Health Care: Death By Budget Cut
January 14, 2011, 4:00am


The Tucson shooting last week shocked the nation. For Arizona citizens, however, the violence lays a fresh wound to a state plagued by recent tragedies. In November, Mark Price, a father of six who had been battling leukemia for a year, died due to complications with his chemotherapy. While a bone marrow transplant could have saved Price’s life, he didn’t receive it in time. The next month, the same fate befell another Arizonan. Now, a plumber in need of a new heart, a high school volleyball coach in need of a new lung, and a father of four in need of a liver remain among the 96 Arizonans who have been facing death since Oct. 1. On that day, Gov. Jan Brewer (R-AZ) and the GOP-led legislature decided the state could no longer afford to support organ transplants for Medicaid patients and callously cut the service. Looking at a $1 billion program deficit by July 2011, Brewer dealt “a death sentence” to these Arizonans to recoup only one-tenth of a percent from the projected shortfall. Adding insult to grave injury, Brewer deemed such “Cadillac” treatment for the dying as “optional” and consistently ignored funding solutions from her own party while championing tax cuts and funding measures that could be easily re-routed to save the transplant program. Rep. Gabrielle Giffords (D-AZ) had been among those warning against the danger of solving budget woes “on the backs” of dying Arizonans. But rather than heed that warning, many Republican governors are electing to follow Brewer’s example of slashing vital Medicaid services and refusing federal help provided by the new health care law. By doing so, these governors needlessly endanger vulnerable populations and risk importing Arizona’s tragic consequences.

PAYING THE PRICE: On top of eliminating dental services and physical exams for low-income residents, Brewer and the GOP-controlled legislature took a knife to state reimbursement for seven types of transplants, including certain heart, lung, pancreatic, bone marrow, and liver transplants for Medicaid patients. Using inaccurate data, the state argued that the “procedures have poor outcomes and that most patients die after the transplants.” In fact, survival rates are higher than the state says. The drastic cuts have left hospitals bereft of any sustainable way to keep 98 affected patients on transplant lists. According to Arizona’s Medicaid agency, either hospitals have to “fund the transplants of patients without payers through their charity care dollars” or the patient would have to find “some other donor source.” Without any funding alternative, these gravely ill are slowly succumbing to the inevitable. Since the October cuts, one of the 98 has passed away each month. And now, denied a liver transplant because the state said funding her treatment wouldn’t be “cost effective,” one of the remaining 96 patients is “going to leave the state to get the surgery she badly needs” to live. Desperate to counteract what they are characterizing as “death by budget cut,” Arizona doctors even proposed cutting other procedures, like tests conducted before surgery, to compensate for the cost of the transplant. “Something needs to be done,” said Dr. Emmanuel Katsanis, a bone marrow transplant expert at the University of Arizona. “There’s no doubt that people aren’t going to make it because of this decision. What do you tell someone? You need a transplant but you have to raise the money?” State Democratic lawmakers who “made it very clear at the time of the vote that this was a death sentence” are so incensed over the GOP’s refusal to fix what one Republican lawmaker admitted was a “mistake” that many are now pointing to the GOP as the source of actual “death panels” under “Brewercare.”

REFUSING RESPONSIBILITY: Democratic lawmakers, physicians, and transplant patients gathered at a news conference last month to plead with Brewer to call a special legislative session so lawmakers could restore the $1.4 million transplant program. But such pleas fell on deaf ears as Brewer repeatedly refused to budge on her draconian budget. Believing “Arizona has provided Cadillac insurance for Medicaid,” Brewer insisted that “the state only has so much money” to provide dying patients with “so many optional kinds of care” and rejected to hold a special session until she “receives a funding proposal for either the reinstatement of the transplant program or the $1 billion shortfall for Medicaid.” Of course, Brewer has been ignoring such proposals since December. Moved by the 98 patients’ plight, Illinois State GOP Central Committeeman Steven Daglas developed 26 funding solutions tailored to Arizona that would allow the state to fully fund transplants for all the remaining patients without raising any new revenue. One such proposal included using $2 million from an AIG settlement for the program. However, after multiple attempts to reach out, Daglas has yet to receive a response from the governor. Brewer, it seems, is busy holding tax breaks for the wealthy as a higher priority. In response to an Arizona State University study implicating past tax cuts — not transplants — as “a major cause of the state’s underlying budget troubles,” Brewer insisted that “tax cuts are never a mistake” and proposed a 100 percent tax break for manufacturing companies over patient welfare as the new year’s first order of business. Other programs Brewer has found more worthy of funding include algae research, a coliseum roof renovation, and “bridges for endangered squirrels.” “I refuse to believe that any person or state will spend $1.25 million to save 5 squirrels a year, but not 98 human beings. It can’t be true,” said Daglas. “That just doesn’t make any sense.”

THE BAD BELLWETHER: When asked “how many people would have to die” before she’d reverse her decision, Brewer offered a curious response: “If people are so worried about the transplant patients then they should ask the federal government in Washington to send us more money.” This is a confusing reaction considering she openly vilifies the Affordable Care Act that would provide her with 100 percent of the funding to cover the health care law’s Medicaid expansion. Now, 32 more Republican governors have joined Brewer. In a letter to the White House last week, all the GOP governors lambasted the ACA’s rule requiring states to maintain Medicaid eligibility levels for federal funding as “unconscionable” and requested leeway to cut Medicaid enrollment, effectively “chopping millions of poor people when the weak economy makes Medicaid coverage critical.” Gov. Rick Perry (R-TX) and former Minnesota governor Tim Pawlenty (R) even flirted with opting out of Medicaid entirely, which would not only force states to scale back health care benefits and reimbursements to providers but would leave “large numbers of low-income children, pregnant women, parents, people with disabilities, and seniors” without insurance. Indeed, only when Perry learned that he’d lose $15 billion in federal funding and leave 2.6 million Texans uninsured did he drop the delusional idea.

Think Fast

Today, RNC members will decide whether to retain Michael Steele as their chairman. Voting will commence sometime after noon. The Washington Times reports that some supporters of Steele are “privately urging him to consider a graceful exit” before the vote occurs.

“A broad coalition of labor unions and liberal groups has launched an intense lobbying campaign directed at the White House” cautioning the President against announcing cuts to Social Security in his State of the Union address. “Nobody in the progressive world thinks the president ought to endorse the Bowles-Simpson Social Security stuff,” said one strategist with the campaign, referring to a proposal that would hike the retirement age.

The EPA yesterday “revoked the permit for one of the nation’s largest mountaintop-removal coal mining projects,” arguing “the mine would have done unacceptable damage to rivers, wildlife and communities in West Virginia.” Arch Coal’s proposed mine “would have buried miles of Appalachian streams under millions of tons of residue.”

President Obama is extending an olive branch to big business, as he negotiates free trade agreements, supports reforming the corporate tax code in a way that could lower rates, and hires a big bank executive to be his chief of staff. Steve Pearlstein wonders whether the business lobby will reciprocate by saying “it will not support Republicans in their effort to repeal last year’s health reform legislation.”

Responding to the Tucson shooting, Rep. Carolyn McCarthy (D-NY) unveiled the text of new gun control legislation yesterday that would ban the “sale or transfer of clips that hold more than ten rounds.” “The only purpose for the existence of these devices is to be able to shoot as many people as possible as quickly as possible,” McCarthy wrote to her colleagues, hoping to get the support to pass the bill.

Rep. Gabrielle Giffords (D-AZ) has made what doctors are hailing as “a major leap forward” in her recovery, as she is “able to keep her eyes open for as long as 15 minutes and can move her legs and hands.” Calling her recovery in past five days a near-“miracle,” her doctors said Giffords will likely regain mental capacity, though “it is too early to say” what her physical capacity will be.

Many members of Congress are looking for increased security as they travel back to their districts for events, following the shootings in Arizona — but local law enforcement agencies may not be able to help due to widespread state and local budgeting problems. A quarter of U.S. cities have reported cutting their public safety budgets in the past year and 80 percent of them have 10 officers or less.

Vice President Biden said yesterday in Baghdad that the U.S. remains committed to the agreement that calls for all American troops to withdrawal from Iraq by the end of this year. Prime Minister Nuri al-Maliki said Biden assured him that the U.S. was “serious about activating the strategic framework agreement.”

And finally: While many politicians’ wives probably think it, few will say it publicly, but the wife of Japan’s prime minister said this week that she “would not marry” her husband again in another life. “My husband sometimes says to me: ‘I really hate going to the [parliament] because everyone is so mean and critical, but it’s a lot easier being subjected to this criticism at the [parliament] than fighting at home with you,'” she joked to reporters.

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Daily Grill

“I think we can all benefit from a more thoughtful discourse.”
— Former Minnesota governor Tim Pawlenty, 1/11/11


“There’s a lot of us who say, ‘You know that feels kind of like government stepping on us, pushing us to the side,’ and there is a continuum between liberty and tyranny.”
— Pawlenty, 1/12/11