AHCCCS memo from 2007 said transplant cuts could kill; special session mulled
THURSDAY, 30 SEPTEMBER 2010
By Mary K. Reinhart and Dennis Welch
The Arizona Guardian
Dr. Jeff Schriber didn't intend for one of his leukemia patients to become a political football. He just wants to remind Gov. Jan Brewer and legislators that people will die if they can't get bone-marrow transplants.
Now Democratic gubernatorial candidate Terry Goddard is urging Brewer to call a special session to restore the AHCCCS services that she and GOP legislators agreed to eliminate, effective Friday, while Democratic lawmakers have drafted a bill to do just that.
"Urgent circumstances require urgent action," Goddard said in a letter, hand-delivered to Brewer's office Thursday afternoon. "I call on you today... to reconsider this reckless decision and to restore funding for these services."
Brewer spokesman Paul Senseman called Goddard's request a "disgusting attempt to exploit a real human tragedy for possible political gain," but wouldn't say whether the governor is considering a special session on the matter. Earlier Thursday, in response to a reporter's question about Schriber's patient, Mark Price, the governor said "no one has asked me to call a special session."
"We have a responsibility as policymakers to make hard decisions," Brewer said following a news conference outside the Executive Tower. "We will do the very best job we can given the limited resources that we have."
As the Guardian reported earlier this week, Price needs a bone marrow transplant, but he doesn't have a relative that's a match. As of today, AHCCCS no longer funds non-relative bone-marrow transplants, along with lung transplants and certain types of heart, liver and pancreas transplants.
AHCCCS says the benefit reductions were made based on studies showing they would affect the fewest people or, in the case of transplants, represented the least effective treatment.
But Schriber says lawmakers based their decision to cut the transplants on flawed data from AHCCCS, which showed that no patients had survived beyond one year following the procedure.
Schriber, director of the state's largest adult bone-marrow transplant program at Banner Good Samaritan Medical Center, has been trying to alert Brewer, legislators and AHCCCS officials since last year that his own data show a 42 percent survival rate for his patients over the past seven years.
"We tried to prevent this," Schriber said Thursday. "I don't think this should be a political thing. I think there are people on both sides of the aisle that recognize this is not a good idea. The frustrating thing for me is, we talked about this back in 2009."
In fact, lawmakers and state officials have been talking about this since at least 2007, when AHCCCS prepared information for the Legislature's budget office indicating that cutting optional services would be costly, in both human and economic terms.
"It is anticipated that as a consequence of not covering transplant services for adults, the number of hospitalizations and other expensive interventions will increase, along with the potential fatality rate for patients who are unable to pay for transplant services out of pocket," then-deputy AHCCCS director Tom Betlach wrote in a November 2007 memo to JLBC staff.
"It is critical to note that the elimination of some transplants will actually increase costs over the long-run," wrote Betlach, now AHCCCS director.
Among the other AHCCCS services that lawmakers eliminated, including physicals, podiatry and dental care, Betlach warned in 2007 that the short-term savings likely would result in long-term suffering for patients and higher costs to taxpayers.
"There are people acting like they didn't know about this," said Rep. Krysten Sinema, the assistant House minority leader. "This is not a shock or a surprise."
When the AHCCCS cuts first made it into a 2009 budget-balancing proposal, Sinema ran a successful floor amendment to restore the services. Lawmakers, however, failed to fund them, but they were still covered under AHCCCS.
Republicans again put the optional cuts into this year's budget, but a Sinema amendment during the House Appropriations Committee meeting in March was defeated and the cuts ultimately approved on nearly party-line votes during the seventh special session. GOP Sen. Jay Tibshraeny and Rep. Doug Quelland joined Democrats to oppose HB 2010, and Sen. Carolyn Allen did not vote.
The AHCCCS cuts will save $5.3 million this fiscal year by eliminating optional services to its 1.3 million adult members, but the state will lose about $20 million in matching federal funds. For fiscal 2012, the first full year of the cuts, the state saves $9.2 million and loses $27 million in federal funds.
As Mark Price's story gathered media steam Thursday, House Majority Leader John McComish said a special session could depend on whether pressure continues to mount on lawmakers.
"I wouldn't say it's a groundswell yet, but it's starting," McComish said. "On one hand, nobody wants to see people die. But we didn't have the money back then. We don't have it now."
He said a key factor is whether lawmakers "acted on bad information," as Schriber says they did.
"There's more we need to know," McComish said. "You don't want to have a special session unless you have the facts, you understand them and everybody's on board."
But Sinema said talk of a special session is a ruse. Brewer could use some of her discretionary federal stimulus funding to restore all of the optional cuts, she said, just as she's used the money for public safety, energy, rural development efforts and a new roof for Veterans Memorial Coliseum.
Schriber said he hopes Brewer and lawmakers figure it out. And soon.
"I would like this guy to get cured," Schriber said. "This is what everyone fears. Everyone fears being told, 'Your life isn't worth saving.' "
