Randy Shepherd is a 36-year-old father of three who needs a transplant to replace a failing heart weakened by childhood bouts of rheumatic fever. When he was placed on a transplant waiting list last year, the prospect of resuming a normal life with a healthy donor heart helped him tolerate the fatigue, lost appetite and the inability to play sports he loved and work at the small plumbing business he founded.
But nothing prepared him for the shock of learning that Arizona's Medicaid program was eliminating transplant coverage for people with his condition.
"They said I would be placed on the inactive list until I could arrange some kind of alternative financing because it is considered elective surgery," said Shepherd, of Mesa, Ariz., who has been disabled for almost two years. The family hangs on financially with his wife Tiffany's salary as a dental hygienist.
As the United States continues debating expanded health care access, the state of Arizona has begun rationing some care it says it cannot afford to give its poorest residents. Beginning on Oct. 1, Arizona's Medicaid program, the Arizona Health Care Cost Containment System, stopped covering seven types of organ transplants, including heart transplants for non-ischemic cardiomyopathy, lung transplants, pancreatic transplants, some bone marrow transplants and liver transplants for patients with hepatitis C.
The reductions made by the Arizona state government were approved by the federal government, according to an Aug. 11 letter from Gloria Nagle, associate regional administrator for the Division of Medicaid & Children's Health Operations. In addition to limiting organ transplants, Arizona also restricted coverage of prosthetics and zeroed out podiatrists' services, preventive dental services, and wellness and physical exams for adult Medicaid enrollees.
"This may be a harbinger of what will evolve in this Obama national healthcare system where the expense of the health system will only be able to be contained by limitation of access," said Dr. David C. Cronin, director of liver transplantation at the Medical College of Wisconsin. "So everybody may be covered, but all services may not be available."
Of Arizona's decision to pull the plug on an insured patient's transplant, he said, "I don't see how that's fair on any level. It's indefensible to renege if the patient did everything they were supposed to do and they don't have another option. You shouldn't try to balance your budget on the backs of the most desperate patients."
Arizona's Republican governor and legislature, who already control the state's purse strings, want even more independence when it comes to determining which health care services Arizona Medicaid patients receive. Indeed, Arizona's newly elected Senate President Russell Pearce has argued for cutting the state's Medicaid program, even if that means Arizona will lose about $7 billion worth of federal grants.
"If we're saving money, the fact we lose some federal money means nothing," Pearce recently said. "If you can't afford Dillard's, even though they're having a great sale, you can't afford Dillard's."
Dr. Michael Shapiro, chief of organ transplantation at Hackensack University Medical Center in New Jersey, balked at the way Arizona chose to reduce its record deficit: "They're cutting in the wrong place."