Prop. 106 raises blood pressure on both sides

By Stephanie Innes
Arizona Daily Star
Sunday, September 26, 2010

Arizona voters in November could create their own law to keep the national health-care overhaul at bay when they vote on Proposition 106.

Bitterly contested, the new health-care law triggered angry, sometimes violent demonstrations in the weeks and months leading up to its March approval, and became a rallying point that helped catapult the tea party movement to greater prominence.

And an Arizona doctor who is leading a campaign to pass Arizona Proposition 106, dubbed the Arizona Health Care Freedom Act, has been at the forefront of the national movement to challenge a key provision of the national law: mandated insurance.

Prop. 106 on the Nov. 2 general election ballot would amend the state constitution, barring any law that forces people to participate in a specific health-care program, including insurance.

Arizona is the second state to give voters a say on the matter. In August, 71 percent of Missouri voters approved a similar measure.

Supporters say the amendment, if passed, would allow Arizonans to opt out of mandated health insurance under the new national health-overhaul law and avoid paying fines.

Opposing the national law has been a big selling point, too. At a Prop. 106 town hall in Green Valley Thursday, a woman holding a "Stop Obama" sign drew enthusiastic applause.

The second key point of Prop. 106 says people can use their own money to buy any health service that's legal and that no government entity can stop them from doing so. That would mean, for example, that a woman who wanted a mammogram every six months instead of yearly could pay for the extra screening her insurance wouldn't cover, said Dr. Eric Novack, the Glendale orthopedic surgeon leading the Yes on 106 campaign. Novack says such choices are threatened under the new federal law.

Arizona Rep. Phil Lopes, D-Tucson, says that claim is "ridiculous." He says he continues to study the new law closely and has seen nothing that would prevent people from spending their own money on health-care services they want.

Critics say the language of Prop. 106 is too broad and will push Arizona into an expensive court battle, as federal law trumps state law. Moreover, they say the provision allowing people to opt out of having insurance will result in others having to pay more to take care of them when they get sick or hurt.

A similar Novack initiative in 2008 - the Freedom of Choice in Health Care Act - failed narrowly. Its worst showing was in Pima County.

This time around, Novack says he's got frustration over the national health legislation on his side. And he's confident this version addresses the problems critics raised two years ago, particularly fears of unintended financial consequences for the Arizona Health Care Cost Containment System, Arizona's form of Medicaid.

In 2008, AHCCCS officials opposed Prop. 101, saying language prohibiting government from restricting a person's choice of private health-care systems could have been interpreted by a judge to include private contractors used by AHCCCS. Now, AHCCCS officials say they're neutral.

"The world is a very different political place from 2008," Novack said. "The public on both sides of the aisle feel health reform was rammed down the throats of the American people. A lot of people are angry."

Arizona Gov. Jan Brewer has joined a multistate lawsuit challenging the new federal health law's provisions. The Arizona-based Goldwater Institute has filed a separate lawsuit challenging the law.

Prop. 106 backers fear the national law will give bureaucrats more power to dictate physician choices and treatment options than insurance companies and HMOs already wield. Physicians' practice habits and fees could be locked up by the same bureaucracy, they say.

Critics disagree

"Their message is that you need Prop. 106 so the government can't come between you and your doctor. That is a totally false premise. People on Medicare don't have the government coming between them and their doctors," said Nancy Martin, a registered nurse in Prescott and co-chair of the Arizona Coalition for a State and National Health Plan, which opposes 106.

"As it is right now, the insurance companies basically come between patients and their doctors," she said. "We believe everybody should have health care, and Prop. 106 does absolutely nothing for people who do not have insurance or who can't afford insurance."

The Arizona Legislature put Prop. 106 on the ballot, but Novack said he worked closely with legislators to create a version worded better than the original.

One point Novack and other supporters repeat is that mandating health insurance will not work. Even under the national law there will still be "free riders" who get their health care at others' expense, they say.

"People are afraid for their health care," said Dr. Donnie Sansom, a Tucson anesthesiologist. "I have a great problem with my government saying, 'You have to purchase this.' It's unprecedented. …

"Prop. 106 is about ensuring you have individual freedoms in place."

But Tucson pediatrician Dr. Eve Shapiro, a longtime advocate of health reform, says 106 does not address the real issues affecting health care - specifically people's access to care and the cost and quality of care.

"Basically, I think the intent of 106 is not really clearly stated. It couches this as freedom of choice - baloney," Shapiro said.

Saying you can opt out of buying health insurance does nothing to fix the real problems with the health-care system, she said.

When people don't have health insurance and are in a bad accident, for example, we all end up paying, she noted. When everyone has health-insurance coverage, all costs go down.

Retired Phoenix physician Dr. George Pauk, past co-chair of the Arizona Coalition for a State and National Health Plan, charges the impetus behind Proposition 106 comes from just "a few selfish doctors" who want to be able to charge extra-high fees.

"This is not a freedom of choice issue. It is a very bad and broad change that would prohibit future reform in health care in Arizona," Pauk wrote in an opposition statement he filed with the Arizona Secretary of State's Office.

He says the law is a deliberately vague and confusing way to hide its main effects, and would actually turn back many protections the public now has.

Some of those unintended consequences, critics contend, are that the state may not have the right to require immunizations, and public-health officials may not be able to follow up on cases of contagious diseases such as AIDS and hepatitis.

People with contagious diseases could "opt out" of the health-care system designed to protect the public, the No on 106 website says. "They could then spread contagious diseases to the public, including you and your family."

Not true, Novack insists.

"This doesn't prevent regulation of public health," he said. Framers of Prop. 106 listened to concerns about the previous initiative and addressed them, he said.

Regardless of the Arizona vote, Novack has been instrumental in starting a national trend. Besides the Missouri vote, lawmakers in Colorado and Oklahoma have put similar propositions on their November general election ballots.

The conservative, nonprofit American Legislative Exchange Council, which backs "free markets, limited government, federalism and individual liberty," held up Novack's Prop. 101 as a piece of "model legislation." Novack says that's how his idea began to catch on with like-minded people - those who don't want government controlling their health choices.

Since September, the "Yes on 106" campaign has collected more than $1 million, mostly from the U.S. Health Freedom Coalition - a national group Novack leads.

As of last week, the "No" campaign had raised about $1,400, in part because the campaign got off to a late start, Lopes said.

Among those supporting the measure are Brewer, U.S. Sens. John McCain and Jon Kyl, the Arizona Federation of Republican Women, the Arizona Ophthalmological Society, the Arizona Orthopaedic Society and the Center for Arizona Policy.

Opponents include the Arizona Alliance for Retired Americans, the Arizona Education Association, the Arizona League of Women Voters, the Arizona National Organization for Women, the Arizona Public Health Association, National Nurses United and the Arizona Democratic Party.

Novack acknowledges there's "no question" the measure, if passed, will wind up in court.

"But the job of our state government ought to be to fight for the rights of individual Arizonans and Arizona families," he said.

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About Proposition 106

The "Arizona Health Care Freedom Act" will appear on the Nov. 2 general election ballot. It would amend the Arizona Constitution, adding this language:

• A law or rule shall not compel, directly or indirectly, any person, employer or health-care provider to participate in any health-care system.

• A person or employer may pay directly for lawful health-care services and shall not be required to pay penalties or fines for paying directly for lawful health-care services. A health-care provider may accept direct payment for lawful health-care services and shall not be required to pay penalties or fines for accepting direct payment from a person or employer for lawful health-care services.

• Supporters' campaign:

• Opponents' campaign: