Democratic state Rep. Matt Heinz of Tucson urges the federal government to deny the Brewer administration's request for waivers to cut back on health-care insurance for low-income Arizonans and charge new fees for various services:

As a practicing physician I know firsthand the devastating consequences that the pending Medicaid waiver will have on our most vulnerable patients, the emergency medical infrastructure and the health care sector of the state economy, which has been a stabilizing force during the ongoing recession.

The federal government should deny this outstanding waiver request to freeze enrollment
for many low-income childless adults and parents.

The waiver request runs counter to affordable health care for all Americans, allowing for fewer individuals to receive health care coverage through the Arizona Health Care Cost Containment System or AHCCCS, forcing almost 200,000 of our most vulnerable citizens to forego comprehensive and preventive care.

Even a temporary setback of this magnitude cannot be tolerated.

Many of these patients have chronic conditions such as diabetes, heart and lung diseases, and cancer. I know from my work at Tucson Medical Center as a hospital physician that people with untreated chronic conditions will develop severe complications requiring urgent and expensive hospitalization. Such delays in treatment increase patient and family suffering and unnecessarily burden an emergency medical system that is already stretched far too thin.

Additionally, the large amounts of limited health-care resources required to treat uncontrolled chronic diseases tend to increase uncompensated care, ultimately increasing the cost of health care for all Arizonans.

The purpose of the waiver request, according to Gov. Jan Brewer and the Arizona
legislature, is to achieve substantial savings to partially address the severe budget shortfall for FY 2012. While there may be some immediate “savings” from the eligibility reduction, any initial cost benefit will be fleeting and rapidly undone by mounting health care expenses associated with treating the thousands of uncovered individuals in our emergency rooms.

The requested changes, if implemented, violate existing state law and the Arizona Constitution. As a result of a constitutional amendment approved by the voters in 1998, ballot measures submitted by the citizens’ initiative that pass into law cannot be ignored or repealed by the executive or legislative branches.

In 2000, Arizonans overwhelmingly approved Proposition 204 which expanded health care coverage through AHCCCS to the low-income populations now at risk because of the requested waiver.

Beyond the legal arguments, this waiver, if approved, will adversely impact the strained health care infrastructure of the state. Of special concern are the negative effects on emergency medical care for all patients in Arizona.

As you know, federal law requires emergency providers to evaluate every individual who presents to the ER for treatment. The newly displaced and uninsured patients will soon be forced to seek medical attention in emergency departments throughout the state—care which can be delivered in a more timely and cost-effective manner through AHCCCS via outpatient clinics. Those with unstable chronic medical conditions will require extra time and care to control their illnesses, diverting limited resources unnecessarily.

In medicine, we must always treat the sickest patients first so implementation of these changes will effectively delay or deny care for all individuals seeking urgent medical attention regardless of insurance status.

The eventual result of the waiver will be a health care system with fewer hospitals and clinics, fewer doctors and nurses, and far fewer health care options for the people of Arizona.

Finally, the approval of the waiver request would have devastating consequences on the state’s economy by eliminating jobs in the health care industry at a time when the State can least afford more job losses.

While the State’s budget crisis dictates the need to make difficult decisions, we simply cannot balance the budget on the backs of our most vulnerable populations by removing their access to basic health care. The health of our most vulnerable populations and the economic efficacy of this State depend on it.