Arizona’s Health Insurance Crisis

Sept. 19, 2005

Transcript:

Michael Grant:
Tonight on "Horizon", we begin a four-part series on Arizona's healthcare crisis. Who needs health insurance but cannot get it? A visit from the top man in the U.S. Census Bureau. And a story of a hilltop in Flagstaff and the contributions the Lowell observatory has made to science.

>> Announcer:
"Horizon" is made possible by the friends of Channel 8, members who provide financial support to this Arizona PBS station. Thank you.

>> Michael Grant:
Good evening, welcome to "Horizon", I'm Michael Grant. Earlier, this year the department of economic security released a collection of numbers that indicated how many employees of public and private entities are getting their health care coverage through AHCCCS. That's the Arizona Healthcare Cost Containment System. At the top of the list of employers was Wal-Mart. According to those figures, nearly 2% of workers who are getting benefits from AHCCCS work at Wal-Mart. Wal-Mart disputes the reliability of those numbers. In the first of a four-part series taking a look at Arizona's healthcare crisis, Larry Lemmons takes us shopping for answers.

>> Larry Lemmons:
Down every aisle at the new Wal-Mart in Glendale, retail activity is bustling. Wal-Mart is the largest private employer in Arizona. What might be surprising to some is that according to department of economic security numbers there are also more Wal-Mart employees than any other getting benefits from AHCCCS or the Arizona healthcare cost containment system. Breaking it down to percentage of workers, Wal-Mart is number one for workers on AHCCCS.

>> Jim McLaughlin:
I wasn't surprised that Wal-Mart was on the top of the list. I think what surprised me more was they had as many employees as they did on the list.

>> Larry Lemmons:
Jim McLaughlin is president of the United Food and Commercial Workers Union, local 99 in Phoenix. The union has tried unsuccessfully to organize workers in Wal-Mart.

>> Jim McLaughlin:
What makes it even more outrageous is that the taxpayers of Arizona are subsidizing their healthcare costs. The issue is whether I shop at Wal-Mart or not I'm making sure that the employees that work there have health insurance. On a pure fairness issue, that doesn't make any sense.

>> Delia Garcia:
I think we need to look at the report and how the information was gathered.

>> Larry Lemmons:
Delia Garcia is director of corporate affairs for Wal-Mart. She is referring to the fact that the numbers for Wal-Mart were released after media outlets filed a public records request. DES resisted, but relented finally, saying the data available is not reliable because the information was provided by the applicant. Although DES says eligibility for the program is based on income.

>> Delia Garcia:
And so we need to take a look at that and not place too much stock in the report. Having said that, I think there is some value in the report in that it shows that health care is an issue in Arizona. It's not a Wal-Mart issue. When you have employers like the state of Arizona and Maricopa County and Arizona republic and unionized grocers like Safeway and Fry's on that list, it shows that it's not a Wal-Mart issue.

>> Larry Lemmons:
Although Wal-Mart disputes the accuracy of the numbers, they, as well as other companies, probably have workers on AHCCCS. And Wal-Mart does offer health insurance to its employees.

>> Delia Garcia:
Wal-Mart provides competitive health insurance options. Options are something that we do provide. In fact, our associates can choose from 8 different plans when they're looking at their healthcare so they can make some decisions about that, about health care for themselves and their family. Our health care plans are very affordable. An associate can cover themselves for as little as $40 a month or the entire family for as little as $155 a month.

>> Jim McLaughlin:
Wal-Mart insurance offered to the associate is so expensive, the employee's pay is not a livable wage and they can't afford to purchase the benefits that Wal-Mart is offering. That's what Wal-Mart wants. They want to be able to say, we give great benefits to our employees, but they fail to mention the part that didn't give them enough money to pay for those benefits.

>> Delia Garcia:
Everybody has different needs and different situations. We provide the option so folks can make decisions about what their needs are in terms of health care for themselves and families. If they want low deductible, that's something our associates have told us is very important to them. When it comes to health care, they want affordability options and protection against catastrophic illness. We have been able to provide that with our plan, so associates can pay as little as $40 a month to cover themselves, that they have eight different options to choose from. And this is very particular to Wal-Mart, in case they do have a catastrophic illness, they're protected against financial failure.

>> Jim McLaughlin:
At the end, When Wal-Mart has as many employees on that list as they did, and they far out number the closest. I think the closest was McDonalds and they were actually twice as big as McDonalds on that list. It just goes to demonstrate that, Wal-Mart, unfortunately, in our economy is setting the standards because they come in, pay lower wages, they don't offer those health benefits, they are setting the standards that their employees can't afford to pay for their health insurance, the rent, the food they eat, the things they need as necessities of life. Kind of tragic that you're forced to decide between whether or not you want to provide health insurance for your family or put dinner on the table.

>> Larry Lemmons:
McLaughlin also heads the local chapter of Wakeup Wal-Mart. The organization has charged that Wal-Mart has encouraged its employees to go on public assistance.

>> Jim McLaughlin:
It's been documented that Wal-Mart encourages their employees to apply for AHCCCS, not just in Arizona but across the country, to apply for state assisted health care.

>> Delia Garcia:
Wal-Mart does not encourage associates to seek public assistance. There may be reasons why, personal circumstances, but is not something Wal-Mart encourages. In fact, we have done studies that show Wal-Mart helps people come off of public assistance. And it was found, surveying Wal-Mart associates, our benefits are very competitive within the retail industry. They also found, very interestingly, that 7% of Wal-Mart associates were on Medicaid three months before joining Wal-Mart. That percentage decreases to 5% once they join and 3% two years later. Clearly what the percentages show is that Wal-Mart is helping take people off of public assistance.

>> Larry Lemmons:
There can be little doubt one of the reasons for Wal-Mart's success is they can keep prices relatively low for consumers. They are no different than any other retailer realizing one cost they can control is wages. All retailers are in the same boat when it comes to attracting consumers. That's a difficult scenario for a union intent on getting better wages and benefits for employees.

>> Jim McLaughlin: At the end of the day, we all as consumers have to ask ourselves what's important. Is it important to have a thriving community with good paying jobs with health care or is it important to get something real cheap and essentially voting with our checkbook. Sometimes I don't know that I want to know the answer to that question.

>> Michael Grant: Joining us to talk about those who have difficulty getting health insurance is the medical director of AHCCCS, Dr. John Molina. John, it's good to see you again.

>> John Molina: Thank you, nice to be here.

>> Michael Grant:
To put it in context, we have to talk briefly about who qualifies for AHCCCS. I think that helps you understand those who are working who are going on AHCCCS. I realize there are a lot of different programs. The base program is to qualify max, 200% of federal poverty level. John, put that in dollar terms for us.

>> John Molina:
200% of the poverty level is equal to a family of four making just over $26,000 a year. To quality for AHCCCS, after passing of Proposition 204 in the year 2000, the general requirements for AHCCCS eligibility was 100% of the poverty level for most programs and it can go up or down depending on the program. 100% of the poverty level of a family of four works out to be about $17,000 a year for a family of four.

>> Michael Grant:
I think I misspoke, it's not 200%, it's 100%. Proposition 204 led to explosive growth in AHCCCS enrollment numbers. How many are covered in Arizona?

>> John Molina:
Just over a million people in Arizona are covered by the state AHCCCS program.

>> Michael Grant: About a fifth of the state's population.

>> John Molina:
Absolutely.

>> Michael Grant:
Remarkable. All right. If you are working, what are some of the primary causes in Arizona that you might qualify for AHCCCS?

>> John Molina:
You might find individuals -- let's talk about the working families first. The working families you might find that there's a family of maybe three or four individuals in the family, maybe only one is working. Take the example of the Wal-Mart where maybe that person is working at an entry-level position. Based on the income and salary at Wal-Mart and size of the family, that might potentially qualify that family for AHCCCS coverage. AHCCCS is designed also for the indigent patients. At the time before Proposition 204 was passed, there was about 30% of the poverty level. When that went up to 100% of poverty level, that brought into the fold a group of individuals who working part-time or entry level positions with larger families and/or a family they had only maybe one working individual.

>> Michael Grant: Obviously, part-time employees are normally not covered by any sort of company's health care insurance plan.

>> John Molina:
Right. Absolutely.

>> Michael Grant:
Does it impact, John -- Arizona has a lot of small companies. Small companies, I think, have the most difficulty putting together health care insurance benefits for their employees.

>> John Molina:
That's correct. There was a merger report put together for AHCCCS back in 2001 and it was pretty astounding to see that in Arizona the number of companies that are 100 employees or less, about 97% of business, compared to 41% nationally. In Arizona, we are actually dealing with an economy that has very small businesses, and it makes sense that a lot of these businesses cannot afford the premiums to cover the employees.

>> Michael Grant:
AHCCCS actually has a program, does it not, that tries to reach out and serve at least some portion of these small businesses?

>> John Molina:
Right. Healthcare group is an arm of AHCCCS that does provide a commercial based insurance plan for companies with 50 or less employees.

>> Michael Grant: We talked a lot here about entry-level wages. Do we know the demographics of that group? Intuitively, there has to be a fair number of young people involved in that group.

>> John Molina:
I'm not quite sure about the demographics. With the entry-level position we're looking at people who are maybe also students looking for flexible hours. Generally a lot of these entry-level positions don't require a large amount of skills or education. Entry-level positions are open to people who may be taking the position as a stop off point, maybe just temporary.

>> Michael Grant:
To the extent that there's at least some fair measure of those people who are young, that of course tends to be your healthiest population.

>> John Molina:
Absolutely.

>> Michael Grant:
Some people making conscious decisions at that age, well, gee, I could pay this $40 a month premium, on the other hand I don't really think I'm going to be sick?

>> John Molina:
I think people make individual choices about how much they want to pay out for insurance. It's not a matter of good or bad choice. It's a decision process you have to go through. When you begin to evaluate your own lifestyle and pretty much your health, and the amount you might have to pay into it. There are other things in life that are possibly priority levels, like maybe the education, paying for books or maybe they do have a family. There's money that has to go to take care of the family, pay the rent, buy food.

>> Michael Grant:
Have we covered the major elements of why people employed would seek out AHCCCS coverage? One of the other interesting statistics that came out from department of economic security, there were several hundred State of Arizona employees on it. State of Arizona offers some fairly attractive health care options, but the cost is fairly high.

>> John Molina:
I think it's partly the cost factor. We have to look at the whole picture. For that individual working for the state. How many family members, how the income has to be parted out, if you will, to meet the demands of the family, the rent, the transportation, and especially when you think about the increased cost of gas prices. There are a lot of factors that go into play to see how far the dollar can go for the family. Maybe there's not enough to cover for the insurance that they would obviously like to have.

>> Michael Grant:
AHCCCS medical director, Dr. John Molina, good to see you again. We very much appreciate the information.

>> John Molina:
Thanks.

>> Michael Grant:
If you have received a survey form for the 2005 census survey, you are encouraged to fill out that form and return it promptly. Mid decade census is designed to account for rapid growth here in the valley. The director of the U.S. census bureau has visited the valley. He spoke before the Maricopa association of governments to underscore the importance of the survey.

>> Louis Kincannon:
The census survey for 2005 in Maricopa County is very important to the well-being of all the communities in the county. So if you haven't returned your questionnaire, please do. It saves the county a lot of money, saves each government money to do so and we want those answers because accurate figures will insure a fair allocation of resources of state funds to different communities. Almost all census forms that you may receive have behind them a public purpose designed to improve the management of government resources. That is get resources where they're needed. Whether it's in reallocating resources in growing communities -- Maricopa County is the fastest growing county in the United States in numerical terms. It's important to measure change here. It's also important that emergency planners and business planners have up to date statistics because that's how they make decisions about how to prepare for emergencies, how to form new businesses, where to place them, where there are resources that will provide customers and employees for businesses. Having your answer does matter. And without them, wrong decisions may be made.

>> Michael Grant:
Recently I talked to the Gilbert city manager, George Pettit. He is the chairman of the census survey oversight subcommittee.

>>> I've got to assume that if we're shelling out $7.5 million, that there are some valley cities that have real dollars at stake here?

>> George Petit:
I think there's a keen interest in the state shared revenues in terms of sales tax, income tax, gasoline tax, all of the sources that come through, they can only be adjusted in their distribution based upon the census. That's the reason behind the survey. For example, Gilbert right now, we're receiving state shared revenue based upon a population of 109,000, which was our count in 2000. Now our population is about 175,000. 60% shortfall in the case of Gilbert, other communities have similar problems.

>> Michael Grant:
I would expect Chandler to be in the same kind of --

>> George Petit:
Any number.

>> Michael Grant:
Model. Buckeye.

>> George Petit:
The west valley has exploded. Queen creek, they've grown leaps and bounds. Other communities that are still growing very quickly - rapidly like Phoenix, like any other national standard, their rate of growth is a percent of the total population is not as great as ours, so they stand to lose a little money.

>> Michael Grant:
From that standpoint, it's a zero gain. Your gain is going to be somebody else's loss.

>> George Petit:
It's a redistribution of a fixed pie; some win, some lose.

>> Michael Grant:
We have some idea of the mechanics, of what's going on here, but let's go a little more into that. This is a survey. It is a statistical survey.

>> George Petit:
Correct. It is a special mid decade census under contract with the census bureau. A survey as opposed to a full count.

>> Michael Grant:
What does that translate to in terms of like one out of how many people are being surveyed to extrapolate the data?

>> George Petit:
On average across Maricopa county, we're talking about 1 in 13 households. Each community has a little bit different statistical sampling. Gilbert, it's 1 in 17 because the census bureau felt in order to get a statistical sample of the characteristics of Gilbert they only needed that level of sample. Phoenix and Mesa, on the other hand, because of physical size are having surveys done in two separate areas to make sure they are getting the correct counts for their population and diversity of their communities.

>> Michael Grant:
Any actual head counts part of this process?

>> George Petit: There are two groups that will actually be physically counted. One are those in group homes and second part will be those in outdoor locations, also known as homeless.

>> Michael Grant:
One of the concerns that pops up routinely on not only special census but the regular 10 year census is under counting of different populations including minority populations. Has there been an outreach program in relation to that?

>> George Petit:
The city of Phoenix has shown outstanding leadership in trying to do that outreach program through the faith-based communities, through a lot of communities they've regularly held access to. They've held special meeting, done special promotions. The survey is being done in English and Spanish, yet they have had a conscious outreach to the Asian community, and faith-based communities to make sure people understand the benefits to their community of participating. If they choose not to participate, their communities lose money. That's a fairly significant issue for those of us in rapidly growing communities and an even bigger one for Phoenix because they still have to figure out how to provide services over the next five years for their population. State shared revenues make up around 20% in general funds, which is police, fire parks and recreation, libraries, things like that. So it's a fairly significant portion of everyone's budget.

>> Michael Grant:
75 years ago, last February, the planet Pluto was discovered. Pluto was spotted first by Clyde Tombaugh from the Lowell Observatory in Flagstaff. Before the discovery and afterward, the observatory played an integral role in the history of astronomy. As Larry Lemmons tells us, the Flagstaff institution does not rest on its laurels, it continues to be a very relevant institution.

>> Larry Lemmons:
A view of Flagstaff from the top of Mars Hill. Looking at objects from a distance has made this spot significant in the history of Arizona and of astronomy. The Lowell Observatory remains a vital part of humanity's desire to understand the stars. Current research and outreach projects keep the observatory relevant. It was the obsession of one man more than 100 years ago that eventually led to some of the greatest astronomical discoveries in history. Percival Lowell is interred in this mausoleum. He was an amateur astronomer from a wealthy background. His desire to find evidence of life on Mars brought him to Flagstaff.

>> Kevin Schindler:
In the 1890s, there's some interesting observations of Mars, and Lowell wanted to see mars and perhaps find out evidence of intelligent life. He set up an observatory out here in Arizona, which wasn't even a state, just a territory of Arizona. Flagstaff had about 800 people, no electricity, and was just a western outpost.

>> Larry Lemmons:
An outpost with a clear view of the stars. Lowell spent 15 years studying Mars with a 24 inch refractor telescope that is still housed in it original dome at the observatory. Lowell made drawings of the red planet and was first to suggest canals were constructed on mars. It was the search for planet X, which yielded greater success. Lowell believed a 9th planet existed beyond Neptune. After Lowell's death, Clyde Tombaugh confirmed what Lowell suspected.

>> Kevin Schindler:
February 18, 1930 he was looking at two photographic sites taken of the same area of the sky, and there were areas of the sky that Lowell predicted this would be. And about 4:00 in the afternoon, February 18, Clyde Tombaugh sitting at the machine, and there it was, Pluto was discovered.

>> Larry Lemmons:
Even that's not the extent of the Lowell observatory's legacy in astronomy. Early in the 20th century, another Lowell astronomer would make history.

>> Robert Millis:
Probably one of the most important discoveries in the 20th century was made with this telescope. Using this telescope, he was able to obtain the first spectra of what turned out to be external galaxies.

>> Larry Lemmons:
Spectra of these galaxies in 1913 showed the galaxies to be moving away from the observer, as indicated by a red shift in the absorption lines of their spectra.

>> Robert Millis:
What was discovered was that most of these objects were moving away from earth at speeds far beyond anything that had been seen by astronomers before. In fact, what he had found the first evidence of the expansion of the universe. His work inspired other astronomers such as Hubble to pursue the investigation and ultimately prove that the universe is expanding.

>> Larry Lemmons: Research at the Lowell observatory is expanding, as well. Lowell was involved in the investigation of near earth asteroids and collaborating with amateur astronomers.

>> Bruce Koehn:
We can find the fast-moving asteroids, which are typically near earth asteroids, and we can send the positions to the minor planet center. The minor planet center posts an approximate position for them and amateurs can pick these asteroids up and get further positions. The more positions you have, the better orbit that becomes. That frees this telescope to continue searching.

>> Larry Lemmons:
The fact that Lowell researchers essentially own their instruments means they can engage in long-term monitoring programs. This is a unique strength of Lowell's research.

>> Jeffrey Hall:
We can go out to our instruments day after day, week after week, performing ongoing observations. This is not something you can do at national observatories like Kitt Peak where the observing time is awarded through a competitive a peer reviewed process. Even if your proposal is the one in four, one in five successful, you might be awarded two weeks of time over six months. You can do fine science with that kind of method, but there are limits to what you can do.

>> Larry Lemmons:
Appropriately, it's the nature of how Lowell was founded, the passion of the founder that gives the observatory its particular strength.

>> Jeffrey Hall:
This goes all the way back to Percival Lowell, in the late 1800s, using the telescope night after night, making his exhaustive sketches of Mars. It goes to the Pluto search where Lowell postulated the existence of a 9th planet, and it was discovered after a long and exhaustive search.

>> Larry Lemmons:
Created at a time when Arizona's documented history was young, the Lowell observatory has contributed to the history in a profound way and continues to make an impact on tomorrow's scientists.

>> Michael Grant:
Tomorrow we continue our health care system coverage, the four part series by looking at the AHCCCS delivery system. Thank you very much for joining us on this Monday evening. I'm Michael Grant. Hope you have a great one. Good night.