PHOENIX -- A bill that would have forced able-bodied Medicaid recipients to get a job and would have limited some to a maximum of five years of insurance was vetoed Tuesday by Gov. Jan Brewer.
Brewer said in a veto letter that the five-year cap could have meant throwing more than 210,000 adults off the state's Medicaid program, and an additional 253,000 children as soon as they reached their 18th birthday.
Brewer said her Medicaid expansion plan passed last year was designed to address uncompensated care that was forcing hospitals to pass on hundreds of millions of dollars' worth of costs on to Arizona families and businesses through higher rates.
House Bill 2367 by House Speaker Andy Tobin, R-Paulden, would have required the state's Medicaid program to apply for a waiver from federal regulators every year to allow it to impose the new rules. Federal officials said after final approval by the Legislature last week that they likely would not approve the waivers. Tobin has said he believes Medicaid's position could change.
Tobin's bill also imposed copays on unneeded ambulance and emergency room use. He said they're needed to protect the state from excess expenses. Democrats argue they would limit the effectiveness of the health system for poor Arizonans.
Tobin said he had never received a rejection message from Brewer's office, but knows state agency directors don't like the kind of requirements the bill would have imposed. And while Republican governors like Brewer would be more likely to make such requests on their own, he believes Democrats would not and a law needs to be in place to force that.
"I'd hate to see Arizona stuck in the budget crisis we just left" because of soaring Medicaid costs, Tobin said.
The bill passed both the Senate and the House on party-line votes, with majority Republicans in support and Democrats opposed.
As originally introduced in February, the bill would have a hard limit of five years for anyone getting Medicaid. After an outcry from Democrats over its effect on the working poor, Tobin changed that provision so it would only affect people who are able-bodied and don't work. He also added exemptions for pregnant women, those on disability and those caring for young children.
Tobin said the federal opposition could change and the requirements give the state tools to cut enrollment if the government fails to fund the program as promised.
Tobin's proposal also included a requirement for a copay for unnecessary visits to hospital emergency rooms or ambulance use. The federal government had been allowing Arizona to charge $30 copays for unnecessary emergency room visits, but that expired Dec. 31. Arizona is now asking federal officials for authority to charge $200 for such visits for newly eligible people on the state's Medicaid plan, called the Arizona Health Care Cost Containment System, or AHCCCS.
Democrats accused Tobin of trying to limit the reach of the program for political reasons. He is running for Congress in Arizona's 1st District.
An analysis of the bill's impact by the Legislature's budget analysts estimated that 141,000 current Medicaid recipients would lose coverage under Tobin's lifetime limit. That could save the state nearly $150 million a year. Only about half of the 440,000 able-bodied adults now getting insurance meet the work requirement. A total of more than 1.4 million Arizonans were enrolled in the state's health insurance plan for the poor as of April 1.