If Republicans End the Medicaid Expansion: Arizona’s Cautionary Tale

A key way the Affordable Care Act (ACA) helped the United States reach a dramatic drop in the uninsured rate was by expanding the Medicaid program to low and moderate income adults. Despite this success, the House Republican plan to repeal the ACA would freeze the Medicaid expansion starting in 2020.  As Arizona’s experience shows, freezing the Medicaid expansion is ending the Medicaid expansion and it’s a move that gambles with the lives of millions of Americans.

Freezing Medicaid expansion is equivalent to ending Medicaid expansion

The GOP bill takes a similar approach to Medicaid expansion as Arizona did when it froze Medicaid enrollment for poor adults in 2011—immediately stopping new enrollment and blocking people who become ineligible due to life changes from re-enrolling if they later re-qualify.

This system of “phasing out” the expansion may sound like a very slow process, where many people who are currently enrolled will be able keep their coverage for a long time. But Arizona’s own experience with a Medicaid enrollment freeze shows us otherwise.

This is because people’s incomes and life circumstances fluctuate frequently. These changes in circumstances also affect their eligibility to enroll in Medicaid. For example, during the Arizona Medicaid enrollment freeze, a seasonal worker whose income temporarily increased was dropped from the program and unable to re-enroll when their income dropped again.

When Arizona froze Medicaid expansion, the results were catastrophic

Arizona expanded Medicaid long before the Affordable Care Act. In 2000, state voters passed a ballot measure to extend the state’s Medicaid program to cover all state residents living below the poverty line.

After its extension of Medicaid to adults living below the poverty line, the number of uninsured residents, mortality rates, and hospital costs spent caring for the uninsured all dropped.

Sadly, in 2011, in response to budget pressures, the legislature chose to cut funding and freeze Medicaid enrollment for childless adults. The freeze kicked 150,000 Arizonans off the program, approximately two-thirds of the childless adult population who had gained coverage under the expansion.

The cost of this decision to families, hospitals, and communities was catastrophic. Advocates and health centers collected stories of those who lost access to health care and the devastating consequences:

• A mother from Chandler who shared her concerns about her adult son with schizophrenia who couldn’t get the services he needed to stay well.
• A cancer patient in the middle of treatment whose doctor was forced to keep him in the ER to administer chemotherapy because that was the only way to get the expensive treatment paid for by the state.

Hospitals took a huge financial hit

Many others who had insurance and could see a primary care physician when they got sick were now forced to go to the emergency room to see a doctor. This strained hospital finances as they provided more and more care for people who were too poor to pay their bills:

• The cost to hospitals nearly doubled.
• In the first year of the enrollment freeze alone, the amount of uncompensated care provided by hospitals increased by 45 percent.
• Rural hospitals struggled to keep their doors open.

These negative impacts were severe enough that Republican Governor Jan Brewer jumped on the opportunity cover poor Arizonans once again though the Medicaid program, made available after the Affordable Care Act was passed. If Arizona had not acted to expand Medicaid, an additional 67,000 people could have lost coverage.

Governor Brewer said at the time, “[T]he human cost of this tragedy can’t be calculated.”

Arizona should serve as a cautionary tale for Republicans seeking to end the ACA’s Medicaid expansion

Better than any other state, Arizona knows what it is like to take health coverage away from people. Right now, Congress is preparing to vote on a bill that repeals the ACA and phases out the Medicaid expansion starting in 2020.

As Republican legislators in Washington barrel toward a repeal that would strip millions of their health insurance, they should consider the disastrous economic and human consequences

Arizona faced when the state froze Medicaid enrollment. It’s an irresponsible decision that will hurt hundreds of thousands of Arizonans and people in every state.

Arizona’s got some history to teach Washington, and lawmakers should listen lest mistakes of the past be repeated.