Governor not yet backing proposed replacement for Obamacare, waiting for improvements

Gov. Doug Ducey said the Republican plan to replace the Affordable Care Act is flawed and should not be enacted as proposed.

The governor late Tuesday repeated his stance that “Obamacare” needs to be repealed. And he wants some replacement in place before it disappears.

But Ducey said the proposal being pushed by U.S. House Speaker Paul Ryan is not ready for prime time.

“I have concerns with the bill as it’s written today,” the governor said. If nothing else, he said the plan is too rigid.

“I’m advocating with the White House, with the Secretary of Health and Human Services for a plan that gives Arizona flexibility, that brings back our insurance market and allows us to benefit from an improvement in our health care law,” Ducey said.

That issue of “flexibility” goes to previous efforts by the Ducey administration to include some cost-savings requirements in the Arizona Health Care Cost Containment System, the state’s Medicaid program.

For example, Ducey sought federal permission to impose work requirements on some Medicaid recipients and kick them out of the program after five years. Those were rejected last year when Andrew Slavitt, the acting administrator for the Centers for Medicare and Medicaid Services said such limits would “undermine access to care and do not support the objectives of the program.”

Slavitt also rebuffed the state’s bid to impose charges on recipients who earn less than the federal poverty level.

On a broader philosophical base, Ducey said he’s concerned that simply rearranging the kind of coverage Medicaid provides does nothing to restore the private insurance market.

“The insurance market has been collapsed,” the governor said, pointing out that in 14 of the state’s 15 counties there is only one company willing to provide coverage for the poor under the Affordable Care Act.

“The last thing we want to do is transition somebody off of a program where there’s nowhere to go,” he said.

And there is also the potential loss of coverage for some Arizonans.

In 2012, the state, under Gov. Jan Brewer, took advantage of a provision of the Affordable Care Act to extend coverage to everyone up to 138 percent of the federal poverty level. That’s currently about $27,800 for a family of three.

What made the deal so attractive is the federal government picked up virtually the entire cost of the expanded population. And as part of the deal, the state came up with money to once again enroll single adults below the federal poverty level, enrollment that was frozen in prior years due to state budget concerns.

The Ryan plan does continue that funding for expansion — but only at current levels. More to the point, no new people will be allowed to enroll. And anyone who temporarily loses eligibility cannot get back into the program.

And after 2020 there is no specific federal funding for expanded coverage. Instead states will be given block grants in a yet-to-be-determined amount to decide how to spend the dollars.

That possibility worries the governor.

“I don’t want to see anybody have the rug pulled out from underneath them,” Ducey said. “And that’s what I’m going to be advocating for.”

The governor said he’s confident that what got introduced won’t be what emerges.

“I think you’re going to see a different bill if it does get out of the House, if it does get out of the Senate, than the bill you see today,” he said.

Ducey said he and other governors intend to be “a positive, constructive part of the process.”