President Donald Trump says his administration will not cut Medicaid — the health care program for low-income Americans.
But budget experts say it’ll be difficult, if not impossible, to achieve the reduced spending the Republican-led Congress and president want without that.
Arizona is one of a handful of states with a law that automatically rolls back its Medicaid expansion under the Affordable Care Act if federal funding falls below a certain level. The state’s Medicaid program, known as the Arizona Health Care Cost Containment System, or AHCCCS, may also add a work requirement for beneficiaries.
Ann-Marie Alameddin, president and CEO of the Arizona Hospital and Healthcare Association, joined The Show to talk about the state of Medicaid in Arizona.
Conversation highlights
How big of a topic of conversation among people who do what you do are these potential cuts?
ANN-MARIE ALAMEDDIN: This is the topic of conversation. Among health care leaders, among hospitals, federally qualified health centers, doctors, nurses, this is the topic because so much is at stake in terms of what's at risk in terms of Medicaid cuts.
What is actually at risk here? People who rely on Medicaid would lose their coverage. So there's the human cost here. There's also a potential economic cost for hospitals and other providers, right?
ALAMEDDIN: Absolutely. You know, AHCCCS Medicaid in Arizona covers 2 million lives in Arizona. So it's 2 million Arizonans who rely on AHCCCS for health care coverage. We estimate about 750,000 may be at risk for losing their health care coverage. So that has tremendous impacts to those patients who have chronic diseases, who need management, who might be in the middle of cancer treatments. It has just tremendous personal impact to those 750,000 Arizonans.
And I might say, you know, some of these Arizonans might not even know that they're on Medicaid. Because it's it appears like a commercial — they have an insurance card. Like any one of us with employer-sponsored health insurance. So I think it's really important for Arizonans to really look at their card to see: Do they in fact have AHCCCS coverage and might their coverage be at risk of being canceled if these Medicaid cuts go into effect?
How concerned are you about the potential of the ACA Medicaid expansion being rolled back under that state law if the federal funding dips?
ALAMEDDIN: I'm very concerned, because as you indicated in the introduction, it's a trigger law that we have in Arizona that if the federal match rate — which is currently at 90% — if that goes below 80%, the hospitals no longer pay their health provider assessment tax that helps fund this population. And that expansion population could go away.
It's also important to note that voters through an initiative process expanded Medicaid eligibility up to 100% of the federal poverty. So it's really only 100% to 133%, which is Medicaid expansion population in Arizona. So the state, through the initiative process, is still responsible for those who are up to 100% of the federal poverty limit. So, lots of lots at stake, and it is the topic of conversation. And I think we're really coming together to build coalitions to really communicate to Arizonans generally and our policymakers, our Arizona congressional delegation, in terms of what does this look like in Arizona? What does it look like in each congressional district? How will rural communities be disproportionately impacted? So that this is all on the table and transparent in terms of what policymakers decide to do.
Let talk about the geographical disparities here, because in the past when this debate over expansion was happening, we kept hearing about how rural hospitals were potentially needing to close or scale back services because of the amount of uncompensated care they were providing people with no insurance, who would basically use the emergency room as a primary care provider come in and couldn't pay anything. And hospitals still are of course are required to provide that care. Is that still the case here that rural hospitals could potentially have to shut down or scale back certain services?
ALAMEDDIN: Absolutely. Particularly when you look at the communities that in rural Arizona, they are disproportionately, the proportion of Medicaid is higher in those communities. So those hospitals rely upon that payer source of to provide care to those patients that there is a payer via AHCCCS. So that really stabilized the whole health care system in Arizona, particularly in rural communities. And as hospital executives are really modeling these impacts, they're preparing, you know, if these cuts go into an effect, what services might we have to close? What are the number of employees we might have to lay off? So that they're prepared. But of course, we want to get ahead of that, so that does not happen. Because there is certainly so much at stake. But rural hospitals, I think hospitals really all hospitals in the state of Arizona will be detrimentally impacted by this.
I mean, first and foremost, it's the 750,000 patients who no longer have access to health care coverage. And then there's that economic impact that impacts hospitals as enrollment goes down — we saw this during the Great Recession. As enrollment goes down, uncompensated care goes up, and then there's the cost shift to the private employers and to our premiums all going up. So it's a tremendous ripple effect. And with some really dire consequences. Of course, first and foremost, going back to those patients who need coverage so that they can stay healthy. We want people to have the right kind of care at the right time and there's a lot that can't be managed in an emergency department. That's not the proper setting for doing primary care screenings — it's good for emergencies and for trauma. But we want people to have access to their primary care providers and to their specialists that they need to stay healthy.
Well, it seems like kind of a vicious cycle if hospitals are treating more patients, for example, but they're not getting paid for it, they have to lay staff off. That's just fewer providers, fewer nurses, fewer doctors, fewer techs to treat those additional people coming to the hospital who can no longer go to a doctor.
ALAMEDDIN: And I think that's important to note ... as hospitals look to potentially — if these cuts go into effect, if Medicaid is restricted — that hospitals will be looking at service lines. What can we close to make sure that our essential core services remain open? What employees might we need to lay off? Those are decisions that hospitals do not want to make.
I think, you know, we've stabilized since COVID-19. We've expanded healthcare services, and we want to keep along that trajectory to meet the needs of our communities. But these cuts are unsustainable, and hospitals will have to make hard decisions — decisions we don't want to make. And we hope that Arizonans really hear this kind of call to action. To really understand how this might personally affect them, it might affect their family, their friends, their neighbors. You know, it's close to 1 in 4 Arizonans have AHCCCS coverage. So we all know people who will be impacted by this, so that we can, you know, help educate policymakers in terms of what's the right decision.
