Four years after former Gov. Jan Brewer pushed a Medicaid expansion plan through the Legislature, the Arizona Court of Appeals has finally set a date to hear a challenge to the legality of a hospital assessment that pays the state costs of insuring more than 400,000 low-income residents.
The Feb. 14 hearing date announced by the appeals court this week comes as Republicans who now control Congress begin their promised repeal of President Barack Obama's health care overhaul law that allowed the expansion.
And it comes as advocates for the expansion continue a series of news conferences across the state designed to show just how it and other parts of Obama's law have helped Arizonans.
"We're just trying to send a message, which is that it's really irresponsible and could cause a lot of chaos if they repeal the (Affordable Care Act) without an immediate replacement," said D.J. Quinlan, one of the organizers of the effort.
Meanwhile, the Obama Administration is pushing to get people who don't qualify for Medicaid to buy insurance on the federal marketplace. That effort appears to be making headway as plan selections during the current open enrollment period are outpacing levels seen in last year's period.
Nationally, 8.8 million people chose a plan through Dec. 31 in the 39 states using the federal HealthCare.gov website, compared with 8.6 million during the same period last year, the Health and Human Services Department announced Wednesday. Similar increases are seen in Arizona, where more than 182,000 people have picked a plan with nearly a month left in open enrollment.
That means the state is about 4,000 enrollees ahead of current enrollment with the busiest period coming before open enrollment ends Jan. 31.
That increase came despite soaring rates and a collapse in the number of insurance companies offering plans here. All but one Arizona county has just one insurer, and premiums for benchmark silver plans soared by 116 percent on Jan. 1. The vast majority of people receive federal tax subsidies that offset those increases.
"I think the focus should be on how do we build on the progress we've made and we do have more than 20 million Americans that have gained coverage and many protections for those folks and also people in the employer markets," HHS regional director Melissa Stafford Jones told reporters Wednesday. "Repeal and delay does not make that kind of progress and does not ensure that we continue to have the progress that we have."
Republicans who oppose Medicaid expansion and the rest of Obama's law said now is the time to repeal it.
"The American people voted decisively for a better future for health care in this country, and we are determined to give them that," vice president-elect Mike Pence told reporters at the Capitol on Wednesday.
The wild card remains just how long a delay is set in a repeal law. Republicans are discussing at least an 18 month period, leaving Medicaid and tax subsidies in place this year.
Repealing Arizona's Medicaid expansion and other Medicaid changes could result in the loss of insurance to nearly 550,000 people, according to a review by the Legislature's budget analysts. Retaining those people while the federal law is repealed would cost the state more than $1.4 billion -- money not available without major tax increases that Ducey and Republican lawmakers oppose.
For his part, Ducey has played it safe on a path forward on Medicaid while backing the state law in court. He said after the November election that the answer is in replacing Obama's law.
"We want to see all of our citizens have access to affordable health care," Ducey said. "That was the objective, that's not where we are. We've got a new president and a new Congress, and a fresh start."
The state court of appeals will hear the challenge more than four years after Brewer shocked her own party by announcing she would embrace a major component of Obama's law.
Brewer battled fellow Republicans in the Legislature for months before finally pushing through the law that now covers more than 400,000 additional Arizonans. The costs are paid by an assessment on hospitals, which Republican lawmakers who sued call a tax that required a 2/3 majority vote to pass.
A trial court in 2015 sided with Brewer and state Medicaid director Tom Betlach, with a judge ruling the assessment was not a tax.
The Goldwater Institute, representing the GOP lawmakers, appealed.