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Let's look at Medicaid expansion in Arizona as if we were buying a first house.

It's a big step financially and not free of risks. But if it works out, the up side in the long run far outweighs the negatives.

In the case of health care for the working poor, Arizona, like most states, has struggled since the Great Recession of 2008 to fully fund some previous commitments. Now, under Obamacare, the federal government will make up that difference and more for the first three years, with only a minimal contribution from the state.

It's almost like those old five-year, no-interest mortgages with a balloon payment at the end that you hope you can refinance -- except the latest plan from Gov. Brewer contains an out clause if the federal share falls below 80 percent. Arizona would still lose the "house" -- i.e., expanded health care for the poor -- but at least it wouldn't be stuck making a big payment, too.

$1.6 BILLION A YEAR

The plan calls for Arizona to go along with Obamacare's requirement to extend coverage to those with incomes up to 133 percent of the federal poverty level, or about $15,000 a year for an individual. Above that, Obamacare sets up a system of mandatory private insurance coverage with generous tax credits for those earning up to 400 percent of the federal poverty level.

The federal government will contribute an estimated $1.6 billion a year to cover an extra 300,000 Arizonans on Medicaid by 2015. The state's share of about 10 percent would come from a new assessment on hospitals that would raise $350 million a year -- an assessment that every other state already collects.

Why are the hospitals kicking in some cash? In part, as FMC CEO Bill Bradel said in a guest column last week, it is for humanitarian reasons -- hospitals are staffed by health professionals who believe patients should have affordable access to primary care like checkups that keep them from suffering more serious problems. But when they do get sick enough to need hospital care, hospitals benefit financially when more patients are covered by insurance. That also lowers premiums for everyone else, who are now paying for the cost of uninsured care.

AHCCCS RUN AS HMO

But won't the hospital assessment raise patient bills and thus result in more costly insurance? No -- the governor's plan says the fee cannot be passed on to patients. The hospitals will have to find the money somewhere else in their budgets.

And what about worries that those receiving free health care will overuse the system, especially if doctors are getting paid per procedure? As it turns out, Arizona has addressed that question by setting up its Medicaid program -- known as AHCCCS -- as an HMO. The result is that the costs per patient covered by AHCCCS are $680 below the national average for state Medicaid programs and emergency room visits are much lower than average.

Wouldn't it be even more effective if AHCCCS patients had co-pays just like patients with private insurance? Yes, but so far the federal government has not allowed co-pays, and the courts have upheld that practice. That battle has to be taken up with Congress, not the Legislature.

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Finally, what about the concern that by going along with the federal Medicaid expansion, Arizona is signaling an acceptance of Obamacare? Without debating the pros and cons of Obamacare here, it's time to realize that the train has left the station and the main impact of refusing federal aid will be a less healthy population of poor adults and children in Arizona.

That's one reason that most leading business organizations have joined healthcare groups in endorsing the governor's plan: If Arizona doesn't claim its fair share of federal funds, it will be left behind economically by the other states that do and have less healthy workers, too.

GOVERNOR DESERVES CREDIT

We have been critical in the past of Gov. Jan Brewer for what has appeared to be a reflexive opposition to federal authority that has been counterproductive economically and harmful socially. So we are also obliged to give credit when elected leaders put politics aside and look for constructive solutions that involve bipartisan compromise.

In this case, Gov. Brewer has shown strong leadership in not only crafting a solution but building a broad coalition of support. That bodes well for Arizona not just on health care reform in the coming years but on whatever approach on illegal immigration comes out of Congress and the White House.

We need to put the days of finger-pointing behind us and build the Arizona all of us know we can be.

Serving this week on the Daily Sun's Editorial Advisory Board were Publisher Don Rowley, Editor Randy Wilson and citizen members Joyce R. Browning, John Lauc, Mark Lamberson and Al White.

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