Many Medicaid-expansion foes in Arizona Legislature get prime state insurance

More than two-thirds of Republican lawmakers who sued to overturn Medicaid coverage for low-income Arizonans took state-sponsored health-insurance plans that offer more-robust medical benefits than what the average Arizonan gets from private employers.

Records obtained by The Arizona Republic show that of the 36 current and former state lawmakers who sued to halt funding of the Medicaid expansion, 26 enrolled in state-funded health-insurance plans.

Eight of the lawmakers who sued the state over the Medicaid expansion no longer serve in the Arizona Legislature. Of the remaining 28 serving in either the Arizona Senate or House of Representatives, 21 are enrolled in the state-sponsored health-insurance plans.

Arizona lawmakers serve part-time, but most now seated take year-round health-insurance benefits that are more generous than what most other states offer their employees. The state-sponsored health-insurance plans offer coverage that is more comprehensive and less expensive than the typical private-sector health-insurance plan for Arizona workers.

Most Arizona legislators take those benefits regardless of political-party affiliation.

Among elected members of the Arizona House of Representatives, 21 of 24 Democrats are signed up for state health-insurance plans, while 24 of 36 Republicans are enrolled in state plans. In the Arizona Senate, 11 of 13 Democrats and 14 of 17 Republicans take state benefits.

MORE: Arizona lawmakers enjoy prime health-care benefits

Arizona's elected legislators, their staff and dependents were billed and reimbursed by state-sponsored health-insurance plans for more than $8 million in medical claims over the past 2½ years, according to Arizona Department of Administration records.

Other elected officials who hold statewide offices also take state health plans. Gov. Doug Ducey, Secretary of State Michele Reagan and Treasurer Jeff DeWit all signed up for state health-insurance plans. Attorney General Mark Brnovich declined the state's coverage. Unlike legislators, who finished this year's session in 81 days, statewide elected officials serve full time.

While most state lawmakers choose to enroll in state-sponsored plans, the Arizona Legislature has taken multiple votes that had the potential to curb efforts to extend health insurance to the uninsured or impose new requirements on Medicaid recipients. During their most recent session, lawmakers approved a bill that would prohibit a state-based health-insurance marketplace under the Affordable Care Act. The legislative vote against a state-based marketplace largely became moot after the U.S. Supreme Court affirmed subsidies for consumers in states that use the federal marketplace, healthcare.gov.

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A Medicaid lawsuit filed by three dozen lawmakers in 2013 is pending in Maricopa County Superior Court. The Medicaid expansion, which reversed earlier program cuts and extended coverage to those who earn up to 138 percent of the federal poverty level, has extended coverage to more than 340,000 Arizonans.

The expansion is mainly funded by the Affordable Care Act, popularly known as "Obamacare," with a local match from an assessment paid by Arizona hospitals. The lawmakers allege that the assessment is a tax that requires the Legislature to meet a two-thirds supermajority for approval.

"I don't find it surprising," said Tim Hogan, an Arizona Center for Law in the Public Interest attorney who represents four Medicaid recipients who have intervened in the lawsuit. "It is easy for legislators to vote to deny benefits and health care to others when it's not going to affect them. They are on the state plan at taxpayer expense, so they are all set."

Former Arizona Rep. Adam Kwasman is among eight former lawmakers who remain as plaintiffs in the Medicaid lawsuit. Kwasman no longer serves in the Arizona Legislature after an unsuccessful run for Congress in 2014, but he remains committed to the Medicaid lawsuit.

He said he believes that then-Gov. Jan Brewer's legislative maneuvering to push through the Medicaid expansion in 2013 was "illegal on its face."

Kwasman acknowledged that while he opposes Arizona's Medicaid expansion, he was enrolled in a state-sponsored health-insurance plan while he served the Legislature. He said he enrolled in the state's high-deductible plan that included a health-savings account — one of eight options available to full-time state employees and part-time legislators.

Employees who take the Aetna high-deductible health plan contribute $12 every other week, but the state reimburses lawmakers nearly $28 every two weeks to a health-savings account.

Such high-deductible plans are increasingly popular among employers because some believe they compel patients to think more like consumers — to question costs and shop for less-expensive, higher-quality care.

"While I rejected the pension, I did accept the health-savings account," Kwasman said. "One of the major reasons is that has to be the future of health care in America."

Arizona Sen. Nancy Barto, who chairs the Arizona Senate's Health and Human Services Committee, said the Medicaid expansion was an "Obamacare bribe" that Arizona can't afford. Although she is suing the state to reverse the expansion, she is enrolled in a taxpayer-supported health-insurance plan.

Barto said all Arizona residents should have multiple options for health insurance.

"Everybody should have a panoply of health-care and insurance choices whether through their employer or not," said Barto, who added that she believes the nation's health-care law restricts health-insurance options for consumers.

Arizona Rep. Paul Boyer, also a plaintiff in the Medicaid lawsuit, said the state plan is his best health-insurance option. He takes the state plan because his other part-time employer, a public charter school, does not offer health insurance to part-time instructors.

When the Legislature was debating whether to expand Arizona's Medicaid program — the Arizona Health Care Cost Containment System, better known as AHCCCS — Boyer floated the idea of making lawmakers and state employees enroll in Medicaid instead of a state plan. The proposal went nowhere.

Still, Boyer said he does not see a problem taking a state plan while also pressing a lawsuit that could strip coverage away from thousands of low-income Arizonans.

"You have to have health insurance or you get penalized," Boyer said of the federal health law's requirement that most Americans must get health insurance or pay a penalty. "You look at what options are available to you and you take them."

Some lawmakers who chose not to take the state plan said they did so to save taxpayers money and because they had health-insurance options elsewhere.

Arizona Sen. Gail Griffin, also suing to undo the Medicaid expansion, said she chose not to take state-funded health insurance to "save the taxpayers money" and because she has her own health insurance.

"I am happy with the coverage I already have and don't need to change," Griffin said.

Christina Sandefur, a Goldwater Institute attorney who is representing the 36 legislators, said the Medicaid expansion is a challenge against an "unconstitutional tax" used to fund the Medicaid expansion. She said it is not a referendum on whether extending Medicaid coverage to those who earn up to 138 percent of the federal poverty level was sound policy.

"They are totally different issues," Sandefur said.

So is it ethical for a part-time lawmaker to sign up for health insurance while crafting a bill or pursing a lawsuit that could restrict coverage for others?

Michael Josephson, who founded the Los Angeles-based non-profit Josephson Institute of Ethics, said he understands that the public may perceive that it's hypocritical for lawmakers to take benefits while restricting coverage for others.

But he said such a perception may not be fair to legislators

Arizona lawmakers are paid $24,000 a year, so providing health benefits for part-time lawmakers may be a way to provide compensation without boosting salary, Josephson said.

"Do you want to make (pay) so skimpy that only the rich can afford to do this?" Josephson said.

Josephson added that lawmakers must decide whether to pass a bill or pursue a lawsuit based on the facts of an issue, not how it will make lawmakers appear to the public.

Brewer assembled a bipartisan coalition in 2013 that included 14 Republicans who supported the Medicaid expansion. The vote sharply divided the Republican Party, with the three dozen lawmakers continuing the fight in Maricopa County Superior Court.

"You question how much will it cost the state. What's the financial impact?" Josephson said. "Is there justification? It doesn't necessarily make it hypocritical."

ON THE BEAT

Ken Alltucker covers health care as a member of The Republic's watchdog team. He has written about the Affordable Care Act, consumer health, insurance, prescription drugs and hospitals.

How to reach him

ken.alltucker@arizonarepublic.com

Phone:602-444-8285

Twitter:@kalltucker