PHOENIX -- Arizona stands to lose a third of its federal funds that support the expanded Medicaid program as early as 2020 if Congress adopts the Graham-Cassidy health care bill, according to legislative budget staffers.
The analysis released late Thursday by the Joint Legislative Budget Committee shows the state now gets about $3.8 billion in federal dollars for Medicaid expansion and the health insurance exchange. That is expected to grow to $4.9 billion by 2020.
Under Graham-Cassidy, the report says, the state would get $3.2 billion in 2020.
That $1.7 billion difference -- a 34.9 percent change compared to current law -- is only part of the financial setback the state would suffer if the proposal currently awaiting a Senate vote is enacted.
Aside from how that might affect the approximately 80,000 Arizonans now getting care under a federally funded expanded Medicaid program, legislative budget staffers say the change in federal funding could trigger a "poison pill'' provision in the 2012 law that levies an assessment on hospitals.
That is significant since the $286.5 million raised pays to provide health care coverage for about 320,000 single adults, people who were cut from the program years earlier in a budget-saving move. The state could have to pick up the cost because of a 2004 voter-approved mandate to provide care for everyone earning less than the federal poverty level.
And analysts said if fewer people have health coverage, then the insurance companies will collect less money which, in turn, will mean they owe less to the state in premium taxes, resulting in an estimated loss of $34.1 million.
The new report is significant because Gov. Doug Ducey, who supports the Graham-Cassidy bill, has brushed aside other studies that also have shown significant losses in federal dollars. On Wednesday he lashed out in particular at one crafted by the Center for Budget Priorities and Planning which showed a $1.6 billion loss to Arizona in 2026 as coming from "a left-wing or left-leaning organization that has a real stake in maintaining the status quo.''
What is in the JLBC report does have a lower figure for that year. But it still shows Arizona collecting $1.2 billion less than what it would otherwise get that year.
More significant, what was released Thursday comes from the staffers who serve the Republican-controlled legislature.
Despite that, gubernatorial press aide Daniel Scarpinato said none of that changes his boss's support for the measure.
"This is not a complete analysis of the bill,'' he said, saying it "specifically ignores policy provisions that are likely to positively impact Arizona.''
Christina Corieri, the governor's health policy adviser, said one of those would alleviate the state of its financial obligations to share the cost when Native Americans get care at nonIndian Health Services facilities. Corieri said she could not say what that would save Arizona other than "it's a very large number.''
But Scarpinato had no counter to the JLBC study, as Ducey's own staff has yet to publicly produce its own analysis, one he said will include "a comprehensive look at all provisions of the bill.''
The report could become crucial to the fate of the entire legislation, coming as there is pressure on John McCain, the state's senior senator, to vote for the measure.
To this point McCain, who rejected an earlier "skinny repeal'' proposal, has not announced his intentions. But in a statement earlier this week, press aide Julie Tarallo said her boss "continues to review the bill to assess its impact on the people of Arizona.''
But Jeff Flake, the state's junior senator, remains a supporter of Graham-Cassidy as he has been of other efforts to repeal the Affordable Care Act. Appearing on The Late Show, Flake told host Stephen Colbert he sees it as "letting those at the local level run it better.''
What's driving the anticipated revenue loss is the way the Graham-Cassidy bill changes the Medicaid expansion of the Affordable Care Act. That provides an incentive for states to provide coverage for people making up to 138 percent of the federal poverty level -- $28,180 for a family of three -- with Washington picking up virtually all of the cost.
Beginning in 2020 the proposal would both eliminate the expansion funding as well as federal subsidies for individuals who get coverage through the ACA marketplace. It would be replaced with a new federal "block grant'' program, with aid to each state based on its share of individuals within a certain income range.
The JLBC report says Arizona's block grant dollars in 2020 would be nearly $3.2 billion, a figure they said they got using estimates developed by sponsors of the federal legislation. That compares with the almost $4.9 billion it would get under current law.
In future years the state's block grant allotment is projected by the sponsors to grow by 8.5 percent a year. Extrapolating that out to 2026 creates the $1.2 billion difference between current law and what Arizona would get under Graham-Cassidy.
After that is anyone's guess, as the grants in the federal legislation self-destruct in 2027.
Corieri said there are other elements in what the Senate is weighing that she believes also could end up saving money to the state, though she provided no specifics and said the language about care for Native Americans is "one of the largest pieces'' that was not part of the JLBC analysis.
"That is one of the things we are putting into the numbers we are working on and making sure it is a holistic look at the bill, not a myopic look at one piece of the bill,'' she said.
"We have a lot of respect for the analysts from JLBC,'' Scarpinato said. But he said "they may have been charged to look at one piece'' of the legislation.
Scarpinato also said Ducey remains convinced that Congress needs to act to scrap the Affordable Care Act.
"The governor believes that we can do better with health care in the United States of America and in Arizona,'' he said. "Obamacare hasn't worked.''
The analysis comes just hours after the Arizona Nurses Association added its voice to those of other medical groups in opposition to the Graham-Cassidy bill.
"This legislation threatens healthcare coverage for hundreds of thousands of Arizonans and may lead to the elimination of protections for individuals with pre-existing conditions,'' according to a statement by Robin Schaeffer, the group's executive director, and Carol Stevens, president of the board.
A man who died in a Flagstaff motel room on Sept. 7 was extremely intoxicated and beaten on the face multiple times, according to a newly released police report.
Four teenagers, all of Flagstaff -- Lawrence Sampson-Kahn, 18, Kayson Russell, 19, Mirelle Gorman, 16 and Jayda Fortune, 17 -- are charged with second-degree homicide after a fight during a party in Room 119 at the L Motel on South Milton Road led to the death of Jaron James, 23.
The party escalated into a deadly affair after James inappropriately tried to touch Gorman and Fortune multiple times, according to police interviews with all four suspects.
The incident occurred at 1 a.m., according to the police report.
Fortune and Gorman then began to hit James in the face, with Russel and Sampson-Kahn joining the two women.
Gorman told police that “the guys were ready to (expletive) him up” because Russell was dating Gorman and Fortune and Sampson-Kahn were close.
James was very intoxicated during the incident and reportedly tried to “block his face lazily” while slipping in and out of consciousness, according to Russell’s interview with Flagstaff Police detectives.
When found by police, James’ face was swollen, with a busted lip and a possible broken nose, according to the police report.
After the fight, the four suspects left the motel and resumed their party in Bushmaster Park, according to police reports.
James’s relative Deon Yazzie, 21, and Yazzie's girlfriend Mariah Johnson, 18, stayed behind in the room overnight while they thought James was sleeping. They called 911 the next morning after checking on James and seeing that he was not breathing.
Police reported James deceased at 9:20 a.m. The four suspects arrested were not aware that James had died until they were interviewed by police the next day.
Police detectives indicated that James died from a combination of his injuries and extreme intoxication; however, the coroner's report is not complete.
The room was rented in Johnson’s name, and both Yazzie and Johnson initially told police that James walked into the room drunk and hurt. They later told police that this story was a lie and that they witnessed James being beaten, but did not participate.
Yazzie and Johnson are being charged with felony endangerment.
The police report contains notes of detectives’ interviews with each suspect with the exception of Fortune. Each suspect told police that they were minimally involved with the fight that killed James.
However, Russel, Sampson-Kahn and Gorman all said that Fortune was the first to attack Gorman on the bed.
Russell said Fortune “took the first swing, which put him (James) out,” and Gorman was the next to hit James. He went on to say that the “girls beat the (expletive) out of him while he was unconscious.”
Russell initially denied having any involvement in the fight, stating that he was out of the room. But later he said he “kicked him once on the way out because he was touching my girl.” He also said he did not personally see James touch the girls inappropriately.
Police found blood stains on Russell’s pants that he said were from a fight with Gorman after the incident, when she hit him on the head with her cellphone.
Sampson-Kahn initially told police that he was not at the motel and stayed home all night. But when confronted about the other suspects' interviews, Sampson-Kahn said he “hit (James) maybe once, but the girls beat him up and not that bad.”
A red stain was found on Sampson-Kahn’s shoe during his police interview and he told police that the stain was cherry pomegranate. The police report did not confirm or deny Sampson-Kahn’s statement.
Gorman told police that James touched her in the groin area and that she only punched him once in the face but that Fortune and Russel repeatedly hit James after he touched Fortune.
Police reported that Gorman’s knuckles were bruised and a broken fingernail found at the crime scene matched Gorman’s.
Sampson-Kahn did not punch James because he had a broken arm, according to Gorman.
The police report states that Sampson-Kahn did have a hand injury, but not that his arm was broken.
When the four-suspects left the motel room, Gorman said Fortune told her “You are pretty and that is what guys do to girls and that is why we did what we did to him.”
According to the police report, Gorman cried “He touched me, he touched me, but it doesn’t matter that he touched me,” after she learned James was dead.
Johnson said she saw James touch Fortune, but described his interaction with Gorman as “a pat on the back.”
The police report states that Russel, Sampson-Kahn and Fortune met at Coconino High School. The Flagstaff Unified School District said that none of the suspects is enrolled in a district school this year. Attempts to obtain comments from their families have been unsuccessful. All the suspects face arraignment in Coconino Superior Court on the charges Monday.