About 135,000 Arizonans living in poverty will not be getting their free health care back.
The state Supreme Court refused Wednesday to disturb a ruling by the Court of Appeals that the Legislature was free to scale back coverage despite a 2000 ballot measure requiring the Arizona Health Care Cost Containment System to provide medical care for everyone below the federal poverty level. The justices did not explain their reasoning.
Wednesday's decision leaves intact the December ruling that the question of whether there is enough money to provide coverage is strictly a political matter. And that, the appellate court said, makes the issue beyond its power to review.
In refusing to review that ruling, the high court sidestepped the question of whether that was what voters intended.
Tim Hogan, attorney for the Center for Law in the Public Interest, said Wednesday's ruling likely ends the matter.
He said it most immediately affects about 135,000 individuals, mostly childless adults, who live below the federal poverty level but have been denied enrollment in the program or are expected to be turned away this year.
But Hogan said the plan is to eliminate this group from coverage entirely. And that, he said, ultimately could affect about 250,000.
The ruling is a victory for Gov. Jan Brewer, who proposed the change.
Central to the issue is that 2000 ballot measure
As approved by voters, it requires the Legislature to use tobacco taxes and lawsuit settlement funds to provide free care for everyone below the federal poverty level. More to the point in this case, it directed lawmakers to supplement that with other "available sources'' of cash.
In adopting a budget for the current year, lawmakers left the taxes and settlement funds in place. But they said the state's fiscal condition left no "available" funds, directing Brewer to save $500 million by scaling back AHCCCS coverage as part of a larger plan to trim $1 billion in state spending.
She responded with a plan to exclude childless adults and some parents from the program. That choice was because the federal Medicaid program, which provides about two-thirds of the AHCCCS budget, does not require states to cover those in that category.
About 230,000 in those groups already enrolled on July 8, when the change took effect, were allowed to remain in the program as long as they remained eligible. But beginning that day, everyone else in this category was turned away, and those who lost eligibility could not re-enroll.
Hogan sued, saying the language of Proposition 204 clearly requires lawmakers to provide the necessary funds to provide free care for everyone below the federal poverty level. That figure, adjusted annually, currently is about $18,500 a year for a family of three.
He also noted the initiative specifically barred lawmakers from putting any limit on the number of people enrolled.
Judge Patricia Norris, writing for the unanimous appellate court last year, agreed that voters did, in fact, intend for the state to provide care for everyone below the federal poverty level.
But Norris said when lawmakers cut funding earlier this year, they concluded they had used all available sources to fund the program. And she said it is legally irrelevant that lawmakers had money to fund other non-mandatory programs.
"Under our system of governance, and in these circumstances, resolution of this issue is entrusted to the Legislature's judgment,'' Norris wrote. More to the point, she said these are political questions.
"In these circumstances, we are ill-equipped to inquire into and second-guess the complexities of decision-making and priority-setting that go into managing the state's budget,'' she wrote.
Norris stressed that the ruling does not mean she and her colleagues believe that the decision to cut funding complies with what voters directed in approving the ballot measure. She said it simply means that the question, being political, is beyond the court's powers to review.
Brewer has defended the cutbacks in who qualifies for free care, saying the alternative would have been "devastating cuts'' to other state services including education and public safety.