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Pulling Plug on Grandma Puts Health-Care Opponents on Defensive

Randall Shepherd's Family
Randall Shepherd poses with his wife Tiffany and his children; Krista, 13, Kelsey, 9, and Nathan, 3, in this photo taken in 2009. Photographer: Brooke Eagleston via Bloomberg

Randall Shepherd, a 36-year-old father of three who needs a new heart after childhood battles with rheumatic fever, is one of 98 Arizonans no longer eligible for state-paid transplants after Governor Jan Brewer and the Legislature eliminated funding.

Shepherd, a plumber from Mesa who no longer can work, said he was next on the list to receive a heart of his size and blood type when the transplant program was eliminated Oct. 1, cutting him off from the $600,000 procedure. Now, “I wouldn’t even be notified,” he said in a telephone interview, his breathing labored.

The Republican governor’s elimination of transplants to save $800,000 toward a $3 billion budget deficit makes Arizona the only state to do so in the past two years, according to a report from the Henry J. Kaiser Family Foundation, a nonprofit health-care researcher in Menlo Park, California.

“Our concern is that patients will die,” said Maryl Johnson, a cardiovascular specialist at the University of Wisconsin Hospital in Madison and president of the American Society of Transplantation, a professional group based in Mount Laurel, New Jersey. “We want to make sure the state is making decisions based on accurate information.” Patients in Shepherd’s condition have a 50 percent chance of living 11 more years if they have the surgery, she said.

‘Brewercare’ Decision

Brewer’s transplant cutbacks have become a rallying cause for Democrats, who call her decision “Brewercare.” It’s hypocritical for Republicans to support the program’s end while opposing President Barack Obama’s health-care legislation on the ground it would create death panels run by bureaucrats, said Anna Tovar, a Democratic state representative from Tolleson.

“We are the only state that has cut transplant care,” said Tovar, 36, who said her insurance paid for bone-marrow transplants in 2000 and 2001 as she fought leukemia.

“What the governor calls Cadillac care, optional service, we’re talking a life-or-death decision,” Tovar said in a telephone interview.

Equating Arizona’s cutback with death panels is “utterly absurd,” said Paul Senseman, a spokesman for Brewer. Every state and the federal government decides which patients and treatments are eligible for funding, he said in a telephone interview.

Health-care costs have soared because Arizona offers services to residents with higher incomes than other states do, Senseman said. Its enrollment in Medicaid, the joint federal-state health program for the poor, jumped 19 percent from December 2008 to December 2009, the fourth-highest growth rate of any state, according to the Kaiser foundation.

Arizona’s unemployment rate rose to 9.2 percent from 7.6 percent in the period, according to Bureau of Labor Statistics data. The rate was 9.5 percent in October.

‘Unsustainable’ Costs

The transplant cuts indicate what other states will face because the federal Patient Protection and Affordable Care Act of 2010 expands coverage for the uninsured, he said.

“Arizona has been doing what Obamacare has promised,” Senseman said. “It’s unsustainable. Neither the states nor the federal government have the ability to pay for it.”

Arizona’s Republican-controlled Legislature voted in March to join 19 other states in suing the U.S. departments of Health and Human Services, Treasury and Labor challenging the constitutionality of the Obama health-care bill. The state’s Democratic attorney general, Terry Goddard, who unsuccessfully challenged Brewer’s re-election this year, declined to do so.

‘Unconstitutional Encroachment’

“We must defend against unconstitutional encroachment upon our core right to govern ourselves, rather than be at the mercy of an overreaching president and a Congress so eager to please him,” Brewer, 66, said in a March statement. The governor also signed legislation authorizing police to check the citizenship of people suspected of being illegal immigrants.

Arizona’s health-care costs were increased by a 2000 ballot measure designed to use money from a tobacco-lawsuit settlement to expand coverage for the poor, according to John Kavanagh, a Republican who chairs the appropriations committee in the state House of Representatives.

The state is one of only six that provides health-care benefits to childless adults whose income is at or equal to the federal poverty level of $903 a month, said Jennifer Carusetta, chief legislative liaison for the Arizona Health Care Cost Containment System, which administers Medicaid.

Brewer’s transplant cuts were part of $5.3 million shaved in March from what the federal government calls optional services, said Carusetta. The cuts included payments for most dental care, podiatry and insulin pumps, according to a fact sheet on the system’s website.

$2.2 Million Saving

Transplant savings would account for $800,000 this year and $1.4 million next year, Carusetta said in a telephone interview.

Tovar, the Democratic state legislator, said funding for transplants could have come from $185 million in federal stimulus funding the state received. She said Brewer didn’t identify how $30 million of the cash -- more than enough to finance transplants -- was spent.

The state used $1.7 million of stimulus funding for roof repairs at the Veterans Memorial Coliseum in Phoenix, according to a press release from Brewer. An additional $2 million went to study the use of algae as fuel, according to a news release from Brewer.

Using federal grants this year for transplants wouldn’t have solved the longer-term issue of funding the procedures, Senseman said. All $185 million in stimulus money has been allocated for education, public safety, job creation and other programs, he said. The roof of the coliseum, which is the home of the revenue-generating state fair, needed repair, while the fuel-research program is a job creator, he said.

Sales-Tax Increase

Arizona closed a $3 billion budget deficit this year by raising the sales tax, selling public buildings such as its legislative offices and taking money from a rainy-day fund, Kavanagh said,

The transplant cuts were made public before the Legislature voted, and were based on information from the Arizona Health Care Cost Containment System that said the procedures were not effective, Kavanagh said. Treatments with less risk have similar outcomes, the system said in a report.

“When there’s not a protocol that works, it’s irresponsible,” Kavanagh said in a telephone interview. “The Democrats want to give everybody everything and call us executioners.”

Surgical Alternatives

Nick Papas, a spokesman for Obama, declined to comment.

Alternatives to transplants such as medication and “less radical” surgeries are as effective as heart transplants for treating Shepherd’s illness, nonischemic cardiomyopathy, according to a report on the Arizona health-care system’s website.

Shepherd said his doctor told him he’s taking all the medicine he can tolerate.

Carusetta, the legislative liaison for Arizona Cost Containment, said she couldn’t comment on Shepherd’s case because of privacy laws. The system’s analysis was validated by an external consultant, she said.

Stimulus Expiration

Arizona faces an additional $825 million deficit for this fiscal year and a shortage of more than $1 billion for the one that begins July 1, according to Kavanagh. The expiration of $651 million in federal stimulus money for Medicaid is one reason for the widening deficit.

Federal law limits states in how they deal with financial pressures on their Medicaid programs, said Joy Johnson Wilson, health-policy director for the National Conference of State Legislatures, in Washington.

The 2008 economic-stimulus package and this year’s health-care overhaul each forbid states from reducing eligibility for Medicaid if they want the extra money those laws provide for the program. States are responding by cutting benefits and payments to providers, Wilson said.

Lingering effects of the recession, which was the longest since the 1930s and increased the number of people seeking government assistance, will force health-care cuts in other states this year, said Kathleen Gifford, a principal with Health Management Associates, a consulting company in Indianapolis.

‘Hit Hard’

“We’re coming into a very difficult budget session,” Gifford said in a telephone interview. “Arizona got hit hard earlier than a lot of states.”

California in the past fiscal year eliminated dental, speech, podiatry and other services, she said. The cuts saved the state $110 million, said Anthony Cava, a spokesman for California’s Department of Health Care Services.

Governor Arnold Schwarzenegger on Dec. 6 proposed capping prescriptions to six a month and increasing payments for hospital stays to $100 a day, said Anthony Wright, executive director of Health Access California, an advocacy group in Sacramento, the state capital.

“That’s a lot if you’re earning $1,000 a month,” he said.

In Arizona, Shepherd is waiting for contributors to help raise money for his operation.

Shannon McMonagle, communications coordinator for the National Transplant Assistance Fund, a Radnor, Pennsylvania- based group, said it has received donations totaling more than $130,000 since November for Shepherd and another Arizonan who has been waiting for surgery.

While legislators are “trying to do the right thing” by reducing the state’s deficit, eliminating organ transplants isn’t the answer, Shepherd said.

“It was the wrong place to start cutting,” he said.

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