Arizona’s Medicaid expansion plan, which former Gov. Jan Brewer signed into law in 2013, continues to reduce the cost of uncompensated care for health providers in the state, especially those in rural areas, said State Rep. Heather Carter (R-15).
Carter serves as chairwoman of the House Health Committee. She joined a room full of health care administrators Monday for a conversation on the importance of Arizona’s Medicaid system, hosted by the Modern Medicaid Alliance and the Greater Phoenix Chamber.
“When you talk about it from an economic standpoint, of the economic engine that the health providers play in those rural communities, this is a game-changer,” Carter said. “It wasn’t all rosy in the urban areas, either. Our urban systems were experiencing incredible amounts of uncompensated care prior to making this decision, but if you look at it holistically across the state, Medicaid is a game-changer.”
Uncompensated care refers to medical services and treatment provided to individuals who do not have health insurance but cannot afford to pay their medical bills out of pocket. Often, this is the result of rising medical costs combined with a lack of access to affordable health insurance.
The state Medicaid program is called Arizona Health Care Cost Containment System (AHCCCS) and was founded in 1981. AHCCCS provides health insurance to low-income adults, families and children and helps hospitals and medical facilities recoup the cost of uncompensated care.
In July 2011, partly in response to budgetary issues related to the economic recession, Brewer announced a plan to freeze Medicaid enrollment for childless adults; enrollment was restored with the 2013 expansion. From 2013 to 2016, almost half a million more people obtained Medicaid coverage, reducing the number of uninsured by 33 percent.
From 2011 to 2013, Arizona hospitals saw the cost of uncompensated care rise from $500 million to $900 million. After Brewer’s plan was signed into law those costs dropped significantly, and by 2015 uncompensated care was lower than 2011 levels.
“At the height of the phase we were at about 8 percent; we’re down below right about 3 percent at this point,” said Jennifer Carusetta, executive director of the Health System Alliance of Arizona. “What that means for Arizona is, it gives us as medical providers the ability to really participate in some incredible innovation that’s being spearheaded through our AHCCCS program.”
Because AHCCCS is the largest medical payer in the state, they have the power to leverage that impact to create positive change in the health care industry, Carusetta said.
“We’re talking a lot about social determinants of care — how we can partner with one another across the continuum between the acute care, behavioral health and social services sectors,” Carusetta said. “We talk about how we can really wrap around the patient and get them healthier, get them to work, help them build their way out of poverty. That is possible because we have a payer source for patients, and it relieves a lot of pressure on us as providers, whereas if we did not have that support in place we’d just be trying to keep our doors open.”
The ability to work is an important thing to keep in mind when considering the factors that make Medicaid coverage necessary for Arizona residents, said Brian Hummell, director of government relations at the American Cancer Society in Arizona.
“It’s important to note that many of these people work,” Hummell said. “I think that’s probably the most misunderstood piece of the puzzle.”
Hummell described a woman in Tucson who was working full-time when she was diagnosed with cancer. She gained coverage under Medicaid and was able to go back to work part-time after her treatment was completed, he said.
“That was her lifeline; that’s how she survived,” Hummell said. “AHCCCS really is a safety net… It’s not fancy, but it gets the job done. And the people that are recipients of the benefits by and large are the people that we want to make sure do get help.”
The vast majority of people using AHCCCS want to be productive members of society and are simply down on their luck, Hummell said.
Arizona has a healthy economy, and rural health is critical to the state’s success, Carter said.
“In our rural communities, our health care providers are sometimes the largest employer,” Carter said. “They not only are providing quality care to the citizens that live in those rural areas, but they’re employing many of the people that live in those areas as well.”
A federal rollback of the Medicaid system or cutbacks to AHCCCS could create serious challenges for Arizona residents, she said.
For Carter, the solution is to get reliable information out to constituents and health care providers alike. Integrated health care — the consolidation of behavioral health and acute care — is a huge undertaking but is the key to innovation, she said.
“There’s a steep learning curve in our rural communities to make sure that we are doing everything we can to support them and make sure that all the innovations are being rolled out in a thoughtful, strategic way,” Carter said.