates coverage if federal reimbursement falls below 80 percent.

About 150,000 Arizonans have lost health coverage since Brewer and lawmakers capped the childless-adult program in July 2011.

Those cuts, in addition to the 2010 budget reductions to the non-Medicaid seriously mentally ill, have taken a toll on public safety, according to county law-enforcement officials. Though data are lacking, those in the field say growing numbers of people with mental illness showed up in emergency rooms, psychiatric hospitals and jails.

Fourteen of Arizona’s 15 county sheriffs — all but Maricopa County Sheriff Joe Arpaio — have signed on in support of Brewer’s expansion plan, as has GOP Yavapai County Attorney Sheila Polk.

Polk testified in favor of expansion before Kavanagh’s committee last month and earlier sent a letter to Brewer saying that people with untreated mental illness are winding up in county jails, putting additional stress on jails and law-enforcement units, in addition to not getting the care they need.

“Formerly stable people with mild to moderate mental-health disorders are taxing the resources of deputies, often unnecessarily. We cannot lose sight of the connection between access to health care and public safety,” Polk wrote. “The expansion will protect our rural communities by creating a safety net around our vulnerable mental-health population through increased care.”

But Kavanagh said he questioned “their ability to do math and accounting” if they’re backing expansion because of the coverage it would provide to a relatively small portion of the population.

“They should be lobbying us for money,” Kavanagh said. “If they need more, let us know. Don’t make us buy the car to get the radio.”

Kavanagh and other expansion opponents also argue that the state will be unable to cope with a flood of new AHCCCS members, and they believe that health officials have underestimated the number who will be eligible, as they did with Prop. 204.

For people with chronic conditions, such as a serious mental illness, Derksen said regular health care is critical. “You want to remove the obstacles ... so you don’t have collateral damage; people off their meds becoming psychotic, injuring other people or themselves.”

In addition to medication, counseling and other treatment, AHCCCS coverage for people with serious mental illness brings other benefits, not the least of which is case management and the opportunity to interact with people on a day-to-day basis at peer-run support centers and other facilities that offer job training, exercise equipment, transportation and regular outings, as well as food and clothing banks.

When Froneberger went missing for several days from the Mesa-based Marc Center’s drop-in facility in the West Valley, where they’re used to seeing him on a regular basis, manager Jennifer Brown went to his apartment.

“He’s a huge part of our little family here,” Brown said. “And when he’s not here, it’s definitely noticed.”

Froneberger, a University of Texas graduate and former prep-school teacher, deals with chronic depression as well as a host of medical ills, including high blood pressure and diabetes. He said the current state of health care in Arizona is built on a “false economy” reliant upon hospital ERs and charity care from providers. Froneberger enjoys the companionship at the Marc Center and couldn’t say exactly why he stops coming from time to time. “I don’t want to isolate,” he said. “But it’s easy.”

<- Go Back