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Whatever 'Obamacare' result, Arizona wise to take federal funds

April 22, 2013

Arizona has come to a critical point of decision regarding health care and the federal government’s deepening occupation of that field. In choosing Arizona’s course, state policymakers must weigh all the circumstances -- many beyond their control  --  and factor a great deal of additional uncertainty into the calculus. Those kinds of decisions are never much fun to make.

Like Governor Jan Brewer, I have opposed President Obama’s federal takeover of health care. I see little reason to expect this will lead to good outcomes for the American people. It’s a complex subject, but here’s the short of it: for the sake of getting health care to the indigent and reducing costs, we will in stages collectivize medical science and human health. Neither history nor human nature nor the present sickly state of American politics suggests this is wise. In fact it may be insane.  

So I applauded Gov Brewer when Arizona joined the other states in the lawsuit against Obamacare.  And because the state was broke, it was also necessary to freeze Arizona Health Care Cost Containment System (AHCCCS) enrollment for childless adults during the economic slowdown. In making health care policy choices for Arizona, she has generally charted the right course. 

Now as Arizona decides the future of its Medicaid program, given the circumstances and uncertainty facing us, the Governor has again made the right decision.  

In the 1990s, facing my own era of federal intrusion which even then was leading us toward the present takeover, I took several actions in light of federal policy realities which were necessary for the good of our state. Then as now, we had a state economy to grow, a health care industry to support and citizens to care for, indigent and otherwise. The fact that I saw foolishness and future problems in the federal policy did not allow me to ignore it. The song may have been ugly, but I couldn’t turn it off. I couldn’t change the channel when Washington had the remote.  

Neither can Gov. Brewer, and less so when she leads a state which has since voted   -- twice  --  in support of expanded AHCCCS coverage. 

The federal government is running massive deficits, carrying a debt in excess of $16 trillion and operating unsustainable entitlement programs whose finances would embarrass a compulsive gambler.  Arizona and Gov Brewer can lament these policies and dread their eventual consequences, but can change none of it. That same outpost of inspired statesmanship and policy genius is also offering our state a multi-billion dollar share of its continuing spending if we will spend a small fraction of that amount on doing what Arizona voters have said they favor.  Arizona would do well to accept the offer, and strive to operate AHCCCS with continued efficiency and excellence, which may ultimately be part of a legitimate solution to the present crisis.

Some now attack Gov Brewer for changing her position or setting her “price” for acquiescence in Obamacare. They are wrong. This is not an academic exercise. It is not a seminar in philosophy or an idle drama of the editorial board room. The federal government has gradually led health care delivery across the United States into a crisis of artificial costs and uncompensated care, and now it has moved precipitously toward collectivizing the entire sector. A decision of the US Supreme Court and a presidential election have in sequence failed to arrest that course.  A governor must see these facts as they are -- not as she wishes they were.  And she must act to protect her state against the range of bad outcomes which might be coming.

As of now no one knows what the outcome of Obamacare is going to be. The entire thing may well fail. If it does, Arizona will be better off for having accepted the federal funding in the meanwhile. We have already demonstrated that we can draw down AHCCCS rolls if necessary, and if necessary we will do so again, as the governor has insisted. The federal finances are what they are, and will be what they will be, whether Arizona draws these funds or not.  The Legislature should follow the governor’s lead.

J. Fife Symington III
19th Governor of the State of Arizona

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