OPEN LETTER

Arizona Legislators
1700 West Washington
Phoenix, AZ 85007

RE: March 26th letter from Randy Pullen

Dear Legislators:

We disagree with the analysis in Mr. Pullen’s letter defending Gov. Brewer’s decision to push hard for expanding Medicaid. Continue reading “AAPS responds to GOP support for Medicaid Expansion”

March 18, 2013 (GLOBE NEWSWIRE) — The following statement was issued by the Arizona State Chapter of the Association of American Physicians and Surgeons:

“Arizona’s Governor Jan Brewer, like some other Republican governors who say they oppose ObamaCare, is pushing for implementation of a key feature of the Affordable Care Act: an expansion of Medicaid.

“The media campaign features the standard formula of presenting hard-luck stories. An upstanding, hard-working citizen has, through no fault of her own, a serious illness, and has lost her insurance, right in the middle of treatment. The only answer: Enroll her in AHCCCS (pronounced ‘access,’ the Arizona Health Care Cost Containment System, the Arizona 100-percent managed care Medicaid system).

“We should be asking a couple of questions. First, will she get the treatment she needs from AHCCCS? Answer: not necessarily. She might not be able to find a doctor, or the system might not approve the treatment-or approve it soon enough.

“Second: what will happen if her income rises above the threshold of 133% of the federal poverty level? Answer: she will become ineligible for AHCCCS, possibly right in the middle of treatment.

“While ‘job lock’ ties people to a job because they fear losing health insurance, Medicaid is a poverty trap that locks people out of getting a job.

“A spokesman for Gov Brewer claimed that, according to the New England Journal of Medicine, a previous expansion of Medicaid saved lives. This study looked at death rates from all causes before and after expansion in three states (New York, Maine, and Arizona). Only in New York did a decline reach statistical significance. Less than 15%
of the study population was on Medicaid, and Medicaid may have had nothing to do with the slight decline in mortality rate.

“The federal government promises to cover added costs, at least at first. Gov. Brewer proposes a ‘circuit breaker’ if funds are not available. If the federal government allows this, what happens to the program’s new dependents?

“The governor didn’t mention that the state might be able to seize the amount paid into AHCCCS on a person’s behalf after age 55 from his estate, even if no actual services were received. For older patients, AHCCCS enrollment is a loan.

“Only one effect is certain: some $2 billion would flow into the coffers of program contractors-managed care plans-and maybe 25% would trickle down to hospitals.”

The Association of American Physicians and Surgeons (AAPS) , which was founded in 1943, is a national organization representing physicians in all specialties.

AAPS is opposed to the Affordable Care Act (ACA) because it is an unconstitutional program that forces citizens to pay money to private entities, ostensibly for a public purpose, and to support programs to which they have a moral objection, or else pay an extra “tax.”

ACA will drive up the cost of insurance and medical care; reduce the availability of care, intrude into the patient-physician relationship, and damage the economy.

States could prevent the implementation of ACA by declining to set up Exchanges or to expand Medicaid. We are disappointed that Gov Brewer, despite her expressed opposition to ACA, now supports a Medicaid expansion, and respectfully ask her to reconsider.

Instead, Governor Brewer and Arizona legislators should consider innovative and proven solutions that empower patients instead of bureaucrats and cut waste such as the Volunteer Physician Health Care Act under consideration in New Jersey.  This act is based on a real life charity care clinic where the cost per patient visit is $13 compared to $160 at a federally funded facility.

It’s like a game of Prisoner’s Dilemma: If all (or enough) states “cooperate,” meaningful reforms could be achieved. However, if too many “defect,” those who remain true to their principles will be disadvantaged (i.e. get less federal money) compared to those who defect.

The Medicaid expansion has been compared to the gift of a baby elephant plus hay for a few years. The Governor believes that if the federal government reneges on promised support, we can undo our decision. That would probably be as hard as shooting an elephant. But we would be dealing with real human beings who are now dependent on the program.

Tax revenues intended to pay for medical care for the poor are instead a cash cow to pad the salaries of administrators, managed-care companies, and hospital executives.

Looking at the 2010 Care1st Health Plan combined statement for Arizona and California, revenue was $651 million, expenses for “healthcare services” were $554 million, taxable income was $24 million, and “selling, general and administrative expenses” were $69 million. While it is not known exactly what is included in “healthcare services,” it is clear that at least $100 million in taxpayer funds went to just one plan for things other than patient care. (AAPS News, January 2013).

Betsey Bayless, the CEO and president of Maricopa Integrated Health System (MIHS) earlier in 2013 received “a hefty $125,000 raise. Her base salary soared 33% overnight, from $375,003 to $500,000 — excluding benefits.” (Seeing RedAZ Blog).

While the Arizona Medical Association has endorsed the expansion of AHCCCS, there is no evidence that the majority of physicians support it or, more importantly, would be willing to provide the promised medical services. Many physicians decline to participate because of:

• Costly, burdensome administrative demands
• Difficulty in getting patients the services they need
• Ever-increasing threats of audits or even prosecution because of errors that are called “waste, fraud, or abuse”
• Payment that does not cover their costs.

Many eligible patients also decline to enroll, but may be forced to do so to avoid the mandate/penalty/“tax.” This may swell the rolls owing to the “woodwork effect.” Some persons may even be enrolled automatically. Reasons for nonenrollment include:

• The burdensome process of enrolling, and repeatedly re-enrolling
• The difficulty in finding a doctor
• Covert rationing by managed care of services that are “covered” but not approved
• The estate recovery process that means that enrollees age 55 or older are receiving a collateralized loan that can be recovered from their assets after death

Materials supplied by AHCCCS make it plain that the estate may have to pay back the total provided to the AHCCCS program contractor even if that is much greater than the value of any services that were received. This is comparable to a 100% “death tax” on the middle class and poor with no threshold.

Questions that legislators need to answer include:

• While many Arizona hospitals may need funds, hospitals receive only about 25 % of the funds that go to AHCCCS. Why not fund hospitals directly, without AHCCCS overhead?
• The AHCCCS expansion is claimed to create jobs. What jobs? And how many jobs will be lost from taxes, crowding out private insurance, loss of facilities owing to AHCCCS regulatory costs and poor payment, and so on? Is the model for predicting jobs different from the one that inaccurately predicted that ARRA (the “stimulus”) would bring unemployment below 6%?
• Is the bed tax a tax or not? How can it be a “tax” to meet requirements for attracting federal dollars, and “not a tax” for meeting requirements for raising taxes? If it is argued that hospitals aren’t really paying the tax because more dollars come back from Washington than are sent, how does this dollar multiplier work despite the administrative losses? And do the same people get the revenue as paid the tax? If hospitals don’t pass along the tax to patients, where does the money to pay it come from?
• Should the State of Arizona engage in systems gaming and word play to extract more dollars from federal taxpayers? Is this a form of fraud? Aren’t accounting gimmicks like the bed tax likely to be prohibited in the future?
• If the State of Arizona supports the principle of systems gaming to get more tax dollars back than it puts in, it can hardly complain if other states beat us at the game. How can we be sure that we will stay ahead and be a tax recipient rather than tax donor, especially given this Administration’s history of actions damaging to Arizona? Why should we send any optional taxes, on the gamble of getting a bigger return?
• People who earn a little too much lose their Medicaid benefits, the equivalent of a greater than 100% marginal tax rate. How does this affect work incentive and tax compliance?

Dear Arizona AAPS members and friends,

Please read this important message from our friends at Americans for Prosperity about what you can do today to help STOP the planned Medicaid expansion in our state.

~AAPS

ACTION ALERT

To all Arizona Taxpayers and Health Care Consumers:

Gov. Jan Brewer and powerful lobbyists are pushing Arizona to impose statewide taxes, including a hospital bed tax, to fund an expansion of Medicaid (AHCCCS) under ObamaCare. It is vitally important for Arizona to stop the proposed Medicaid expansion, because the human and fiscal costs of that expansion would be enormous.

The most important issue in the Medicaid expansion is the human cost.  If Arizona were to expand Medicaid, it would railroad 250,000 Arizonans into a low-quality, government-managed health insurance system. Medicaid patients not only have worse medical outcomes than patients other low-income people without insurance — even when they had the same medical conditions.

But here is another crucial issue: The proponents of the expansion are trying to do an end-run around Prop 108, the most important taxpayer protection in the Arizona Constitution. Under Prop 108, it is supposed to take a two-thirds majority of the Legislature to raise taxes. But Medicaid expansion proponents want to allow unelected bureaucrats at AHCCCS to raise state taxes (mainly hospital bed taxes) by $369 million over the next three years — without a two-thirds vote of the Legislature!  If the Legislature delegates to bureaucrats the authority to impose gigantic taxes on hospital patients, Prop 108 will be a dead letter and will no longer protect Arizona taxpayers.

Gov. Brewer told Arizonans to “do the math” on the Medicaid expansion. With all due respect, she should do the same. According to Brewer’s projections,the Arizona Medicaid expansion would cause the federal government to spend $3.6 billion over the next three years alone. The people who will pay those taxes include most of the people of Arizona and — thanks to the federal debt — our children and grandchildren. 

TAKE ACTION!

Please send a quick email note to Gov. Brewer, asking to reconsider her support for the ObamaCare Medicaid expansion. She changed her mind on the ObamaCare insurance exchange, so we know that she can do the right thing — but we must confront her with the evidence against the Medicaid expansion. 

REGISTER FOR THE DEBATE!

Please register now for AFP-Arizona’s debate on the ObamaCare Medicaid expansion, which will take place from 11:30 am to 1:30 pm on Thursday, February 21 at the Goldwater Institute. At the event, Michael Cannon of the Cato Institute, Goldwater Institute health care policy analyst Christina Corieri, and Phoenix surgeon Jeff Singer will take on any three pro-expansion advocates who want to debate these issues publicly. We have extended the invitation to debate to Brewer adviser Chuck Coughlin, AHCCCS director Tom Betlach and members of the hospital and insurance lobbies. All concerned citizens who wish to attend the debate should RSVP to Shane Wikfors at swikfors@afphq.org

LEARN MORE!

For more about the problems with the proposed Medicaid expansion, read our line-by-line refutation of Gov. Brewer’s pro-expansion arguments in her January 14 speech.

DONATE!

Please help AFP-Arizona fight the battle for economic freedom in Arizona by going to www.aztaxpayers.org  or clicking on the Donate button to the right.  A contribution of $10, $25, $50, or $100 would be a huge boost to our efforts, and would enable us to mobilize more activists and put more pressure on elected officials.  Every little bit counts, and we can’t do what we do without great people like you standing with us.  Thank you for your support, financial and otherwise!  Let’s make 2013 a great year for free enterprise in Arizona!

For Liberty, Tom

Tom Jenney

Arizona Director

Americans for Prosperity

www.aztaxpayers.org

If you missed the 8/22 town hall with Dr. Vliet and Senator Antenori, please come:

Sept 1, 12:30-2:30 pm, Coco’s Restaurant, 6095 E. Broadway Blvd

Senator Frank Antenori and Dr. Elizabeth Lee Vliet, M.D.

The recent U.S. Supreme Court rulings on Obamacare will have a significant impact on the financial and economic health of AZ. Obamacare affects your medical care and choice of treatment options, prescription medicine, your medical privacy, and the personal relationship you currently enjoy with your doctor.

To many the Supreme Court ruling is complex and confusing. To help clarify the rulings and their impact on the State of Arizona and your family please join Senator Antenori and Doctor Vliet.

You are invited!

Please join

ObamaCare Exchanges Undermine Liberty  5 ratings 34 views

This email is paid for by AAPS and is not approved by any candidate or political committee.

ACTION ALERT

Arizona talked the talk by becoming a plaintiff in NFIB v. Sebelius, just decided by the U.S. Supreme Court. It’s now time to walk the walk. All Arizona elected officials swore an oath to uphold the U.S. Constitution. Therefore, it is their duty not to implement an unconstitutional law. The U.S. Supreme Court cannot re-write the law or the Constitution. It can simply render an opinion, restricted to the issues presented. Arizona legislators do not fulfill their Oath by hiding behind this opinion.

States have the power to block ObamaCare by refusing to implement the exchanges or the Medicaid expansion. They are under pressure to implement these things, primarily by lobbyists of the insurance cartel and big hospital chains, for which Medicaid is a big cash cow. Exchanges are a tool to drive small insurers out of business.

We need your help to overcome the pressure by special interest groups.

Below is a list of Arizona Senators who have not signed the Arizona Health Care Freedom Pledge and need to be called, in estimated order of likelihood of convertibility. We have 11 signers and need at least 16 (five more) in order to prevent the Senate from approving the exchange in a special session this summer or fall.

Please call them. Tell them you are a physician who is very concerned about the impact of ObamaCare on the cost and availability of care in Arizona.  Ask them to sign the Arizona Health Care Freedom Pledge.

Here are some suggestions:

Doctor: I’m concerned about the Brewer Administration’s efforts to set up a state health insurance exchange under ObamaCare. I wanted to ask you some questions about that…

Doctor: People in the insurance industry (including otherwise strong conservatives, such as Constantin Querard) are telling conservative legislators that Arizona will have more “control” over its health care market if we set up our own state exchange. Do you really believe that?

Follow-Up: All exchanges will have to follow federal rules. Just as AHCCCS must. We have almost no state control in the federal-state Medicaid “partnership,” and ObamaCare will be worse. Under ObamaCare, we will have the HHS mandates PLUS anything that local lobbyists, including disease group lobbyists/advocates, will push on the Arizona exchange. Arizona already has some of the heaviest mandates on private insurance of any state in the country.

Doctor: Did you know that President Obama’s health care system, as enacted, is dependent upon the creation of state exchanges for the distribution of federal subsidies? Because of the flaw in the drafting of the legislation, federal subsidies cannot flow through federally established exchanges. Further, employer fines under ObamaCare are only for employees who get federal subsidies (through a state exchange). So…

No Arizona exchange = No federal subsidies = No employer penalties/fines We can avoid job-killing employer penalties by not establishing an exchange.

Doctor: Are you concerned that ObamaCare may become much harder to repeal if Arizonans are allowed to become addicted to federal subsidies?

Doctor: Do you know how much the exchange will cost Arizona families and businesses in new taxes or fees if Arizona sets up its own exchange? The Massachusetts exchange under RomneyCare is costing tens of millions of dollars a year. Jan Brewer’s insurance czar, Don Hughes, can’t even tell us how much this is going to cost us. (Probably tens of millions of dollars per year, after 2015.)

Doctor: Do you know when Governor Brewer is planning to try to get legislative approval for the exchange? Some of the folks in our coalition think she could try to push it through in a special session after the August 28 primary, but before October 1, so that she can give federal HHS a 90-day period to approve the Arizona exchange before the January deadline.

Doctor: If RomneyCare is a guide, the exchange system and the new mandates will cause insurance premiums to skyrocket. This is going to be a disaster. Do you really want YOUR fingerprints on the thing? Why not let the Federal Government take the blame for the disaster?

Doctor: Would you consider OPPOSING any bill, regulation, legislation, or executive action–including the exchange–that implements President Obama’s health care legislation, including bills that create new bureaucracies that must be funded by new surcharges, fees, or taxes of any kind.

THE CLOSER: Thank you! Would you be willing to sign the Health Care Freedom Pledge at www.ArizonaHealthCareFreedom.com ? May I ask the organizers of the Pledge to give your office a call to collect the signature?

Yes, that’s the Pledge promoted by the Arizona chapter of Americans for Prosperity. Tom Jenney says you’re doing a fine job down there… AFP is offering to add points to its scorecard for any Legislators who sign the Pledge before the start of a special session on the exchange. Legislators can make arrangements to deliver the pledge by contacting tjenney@afphq.org or (602) 478-0146.