Health-care law: Arizona tries new approach to get by federal Medicaid rules

Washington Post Staff Writer
Sunday, January 23, 2011; 10:58 PM

Republican efforts to repeal or limit the reach of the new health-care law took a new direction last week when Arizona lawmakers approved a novel and controversial attempt to cut Medicaid for 280,000 of the state's poor.

The bill, requested and signed by Gov. Jan Brewer (R), empowers her to make a formal request, most likely this week, for a federal waiver to avoid complying with provisions of the law that prohibit states from tightening their eligibility requirements for Medicaid.

Twenty-nine Republican governors, including Brewer, have signed a letter calling on President Obama and congressional leaders to remove the provision from the law.

But Arizona is the first state to, in effect, play chicken with the Obama administration by directly requesting a reprieve and daring Health and Human Services Secretary Kathleen Sebelius to refuse.

The move is widely regarded as a long shot. While a spokesman said the White House had no comment on Arizona's request, administration officials have shown scant interest when asked about the idea in the past.

Still, Arizona's move reflects two pressing realities: Many states face large budget shortfalls because of continuing economic difficulties, and Republican governors point to Medicaid cuts as one of the most logical ways to balance those budgets.

"The effect of federal requirements [in the new law] is unconscionable," the Republican governors wrote in their letter earlier this month. "States are unable to afford the current Medicaid program, yet our hands are tied."

Advocates for Medicaid, the health insurance program for the poor and disabled that is jointly funded by states and the federal government, say the Republican argument amounts to political posturing at best and heartless, shortsighted policy at worst. Most of the men and women Arizona wants to cut from Medicaid have to earn less than $10,830 per year to qualify for the program.

"If you're a family and you hit tough times such that you can only afford to feed two out of your three children, you don't tell your third child, 'Sorry, Johnny, you're not going to eat.' You go out and find a way to get more food," said Arizona state Sen. Kyrsten Sinema (D-Phoenix), who has made health care a focus.

Similarly, Sinema said, Brewer should attempt to restore the substantial cuts Arizona has already made to its Medicaid coverage in recent years, not seek new ones.

And while Sinema said she was confident that this latest effort at a rollback would be blocked by the Obama administration, she charged Brewer with engaging in a cynical strategy to win political cover for "gutting" other state programs if the Medicaid request is denied.

"She's trying to take an opportunity to stick it to the feds and blame Obama for our state budget crisis," she said.

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