PHOENIX -- Gov. Doug Ducey said Thursday he does not want the new president and Congress to repeal the Affordable Care Act unless and until they come up with a replacement that protects Arizonans.
Ducey acknowledged that one of the key campaign promises of Donald Trump is to scrap was has become known as ObamaCare. That program is designed to provide affordable health insurance for those who do not get it from employers or elsewhere, with a financial penalty for those who have no coverage.
Trump and other Republicans have focused on double-digit premium increases and fewer options for those who purchase coverage through the Affordable Care Act.
But there's more to the program.
It bars insurers from denying coverage because someone has a pre-existing condition. Lifetime limits on benefits also are generally off limits.
And potentially most significant for Arizona, it provides states with financial incentives to expand their own Medicaid programs. Arizona took advantage of that.
If the law is repealed, those federal funds would dry up, endangering coverage for about 400,000 individuals. And that, said Ducey, is unacceptable.
"We know that ObamaCare isn't working, we know that it's badly broken and in need of improvement,'' the governor said. But Ducey said any solution has to be about not just repeal but replacing it with something.
"We want to see all of our citizens have access to affordable health care,'' he said.
"That's not where we are,'' the governor continued. "We've got a new Congress, a new president and a fresh start.''
Ducey said there are things in the Affordable Care Act that probably should be preserved, like the ban on denying coverage for pre-existing conditions and the prohibition against lifetime caps. But the direct impact on Arizona is the dollars the federal law provides for the expanded Medicaid program.
Prior to 2013, the state provided care to people below the poverty level, a figure at the time that was $19,790 for a family of three. The federal Medicaid program provided about two-thirds of the necessary cash.
The Affordable Care Act said Washington would pick up virtually the entire cost for the first few years for any state which expanded eligibility up to 138 percent of the poverty level.
Then-Gov. Jan Brewer pushed the expansion through the legislature to take advantage of the federal dollars.
Arizona also had to restore coverage to single adults below the poverty level whose insurance had been cut years earlier in a budget-savings move. That also drew in federal dollars; the state's share of that is funded by a separate assessment on hospitals, the legality of which is still being hashed out in Arizona courts.
But if there is no Affordable Care Act, all that federal money for the expansion goes away.
That would put Ducey in the position of either having to kill health coverage for those in the expanded program or find the money somewhere in the state budget.
And that does not even consider the more than 150,000 Arizonans who are not in the expanded Medicaid program but who have obtained their own coverage through the Affordable Care Act, about 75 percent of them with federal subsidies to make the premiums more affordable.
All that, said Ducey, makes outright repeal without something else to take its place unacceptable.
"I'm not talking about repeal,'' he said.
"I'm talking about repeal and replace,'' Ducey continued. "I want to see all of our citizens have access to health care that's affordable.''
With outright repeal unacceptable, the governor said it remains to be seen what Trump and Congress can come up with as an alternative.
"The devil is going to be in the details of a health care plan that allows accessibility to all of our citizens,'' he said.
"That's the discussion that we're going to have,'' the governor continued. "What we have currently isn't working.''
This isn't the only time Ducey has been in the position of defending the Affordable Care Act and specifically the Medicaid expansion that Brewer got enacted using ObamaCare dollars.
As far back as 2014, while running for governor, Ducey called it an unacceptable expansion of government. But he said he would veto any attempt by the Republican-controlled legislature to repeal the expanded program financed with Affordable Care Act dollars, saying that's not a realistic option with hundreds of thousands of Arizonans now in the program.
And Tom Betlach, Ducey's director of the state's Medicaid program, continues to defend a lawsuit filed against him by lawmakers that contends the assessment on hospitals which pays the state's share of funding for the expansion was enacted illegally because it did not have a two-third vote of the legislature.