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Medicaid-expansion math makes sense

February 28, 2013

From the Arizona Republic

By Editorial board
The Republic | Thu Feb 28, 2013

Gov. Jan Brewer’s plea is simple: Just do the math.
If you can get beyond politics and labels, the math is convincing. Arizona would be foolish not to expand the Arizona Health Care Cost Containment System to cover childless adults up to 133 percent of the federal poverty level.
Admittedly, getting beyond politics can be difficult. Influential voices on the right — from the National Journal and the Wall Street Journal editorial pages to the Goldwater Institute and Arizona arm of Americans for Prosperity — have slammed Brewer for seeking to expand the state’s Medicaid program under the Affordable Care Act. Legislative Republicans pay attention to such critics.
But there is a significant difference worth remembering. It’s easy for editorial writers in New York to be philosophically pure when they bear no responsibility for the consequences, but the governor and lawmakers of Arizona are accountable to the people who elected them. They must balance purity with pragmatism.
That’s what Brewer did, and she came to the inescapable conclusion that taking the federal offer was the best deal for Arizonans. It is, in several ways:
It saves the state money.
State and local government spends $350 million annually on health care for low-income childless adults, which brings $700 million in federal spending.
If the state takes the federal deal, it would replace public funds with a $230 million assessment on health providers. That would attract more than $2 billion in federal funds annually.
Arizona would spend less and get more from the feds.
Foes say the federal government can’t afford this largess. But that’s an argument to be made in Congress, as it was before the Affordable Care Act was passed.
They lost that battle. The act was passed and upheld by the Supreme Court. It is the reality Brewer must deal with — as the governor of Arizona, not of the United States.
She’s in the same position as the shopper offered a tremendous deal by her favorite retailer. You don’t ask if the retailer can afford it; you weigh if you want the item at that price.
For Arizona, helping keep low-income adults healthy for a minimal state outlay is the right thing to do.
It saves jobs and boosts the economy.
After the state froze enrollment for low-income childless adults in July 2010, more than 120,000 people lost health coverage. Hospitals report up to a quadrupling of uncompensated care costs.
They can shift only so much onto their paying customers. If uncompensated care continues to rise, hospitals will have to lay off nurses and technicians.
In contrast, taking the federal match and putting 200,000 more Arizonans on health insurance should save or create 21,000 jobs, according to the Grand Canyon Institute. The group says the economy would grow by an additional 1 percent.
That’s the math. But if you want to turn back to political philosophy, there’s this:
Arizonans have consistently voted to expand Medicaid coverage, including for childless adults.
For understandable reasons, the Legislature set aside the people’s wishes during the economic downturn. But now, with the economy improving and this enhanced federal match available, lawmakers need to listen to voters, their bosses.
“There is no way you can look at this issue and say this is not the right thing for Arizona at this time,” Brewer has said.
That’s the pragmatic governor of Arizona speaking. She’s right. The Legislature should follow her lead.


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