COLLINS: Arizona strikes again, with Medicaid

Let us revisit the matter of pulling the plug on grandma.

You may remember the historic day in 2009 when Sen. Chuck Grassley brought the issue to the fore at a town meeting in Iowa. “We should not have a government plan that will pull the plug on grandma,” he said to loud cheers.

Later, President Barack Obama asked Grassley whether he would vote for the bill if all his suggestions for change were included. Grassley said probably not. This was taken to be a bad sign.

Then all hell broke loose and the Republicans kept ranting about how “Obamacare” would put the federal government between you and your doctor and try to save money by prohibiting said doctor from using the best treatments and procedures.

All this came to mind when I was talking to Flor Felix, whose husband, Francisco, a 32-year-old truck driver with four kids, was denied a liver transplant because the Arizona Legislature had yanked funds for it out of a state Medicaid program.

Francisco had been prepped for surgery after a friend whose wife was dying asked that he be given her liver.

“It was good news when we heard the liver matched,” Flor said. “The doctor said: ‘Everything’s going well. We’re going to proceed with the surgery.”’

But Francisco, who has hepatitis C, had lost his health insurance when he had to stop working and had gotten coverage under the state Medicaid program. And Gov. Jan Brewer had signed a law eliminating Medicaid coverage of certain kinds of transplants as a cost-cutting measure. Flor said the next words she got from the doctor were: “You need to bring $200,000 as a deposit for the hospital.”

Francisco was summarily discharged. The Arizona state government, which is totally controlled by Republicans, got between him and his doctor.

“The state only has so much money and we can only provide so many optional kinds of care,” said Brewer, who we all remember for her path-breaking efforts to convince the world that the Arizona desert is strewn with the headless bodies of illegal immigrants.

Felix was one of 98 people in the transplant pipeline when the law went into effect. Arizona claims cutting them off will save $4.5 million this year. Advocates have called on Brewer to use some of the state’s $185 million in federal stimulus funds to restart the procedures. Brewer, who opposed the stimulus, says all the money is gravely needed for other projects. Which she will not name.

The best possible spin to put on all this is that it was a terrible mistake. The chairman of the Arizona House Appropriations Committee, John Kavanagh, says that the lawmakers got bad information from the state Medicaid experts, who said that the transplants weren’t effective. “Based on the information I’ve received, it looks like most of them should be reinstated and we hope to do that in January,” he said.

Ironically, trying to answer questions like this is one of the great goals of the Obama health care law. “What it promises to do is attack the vast reservoirs of ignorance about relative benefits of different ways of treating different diseases to see which is most effective,” said Henry Aaron of the Brookings Institution. Although, as Aaron carefully pointed out, the law steers clear of any mention of cost effectiveness. This is because Republicans in the House and Senate kept howling about death panels and plug-pulling.

It’s hard to give Arizona the benefit of the doubt on anything these days, what with the state’s dubious performances in matters like illegal immigrant hysteria, the selling of the state Capitol to help balance the budget, and the electing of Jan Brewer. However, let’s accept that given their economic problems, it would be natural for the Legislature to want to try to cut the Medicaid budget. Although preferably in some saner, less brutal manner.

But try to imagine what the Republicans would have said if someone in the Obama administration proposed cutting off liver transplants for Medicare recipients.•

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Collins is editor of The New York Times editorial page. Send comments on this column to ibjedit@ibj.com.