Photos by Sarah Prall,
The Arizona Daily Star
Gilbert Gamez, who originally came to El Rio Clinic over his asthma problems, has his blood pressure checked

Prop. 203 expands AHCCCS rolls

October 23, 1996

Beatrice Gamez often has a horrible choice to make: buy food for her family, or buy an asthma inhaler for her 14-year-old son, Gilbert.

As a $7-an-hour teacher's aide and sole supporter of a family of six, Gamez juggles her children's needs as best she can.

But sometimes, a ball drops.

Like yesterday, when a checkup showed Gilbert's untreated asthma was severe enough to require immediate attention.

``I just don't always have the money to pay for his medication,'' Gamez said yes terday, as a nurse at El Rio Health Center prepared a breathing treatment for her son.

El Rio is where Gamez and her children, along with 25,000 other working Tucsonans, go for the health care they cannot afford.

They are the ``working poor'' - people whose incomes exceed the $6,000 a year limit for a family of four to be eligible for the Arizona Health Care Cost Containment System, the state's indigent health care program.

Gilbert's story illustrates why El Rio and other agencies are backing Proposition 203, the ``Healthy Arizona'' initiative that would expand AHCCCS. Proposition 203 would add up to 180,000 more people like Gilbert Gamez and his family to the 450,000 Arizonans now cared for under the program.

Without regular care, those people's otherwise manageable health problems - like Gilbert's asthma - require more expensive interventions, even hospitalizations.

Supporters say Proposition 203 would save the state money. Because the federal government reimburses the state for AHCCCS care, making more people eligible would increase federal funds while reducing the burden on the state-funded ``medically needy, medically indigent'' pro gram.

That program helps people who cannot afford the $5,000 it can cost to buy health insurance for a family. They therefore rely on reduced-fee care from El Rio and other clinics that care for the working poor.

While the care at El Rio is good, it can only go so far for people like Gilbert Gamez. A bad strep throat infection six years ago developed into a life-threatening kidney disease that probably will require Gilbert to undergo a kidney transplant before he reaches adulthood.

The medically needy program that pays for most of the care the Gamez family gets at El Rio will not pay for hospitalizations or specialty care like transplants.

It has, for example, left Beatrice Gamez with $4,000 in unpaid bills at University Medical Center, where Gilbert has been treated by a pediatrician who specializes in kidney disorders.

While Proposition 203 would expand health care coverage to all Arizonans, supporters say half of them would be children.

``It is the most important piece of legislation related to the health care of children in the seven years that I have been in Arizona,'' says Dr. Andrew Arthur, chief of pediatrics at El Rio.

``It emphasizes prevention. It takes people out of the emergency room who should not be there. People without insurance are far more likely to progress from a simple sore throat to a major medical problem. It makes medical sense, it makes humanitarian sense, it makes financial sense.''

Proposition 203 is not the first effort to expand AHCCCS. Last year, conservative legislators defeated a similar bill.

They argued that the measure would make Arizona more dependent on federal welfare, at a time when the government is looking for ways to reduce welfare spending.

Supporters argue just the opposite. They say Proposition 203 would reduce the need for welfare by allowing people to keep their jobs and still qualify for health care assistance.

AHCCCS now forces people to quit their jobs to get their families the care they need, say supporters of the proposition.

Even if voters pass the measure on Nov. 5, the federal government still must approve the expansion.

But El Rio Director Robert Gomez says it's more than worth a try.

El Rio will write off $5.5 million in charity care this year - nearly four times what it wrote off five years ago. Still, only one-third of Tucson's working poor are getting close to the care they need, Gomez says.

``The need is growing all the time, and El Rio can't take care of all these people,'' he says.

A second part of the initiative calls for setting aside $17 million a year from state lottery funds to pay for six health and nutrition programs.

That would include $5 million for child abuse prevention and checkups; $4 million for scholarships for medical students who agree to practice in underserved areas of the state; and $3 million for disease control research.

If Proposition 203 passes, several legislators plan to introduce a ``premium sharing'' bill next session that would allow working families to pay part of their AHCCCS costs, while still qualifying for the program. That would further ensure that the working poor can stay off welfare while staying on AHCCCS.

While there is no organized opposition to Proposition 203, it has come under attack from a few legislators, notably Senate Majority Leader Tom Patterson, R-Phoenix, an emergency room physician.

But Tucson pediatrician Andrews sees it differently.

``These people (like the Gamez family) have to choose between medicine, food and rent,'' he says. ``This would allow them not to have to make that choice.''

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