Governors from states considering balancing their budgets on the backs of their most vulnerable residents should not read too much into Secretary Sebelius’ letter to Governor Jan Brewer this week.  HHS Secretary Sebelius did not waive the stability protection (aka “maintenance of effort”) provisions of the Affordable Care Act as Governor Brewer had requested.  Secretary Sebelius pointed out that states are not required by the Affordable Care Act to renew expiring waivers.  

Of the states that have expanded coverage to childless adults though a waiver, Arizona is in a unique situation in that its waiver expires on September 30th this year and the state is interested, as we have previously blogged about, in cutting off hundreds of thousands of people made eligible by the waiver. There was nothing HHS could do to stop them from making such an unwise choice. Massachusetts’ waiver is also expiring this year, but it is not interested in making such a bad choice. 

There may be legal remedies to the Arizona situation because the state is seeking to overturn a policy that was adopted with popular support through a ballot initiative.  Arizona’s constitution protects the integrity of ballot propositions from legislative changes that run contrary to the voters’ intent. That issue, it seems, will be played out in state court.

Arizona is truly an outlier.  The state has already made some of the country’s most drastic cuts to health care coverage including becoming the only state to freeze enrollment its Children’s Health Insurance Program and deny coverage for organ transplants to  people covered by Medicaid.  While the Governor and legislative leaders say they can’t afford to uphold the state’s commitment to helping the uninsured, the Governor has proposed a 30% corporate tax cut.  Clearly not an example other states should follow.