Arizona: Where healthcare and immigration intersect

By Tom Sullivan
09:29 AM

Tuesday is presidentail primary day in Arizona, and while the candidates may all be elsewhere, The Grand Canyon State has its share of healthcare logjams.

“In a nutshell, it’s a hot mess here in Arizona – and I don’t mean the temperature,” says Carol Flagg, managing partner of HITECHAnswers.

Or as Tara McCollum Plese, director of government and media relations of the Arizona Association of Community Health Centers put it, “there’s a huge shift from having state and federal funding to putting it all back on the healthcare system.”

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Indeed, last year the state legislature reduced the budget for the Arizona Health Care Cost Containment Systems (AHCCCS) by $500 million, which subsequently meant foregoing nearly $1 billion in Medicaid matches, such that the total hit was $1.5 billion, according to Plese.

And then there are "the 204 people" – as in Proposition 204. That essentially cuts childless adults who previously qualified for Medicaid. “I just got the numbers today," says Plese. Since July, when it was frozen, we’ve seen 90,764 people lose their coverage. We’re at risk of losing 250,000 people who now have coverage.” What’s more, some 128,000 kids are currently on a waiting list to get insurance, since the Kids Care program was frozen last year.

All of which is causing a serious deterioration of the healthcare system in Arizona and putting the burden on health centers that – despite having what Plese describes as “very sophisticated health IT, EHRs and in some instances ePrescribing” – are challenged by several funding reductions amid the onslaught of residents being dropped from Medicaid.

“There’s nowhere for these people to go,” says Plese. “Our community health centers can only take so many patients who don’t pay.” Indeed, the community health centers performed $72 million in uncompensated care last year.

The Grand Canyon state is also facing a pair of contentious bills that threaten to make delivering care even trickier. The proposed Senate Bill 1405 would require hospitals to inquire about the legal status of anyone not carrying health insurance, and Senate Bill 1611 could withhold federal emergency care funding from any hospital that treats illegal immigrants; these despite the law that hospitals have to treat anyone who presents at the emergency department.

Flagg adds that Arizona is also up against Medicaid cuts to balance the budget, as are many other states. And Arizona challenged President Obama’s Patient Protection and Affordable Care Act with Proposition 106, which essentially bars the individual mandate.

“Both are problematic in a border state with higher than average illegal immigration,” Flagg explains.

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Even still, Arizona is pushing ahead with health reform, including standing up a health insurance exchange, among the most controversial aspects of President Obama’s Patient Protection and Affordable Care Act.

“There’s a lot of disdain for the Affordable Care Act but we are moving forward with key measures of health reform while some of us are wondering if the community health centers will make it to 2014,” Plese says. “What’s unique in Arizona is that I sense this whole crisis has created a tight community – it’s a unified front of private providers, community hospitals, and it even includes health plans.”

For more of our primaries coverage, visit Political Malpractice: Healthcare in the 2012 Election.