Medical Mystery

Ask different people what the consequences of Prop 101 would be, and you'll get different answers

Proposition 101 on November's ballot contains only a few dozen words, but those words are causing considerable controversy about their legal meaning.

Supporters claim this proposed amendment to the Arizona Constitution would protect individual health-care choices involving doctors and treatments. Opponents argue the measure is a sham which will result in chaos and higher costs to taxpayers.

Using just two sentences to explain itself, the proposition prohibits the adoption of any law that "restricts a person's freedom of choice of private health-care systems or private plans of any type."

Additionally, Prop 101 forbids any legislation which interferes "with a person's or entity's right to pay directly for lawful medical services ... ."

Finally, the measure bans laws that would "impose a penalty or fine, of any type, for choosing to obtain or decline health-care coverage or for participation in any particular health-care system or plan."

"I really don't know what they're talking about," reflects Eve Shapiro of the proposition's language. Shapiro is the Tucson physician who spearheaded two successful ballot propositions to expand health-care coverage for low-income residents of Arizona. "This is a change to the state's Constitution, and we don't know its consequences. It could affect state and federal (health-care) programs, because the term 'choice' is so ill-defined.

"Our health care system is a big mess," Shapiro continues, "but this measure doesn't do anything to address that issue."

Dr. Eric Novack from Glendale is heading up the campaign to approve 101 and agrees medical reform is desperately needed. But before that happens, Novack insists: "The cornerstone (of this change) should be the right of an individual to protect their health-care choices.

"If we don't protect the right of the individual to make (health-care) choices," Novack says of future reform measures, "those rights will be lost."

Because of the vast sums of money involved in health-care reform, Novack believes government bureaucrats and special interests will do away with individual medical choices during the legislative process.

However, some anti-abortion advocates have raised questions concerning passage of the proposition. They fear the state could no longer forbid the use of public money to pay for abortions for pregnant minors in foster care or women using the Arizona Health Care Cost Containment System (AHCCCS), the state's medical insurance program for low-income people.

Novack rejects that allegation, pointing out that lawyers for several anti-abortion groups vetted the language of 101. He also stresses that an exhaustive legal analysis prepared on the proposition showed it would have no substantive impacts on AHCCCS in general.

On the other hand, a review of the proposed measure by the law firm of Lewis and Roca comes to a much different conclusion. Their critique, done for the firm's clients, states: "The argument could be made that it applies to AHCCCS and the plans which deliver benefits for the AHCCCS system."

Novack calls opposition to the proposition "fear-mongering" while adding, "Opponents are just making things up."

Indicating that an unsuccessful push for medical choice was first introduced at the nation's founding, Novack says the passage of Proposition 101 would be groundbreaking. "This has never been done anywhere," he declares.

For his part, Tucson Democratic state Rep. Phil Lopes hopes the effort fails. "This will make things worse than the status quo," he says of 101.

In the past, Lopes has sponsored health-care reform legislation in the Republican-dominated Arizona Legislature. He managed to get a hearing on the bill earlier this year and promises to introduce it again during the next session.

It is health-care reform like Lopes' effort, which he calls a "single-payer system of the Canadian style," which Tom Jenney, executive director of the Arizona Federation of Taxpayers, is worried about as he supports Proposition 101.

"Under that system," he suggests of Canada's national health-care program, "you end up with high-cost and low-quality medical care. ... Adoption of 101 will prevent future (state) legislation that interferes with the doctor-patient relationship or the patient's relationship with an insurance company."

Jenney rejects arguments that the proposition could cause unintended consequences. "It doesn't have any impact on current programs," he believes. "My understanding is the legislation is prospective. It will prevent future legislation to restrict (health-care) choice."

As for those opposing the measure, Jenney says they are using the same "standard operating procedures" used in every election to convince people to vote against a ballot measure: "Our argument is that it will prevent bad health-care systems in the future."

For her part, Linda Brown, of the Arizona Advocacy Network, worries about the impacts of 101. She believes the consequences of the proposition could be dramatic and expensive.

"The way it is worded, it looks like Arizonans on AHCCCS will be required to be free to choose any doctor or hospital they want," she says. Since that isn't presently the case, Brown estimates: "That could end up costing taxpayers unending amounts of money."

Brown points out that passage of the proposition would limit future health-care-reform options. "Arizonans don't like to be lied to or duped," she says, "but the backers of 101 are doing that. ... This proposition is designed to protect the profits of those in the medical industry."