As states across the country are moving to expand Medicaid coverage to additional low-income people under the Affordable Care Act, lawmakers in Arizona want to take the opposite approach.
On Friday, Gov. Doug Ducey (R) approved a measure that seeks to tighten the state requirements for Medicaid eligibility, ultimately limiting public health insurance to fewer residents. The legislation proposes requiring the program’s recipients to be employed in order to qualify for assistance and kicking them out of the program after they’ve been enrolled for five years.
A nearly identical bill was vetoed last year by former Gov. Jan Brewer (R) — one of the Republican leaders who bucked her party and embraced Obamacare’s optional Medicaid expansion when she was in office. In 2014, Brewer estimated that a five-year limit on Medicaid benefits would drop nearly 213,000 adults and 253,500 children from the rolls. She said that, since all of those newly uninsured people would end up seeking uncompensated care at hospitals without any insurance to pick up the tab, Arizona’s health care system would be pushed to “the breaking point.”
Ducey’s office, on the other hand, released a statement on Friday saying that the new legislation will “ensure that we have a responsible Medicaid program that protect taxpayers and provide care to those who need it the most.”
The federal government, which has the authority to reject state’s proposed changes to their Medicaid programs, likely won’t approve Arizona’s reforms. The U.S. Centers for Medicare and Medicaid Services typically shoots down work requirements because they put too much of a burden on the low-income people who rely on public benefits, who often need Medicaid coverage precisely because they are unemployed. Similar GOP-sponsored proposals have been rejected in Pennsylvania and Utah.
Nonetheless, Arizona lawmakers are prepared to keep trying: The measure that Ducey approved stipulates that Arizona will ask permission to impose these Medicaid reforms every single year for the foreseeable future.
Over the past several years, other governors in states like Maine, Rhode Island, and Wisconsin have also moved to cut people from their Medicaid rolls. Many of the people in those states who lost access to public coverage are now eligible for tax subsidies to buy private plans on Obamacare’s marketplaces — except in Maine, where about 10,000 childless adults lost access to affordable health care altogether.
Thanks to the GOP-controlled states that continue to resist Medicaid expansion, Obamacare implementation has been uneven across the country. An estimated four million low-income Americans fall into a coverage gap where they’re unable to access subsidized insurance under Obamacare, keeping the national uninsurance rate at least two percentage points higher than it would be otherwise.
Republican governors typically say that it’s simply too expensive to provide public insurance to additional low-income people. But some of them also make arguments along the same lines as Ducey, suggesting that Medicaid coverage should be limited to “responsible” people because too many Americans are abusing the system. Wisconsin Gov. Scott Walker (R) once said that denying Medicaid coverage to low-income people helps them “live the American Dream” because they won’t be “dependent on the American government.”