PHOENIX — A watered-down proposal by Republican Speaker Andy Tobin that would force Medicaid recipients to get a job and limit some to a maximum of five years of insurance was approved Thursday by the Arizona House of Representatives, despite Democratic objections that it would kick people in need off the health insurance program.
House Bill 2367 passed on a 35-22 party-line vote and requires 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 have said the work-rule and time-limit proposals are unlikely to be approved because they run counter to federal law and regulations covering Medicaid plans, which receive a large amount of federal funding.
But Tobin said that the amendments he added have removed most of the concerns about the time limit. As originally introduced last month, 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, he changed that provision and it now only affects people who are able-bodied and don't work. He also added exemption 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 federal government fails to fund the program as promised.
"Clearly, these dollars are going to end up on the backs of the states. They are struggling to even move the system they have now," Tobin said. "All we're doing is saying let's request every year the opportunity for some of these waivers. It could be more or less, but at the end of the day what they want in Washington is a single-payer system."
Tobin's proposal also includes a requirement for a co-pay for unnecessary visits to hospital emergency rooms or ambulance use. The federal government had been allowing Arizona to charge $30 co-pays 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.
Democratic Rep. Eric Meyer said Tobin was trying to limit the reach of the program. A Medicaid-expansion proposal pushed by Republican Gov. Jan Brewer last year led to a fracture among Republicans and led to an impasse she finally broke by calling a special legislative session.
"It's going to take a whole segment of the AHCCCS population that we spent a lot of energy, and the governor did, on last year, and eventually remove them from their ability to get health care in this state," said Meyer, D-Paradise Valley. "But from my standpoint as an emergency medicine physician, where I saw a lot of patients who need the care and came in late because they didn't have insurance and couldn't get the preventative care that the ... expansion provides, it's not a wise move."
Meyer also noted that Tobin is running for Congress.
"He needs to get through his primary, and this helps him to say he's conservative, shrinking government and fighting against the Affordable Care Act," Meyer said. "Which is unfortunate. I wish we wouldn't put politics before our people, and this definitely does that."
Tobin said his candidacy had no influence on his bill.
"I don't need to burnish my conservative credentials for a primary. Just because you're running for Congress doesn't mean you abdicate your role as not just Speaker but as a legislator," Tobin said. "I've got many bills moving out here. You can make the same claim on each and every one of them. It has nothing to do with that."
Follow Bob Christie at http://twitter.com/APChristie.