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Healthcare reform scares

July 6, 2009 |  6:01 pm

Could healthcare reform be the next big drive-'em-to-the-polls wedge issue? Conservatives in some states think so -- witness the anti-Obamacare referendum that the Republican-controlled Arizona legislature recently approved. The measure, which will go on the ballot in November 2010, would change the state's constitution to declare that "A law or rule shall not compel, directly or indirectly, any person, employer or health care provider to participate in any health care system." Except if that law happens to be Medicare, Medicaid or workers compensation, all of which are exempted from the measure. According to the conservative Tenth Amendment Center, advocates of similar measures are working to get them on the ballot in at least five other states.

Sponsor Nancy Barto, a state House Republican from Phoenix, said the goal is to protect Arizonans from being forced into a "government run healthcare system." No such measure has ever gotten a hearing in the Arizona legislature, Barto acknowledged in an interview, but Congress is heading in that direction now with its proposals for an optional "public plan." She added that calling the public plan an "option" was misleading because "when government enters the field and starts competing, and starts making the rules for their competitors ... [it] will  -- drive their competiors out of business."

The funny thing about the "Arizona Healthcare Freedom Act," though, is that the proposal was around before Barack Obama became president....

Arizona voters defeated a similar measure in 2008. The main difference now is that Barto's bill included language that exempted existing government programs such as Medicare and Medicaid. Not that Barto is a big fan of the federal health programs for the elderly and the poor; she says she'd like Arizonans to be able to opt out of those systems too.

And that's one of the problems with the referendum -- it treats healthcare as an optional cost that people should be able to shed. The only people who avoid paying for healthcare today are those who are indigent or who manage not to pay income taxes. The expense of caring for the uninsured and the underinsured is borne by everyone else, in the form of higher insurance premiums and healthcare bills. The gaps in coverage and cost-shifting are not only inefficient, they stand in the way of badly needed changes in the way heathcare is delivered and paid for.

The referendum ostensibly protects Arizonans from being required to carry health insurance, even though such a mandate is essential to requiring insurance companies to offer coverage to anyone who seeks it ("guaranteed issue") and to charge everyone in the region the same premiums ("community rating"). Barto, who favors a tax-subsidy approach to healthcare reform, said she doesn't support guaranteed issue or community rating because they drive up the price of insurance. And that may well be true, if those steps are taken without pursuing other reforms that improve quality and control cost. Yet the focus in Washington, at least at this point, is as much on controlling costs as it is on expanding coverage. That's because the two go hand in hand -- for example, increasing access to primary care is seen as a way to improve results and control costs by reducing unnecessary procedures and better coordinating treatment.

Anyway, Arizona voters will be able to express themselves again on this issue in a year and a half, by which time the fate of the administration's push to change the healthcare system will be known. Either way, the measure appears to be moot. There's no support in Arizona for trying to achieve universal coverage within the state's borders; as David Landrith, vice president of policy and political affairs for the Arizona Medical Assn. put it, "This is not Massachusetts. We have a hard enough time getting our legislators to cover kids with somebody else's money." Nor is there any chance of Congress adopting a single-payer plan that eliminates private options. And any mandates to carry insurance that Congress imposes will arguably pre-empt state laws. Barto admitted that "anything that Arizona passes that conflicts with what's going on in Congress is going to end up being challenged in court." So the most likely effect of the referendum, if it passes after Congress enacts a healthcare overhaul, would be to provide more work for Arizona's struggling litigators. In the meantime, it will give conservatives another issue with which to drive people to the polls. "It's a Red Scare thing," said Democratic state Rep. Kyrsten Sinema of Phoenix. "That's what most initiatives in Arizona are."

-- Jon Healey

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