Saying there are technical problems with the proposal, Gov. Jan Brewer vetoed legislation Friday which would have allowed individuals to shop around for the best price on health care needs.
The legislation crafted by Sen. Nancy Barto, R-Phoenix, would essentially have put hospitals and doctors in the same position as retailers: They would have to give people an opportunity to learn what certain procedures will cost, before they show up in a waiting room.
That would have included both a requirement for online posting as well as making a price list available on site.
Barto promoted the legislation as a cost-containment measure, especially for patients without comprehensive health insurance who end up having to pay all or part of their medical bills.
In her veto, the third of the legislative session, Brewer said she supports the idea of transparency "which will provide useful information to help patients manage their health care needs.'' But the governor said there are "practical and potential legal implications of this bill.''
Barto, however, called the veto "an incredible insult to consumers.''
The senator said she had been in contact with the governor's office all along about her proposal and had not heard any objections -- until now. Barto said she would have made necessary changes had the Brewer's staff raised issues before final approval -- and before this year's legislative session was so far along as to make it too late to start over.
And Barto said it may be that Brewer's veto has less to do with the text of the legislation than the fact she has been an outspoken foe of the governor's push to expand the state Medicaid program.
"It's not to her benefit to play those games,'' Barto said of the governor. "She's not going to gain votes by being petty.''
Gubernatorial press aide Matthew Benson said the veto is totally unrelated to Barto's opposition to the Medicaid plan. He said there were "technical concerns.''
Among those, Benson said, is that hospitals do not have one flat rate they charge for procedures. He said different charges apply depending on whether the patient is paying his or her own bill, has coverage from an insurance company that has negotiated a discount or is a Medicaid patient.
"If they're making that case, they're misrepresenting the bill,'' Barto responded.
"We're asking them to provide the price for health care when you pay without a third party,'' she said, meaning those without insurance. "That's the price nobody wants to admit that they want out there because it's going to enable and empower consumers to compare prices. That's why the hospitals are fighting it.''
Barto said this is important, and not only for the approximately one out of every six Arizonans without some form of insurance.
She said 53 percent of employers who do provide insurance are offering "high deductible'' plans, meaning the workers and their families are responsible for large out-of-pocket costs. "And it's going to climb to 67 percent next year,'' Barto said.
Benson said there were other issues.
For example, the measure would have affected not only traditional hospitals but facilities run by the Veterans Administration, Indian Health Services, tribal clinics, military hospitals and even the Arizona State Hospital. He said these facilities do not serve the general public and should be exempt.
And Brewer, in her veto message, said the bill "contains a number of ambiguous terms and definitions that likely would cause unnecessary litigation and create conflict with both state and federal law,'' though she provided no specifics. And she said -- again without providing details in her veto -- the legislation could impede the ability of the Arizona Medical Board to effectively investigate complaints and discipline doctors for billing abuses and excessive fees.
Barto said these are simply excuses that are irrelevant to the underlying issue of transparency.
Benson said Brewer is willing to work with Barto to find an acceptable plan -- next year.
This isn't Barto's first tiff with hospitals. She has been attacking their contention they need Brewer's Medicaid expansion to stop losses from uncompensated care.
Those losses, Brewer has argued, are passed on in higher costs to uninsured individuals and insurers. Brewer has pegged this "hidden health tax'' at $2,000 per family.
But Barto, in an online point-by-point argument against Medicaid expansion, said that's not really true.
"Most big hospital systems are not actually losing money,'' Barto wrote. The worst that has happened, she said, is that their profits are smaller.
She also noted the perennial argument by hospitals that what Medicaid reimburses them does not cover their actual costs. If that is the case, Barto said, "how will expansion of Obamacare solve the problem.''
Under the governor's proposal, the Arizona Health Care Cost Containment System, the state's Medicaid program, would provide coverage to individuals and families below what amounts to 138 percent of the federal poverty level. That works out to about $26,000 a year for a family of three.
AHCCCS currently funds care for most individuals below the federal poverty level. Estimates are that Brewer's proposal, which would take effect in 2014 along with the federal Affordable Care Act, would add about 300,000 individuals during the next three years on top of the nearly 1.3 million now enrolled.
Part of Barto's objection is how Arizona would pay its share: the AHCCCS director would be empowered to impose an assessment to raise the $240 million. By calling it an assessment -- and leaving the exact amount of the levy up to the agency -- Brewer contends it is not a tax.
That distinction is politically important.
Authorization for an assessment requires only a simple majority of the Legislature. But the Arizona Constitution mandates a two-thirds vote of both the House and Senate, a goal that could be politically insurmountable for Brewer given the opposition by Barto and other Republicans.
Barto also said she is not swayed by the fact the plan will bring $1.6 billion federal dollars into Arizona, money the governor said will go elsewhere if Arizona does take its share. The senator said if Washington does not send the money to Arizona, it simply reduces the amount of money that the federal government, with its deficit budget, has to borrow.