Matters of Life and Death

Florence (Beth) Clarkson

Case Report 7

Matters of Life and Death

This case describes the impact of the state of Arizona’s decision to defund most organ transplants from the health care program for the indigent, the Arizona Health Care Cost Containment System (ACHCCCS). In contrast, the legislature voted to increase funding for basic health service to pregnant women and to children between the ages of six and thirteen, labeled the “notch group”. These families earn too much to qualify for ACHCCCS but still earn less than the federal poverty level. In 1987, Arizona’s income eligibility cut-off for a family of four was $5,354 while the federal poverty level for a family of four was $11,650, leaving many of Arizona’s poor with no health coverage of any kind.

Distinguishing itself as a conservative state, Arizona legislators, fearing intrusion from the federal government, chose not to sign on for federally funded Medicaid when it was created at the national level in 1966. This program was designed to pay a share of the costs of providing health care for the poor depending on the relative wealth of the state. For fifteen years Arizona counties provided varying levels of health care to the poor with its own dollars. This system eroded over time resulting in unequal eligibility, uneven services and an increasing cost burden on the counties.

As health care costs continued to rise, Arizonans found that they (costs) consumed, on average, a quarter of each county’s annual revenue, coming mostly from property taxes. In 1980 a referendum was passed limiting the property tax levy. The result of this was a budget crisis that required immediate action. At this point, the state legislature began to consider tapping in to the federal Medicaid program. The legislators remained skeptical of the potential fraud and abuse of the program so they bargained with HCFA to set up a program significantly different from the conventional Medicaid system. The Arizona program...