The red state, blue state Medicaid debate


My heart goes out to Randy Shepherd. I only wish I could perform this act literally.

As National Public Radio recently reported, Shepherd was atop the list of heart transplant recipients within the Arizona Health Care Cost Containment System, the state's Medicaid program. But Arizona lawmakers recently decided to eliminate the budget for organ transplants. So, Shepherd, who suffers from cardiomyopathy as the result of rheumatic fever he had as a child, is out of luck--along with 97 other Arizonans awaiting behind him.

Shepherd can't get private coverage because of his preexisting health problems, and his condition has left him too weak to work. So, he has to wait at least a year to get onto Medicare via a permanent disability. His 3-year-old son's chances to have actual memories of his dad have become alarmingly slim.

No matter to Arizona's political leaders. They face a relatively modest $1.5 billion budget deficit. Putting the kibosh on organ transplants will close that gap by a stupendous three-tenths of 1 percent--perhaps a tad more should Shepherd and those 97 other constituents promptly expire. But you have to start somewhere.

Medical ethicists have condemned the decision, saying reneging on transplants is unconscionable. But Arizona's lawmakers are unmoved, which is unsurprising. Its governor wants undocumented workers rounded up without warrant. The sheriff in Phoenix forces inmates to wear pink underwear and sleep in tents in 115 degree heat, even if they haven't been convicted of a crime.

In short, Arizona is as red as an angry boil. It practices the politics of punishment with more panache than any other state in the nation.

Arizona isn't at all alone when it comes to chipping away at Medicaid. Texas is considering opting out of the program altogether, even though 60 percent of its program's current funding comes from the federal government, and nearly all of the costs in expanding the rolls under reform will be paid for by the feds.

The Lone Star State's deceptively sunny governor Rick Perry boasts he can best Medicaid with private sector alternatives. His amnesia is so convenient that he will likely never recall that nearly one-third of Texans currently lack coverage even with Medicaid in place. That's double the nationwide uninsured rate.

I'm always a little amazed Arizona is just a four-hour drive from my home in Los Angeles, and Texas a mere 12-hour shlep. California is as blue as one of Paris Hilton's home videos, with Democrats sweeping statewide offices in the recent mid-term elections. Even our lame-duck Republican governor is just a girly-man liberal whose physique has gone to fat.

And if you think those cow punchers to the east have budget worries, they're pikers. California's funding gap is at $25 billion and continues to soar into the stratosphere. Were we Arizonans, not only would we have peremptorily halted transplants, but we'd probably be yanking vital organs out of our neighbors like an "Itchy and Scratchy" cartoon come to life.

Except we're not.

California just got the go-ahead on a $10 billion waiver from the feds to remake Medi-Cal ahead of the implementation of reform. It will include expanding the rolls of insured by about 500,000 lives and giving safety net hospitals more funding.

In exchange, state officials agreed they'd cut costs elsewhere, such as in the way the aged, blind and disabled populations are cared for. There's been some criticism about moving this bloc of lives into managed care, but no one is cutting them loose.

States like Arizona and Texas could apply for such waivers themselves, but seldom do. No red state pol would assist those who can't take care of themselves or haven't been deluded into believing they can. Can't do your own danged transplant? Looky here--we got ourselves a socialist!

Thus, the notion of healthcare finance as seen by red and blue states are at polar opposites. During the reign of Bush fils, states were prodded to cut their S-CHIP coverage because it was more politically important to embrace family values than ensuring kids had coverage. The Obama Administration and blue states like Massachusetts and California have taken the opposite tack. With reform on the horizon, the ideological tug-of-war over healthcare is now fast and furious.

Randy Shepherd has been particularly gracious about being caught in the middle. "If I were to die because they didn't give me the transplant, I've had the last 18 months with my kids that I wouldn't have had otherwise because AHCCCS paid for my pacemaker," he said.

It's presumptuous for me to believe that Shepherd and the rest of the transplant designates aren't as red as their fellow residents. But I bet most would want to tiptoe across the state line right about now. Perhaps someone should ask them their preference--before it's too late. - Ron

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