Stop Medicaid Expansion in AZ

Dear Arizona AAPS members and friends:

Please read the message below from our friends at Americans for Prosperity AZ about an important event at the Arizona Capitol on Thursday April 25, 11am.

We hope to see you there!

~ AAPS

Dear Arizona Health Care Freedom Activists,Please join the Arizona chapter of Americans for Prosperity, the Goldwater Institute, Representative Warren Petersen, and other Legislators for a special press conference and rally this Thursday, April 25th at the Arizona State Capitol.

At the rally, you will hear experts and lawmakers explain why expanding Medicaid in Arizona under ObamaCare would be a costly and dangerous policy choice.

The rally begins at 11:00 am, but please arrive early to find parking and a place to stand in unity with others who oppose ObamaCare.  The Capitol is located at 1700 W. Washington Street – just west of downtown Phoenix (map).

I will be speaking at the rally, along with Christina Corieri of the Goldwater Institute and several lawmakers.

Now more than ever, health care freedom advocates must unite to oppose ObamaCare’s deceptive and damaging government takeover of health care in Arizona.  We must send a message to the Governor, to the Legislature and to the hospital industrial complex that Obamacare’s Medicaid expansion is very bad medicine for Arizona.

For more information about the rally, please visit our website or the Arizona Against Obamacare Expansion Facebook page.

Stand with us on Thursday as we fight for health care freedom and patient protection!

For Liberty, TomTom Jenney
Arizona Director
Americans for Prosperity

Arizona Legislators
1700 West Washington
Phoenix, AZ 85007

RE: March 26th letter from Randy Pullen

Dear Legislators:

We disagree with the analysis in Mr. Pullen’s letter defending Gov. Brewer’s decision to push hard for expanding Medicaid.

ObamaCare is “here to stay” only if the states implement it. A key feature in its survival is the effort to dump a lot of people into Medicaid (AHCCCS in Arizona). That move would mean turning as many as 300,000 vulnerable Arizonans over to a system in which access to care is increasingly problematic, and in which the death rate of people who actually use medical care is higher than even among uninsured patients, and much higher than in privately insured patients.

The New England Journal of Medicine (Harvard) study, cited by advocates for the expansion, does not compare persons on Medicaid with persons not on Medicaid, but looks at all-cause mortality in the adult population in three states, before and after a Medicaid expansion, compared with neighboring states with no expansion. The results for Arizona were not statistically significant. Results in New York were small, even if statistically significant, and the study could not show they had anything to do with expanding Medicaid.

Pullen says that “it is becoming clear that a majority of Americans are viewing healthcare as a right and not a privilege.” Whatever the truth is about this asserted right, ObamaCare is turning medical care into a privilege that you can have only at the discretion of the Secretary of HHS.

Pullen says that the state is now running a surplus. How long will that continue, especially if another 300,000 people are loaded onto AHCCCS? Pullen worries about what will happen if Arizona does not restore Medicaid coverage—but Medicaid is the reason that states are siphoning money from public safety and other programs.
Hospitals now receive DSH (disproportionate share hospital) payments to help cover uncompensated care. ObamaCare slashes these payments, but cuts them more if Medicaid is expanded than if it is not. This effect needs to be considered.

Pullen asserts that the expense of added enrollment would be paid for by a provider tax on hospitals. Aren’t these the very hospitals that are complaining of financial distress? Where is this money to come from, since hospitals allegedly can’t pass it on to anybody? From cuts in service?

Proposition 204 has the caveat, already litigated, that legislators can’t be forced to spend money that the state does not have. Pullen’s concern about the will of the voters apparently does not extend to Proposition 108. Are taxpayer protections in Prop 108 meaningless until the courts rule on them? Pullen says that “the state has enacted all kinds of ‘fees’ for different reasons over the past few years including a provider tax on nursing homes in 2012.” That reminds us of Jonathan Swift’s remark in Gulliver’s Travels that if a wrong can be legally done once, then it can be done again. In other words, if politicians get away with violating the law once, they can keep doing it over and over again. In this case, Brewer and Pullen want to gut the Arizona Constitution by changing a word from “tax” to “fee.” This unprincipled stand violates the oath that elected officials take to defend the Constitution.

The argument from the Jackson Hewitt tax service about the added cost to employers does not take into account the fact that the ObamaCare legislation does not permit a tax to be imposed on employers if the state does not implement an exchange. (And why has Arizona not filed a parallel lawsuit to the Oklahoma effort, to fight against the attempts by the IRS to rewrite the law?)

Prop. 204 brings to mind the Yogi Berra quip that Pullen cites. In general, Prop 204 failed to solve the uncompensated care problem, just as it failed to budge the percentages of uninsured people in Arizona. (In fact, the $2,000 per family figure was used in the 2000 ballot fight!) Why do Pullen and Brewer think this time will be different? It really is “déjà vu all over again.”

Pullen urges Republicans to make a smart choice in following the lead of the Governor. But we suggest following the money. The $2 billion coming to “Arizona” would be coming specifically to AHCCCS, which has failed to solve the problem with the $9 billion it already gets every year. From AHCCCS, less than 25% trickles down to those troubled hospitals. Will some of it fund the treatment of the patients whose hard-luck stories are being solicited? Possibly. But what about the invisible people harmed by diverting the $2 billion from taxpayers into special interest lobbies, including AHCCCS, its program contractors, and certain hospitals?

Sincerely yours,
Jane M. Orient, M.D.
Executive Director, AAPS

(Below is the letter sent from former AZ GOP chair Randy Pullen to AZ Legislators mentioned above.)

March 26, 2013

As a conservative Republican, a Republican Precinct Committeeman and the former Chairman of the Arizona Republican Party, I have listened closely to the debate on restoring and expanding AHCCCS to come into compliance with the Federal requirements for Medicaid covering adults up to 138% of the Federal Poverty Level. As with the debate over the temporary one cent sales tax increase in 2009, which was overwhelming approved by the voters in a special election in 2010, both sides have made strong arguments as to why we should or should not expand AHCCCS.

The one thing that is certain is the American health care system provides the best health care in the world and it is to our benefit that it remains that way; however, the current delivery system for all of us is costly and dysfunctional and needs to be restructured. What also is becoming clear is a majority of Americans are viewing health care as a right and not a privilege.  I continue to oppose Obamacare and believe it is not the answer. It is the typical Democrat big government answer to a problem, which always turns out be more expensive and falls well short of public expectations.

While the national healthcare issue is being sorted out, here in Arizona, we have to make some tough choices in the very near future regarding our Medicaid program. In 2000, Proposition 204 mandated an expansion of AHCCCS in Arizona to cover all adults up to 100% of the Federal Poverty Level. In order to balance the State budget during the recession, Governor Brewer and the Republican legislature significantly reduced the coverage for adults under AHCCCS.  The court approved the reduction as the State was broke; however, that is not the case any longer with the State running a surplus. This also was viewed as a temporary solution by the federal government and their suspension of the rules is set to expire at the end of this year.

Anyone who believes that the State will not be sued over Proposition 204 if it does not restore adults up to 100% of the Federal Poverty Level to AHCCCS, or the court will continue to rule that the State does not need to adhere to Proposition 204  is gambling the future of Arizona on a bad hand. Also, if we do not come into compliance with the federal government, we stand to lose all of our matching funds for the people that the voters approved coverage for under Prop 204; they have the power to do this.

Based on my review of information available, here are four things we can be pretty certain will happen if we don’t restore the cuts to AHCCCS and further agree to increased coverage for adults up to 138% of the Federal Poverty Level:

If Arizona does NOT restore Medicaid coverage, Arizona taxpayers (and not the hospitals) will continue to subsidize Medicaid spending instead of using those dollars for education, public safety or further tax cuts.  Arizona voters approved Proposition 204 in 2000 to expand Medicaid eligibility to 100% of the Federal Poverty Level to be funded by a tobacco tax, funds from a settlement with the tobacco companies and the State General Fund.  We will have to restore the temporary cuts to AHCCCS next year and this alone will add around 360,000 new and reenrolled recipients to AHCCCS. None of this is required to be paid for by the federal government unless they agree. Given the dislike for the State by the Obama Administration, it could happen and we could be going it alone.

Under the Governor’s proposed Medicaid restoration plan, the added enrollees would be paid for by a provider assessment on hospitals that would cover not only the expansion of Medicaid for adults between 100% and 138% of the Federal Poverty Level, but would also cover the General Fund portion under Proposition 204. Arizona hospitals support this idea. Under the proposed law, this hospital assessment could not be passed along to patients or insurance policy holders.

If Arizona does NOT restore Medicaid coverage, legal aliens will qualify for health care benefits greater than those given to U.S. citizens in our state. Because Obamacare assumes that states would expand Medicaid coverage, the only provision for a subsidy below 100% of the Federal Poverty Level is for legal aliens who are in the country legally but are ineligible for Medicaid because of their alien status. The ACA allows them to receive a federal health insurance subsidy as though they had an income of 100% of the Federal Poverty Level.  Thus, if Arizona does not restore Medicaid for poor Arizonans below 100% of the Federal Poverty Level, only legal aliens, but not citizens, would be eligible for subsidies.

If Arizona does NOT restore Medicaid coverage, Arizona hospitals will continue to pay for uncompensated health care provided to childless adult citizens. Arizona hospitals report that they have experienced an 81% increase in these costs over the last 6-months. This will undoubtedly increase next year as another 60,000 adults will be dropped from AHCCCS. There is no certainty that the federal government will compensate hospitals for these additional costs while continuing to require them to provide the care. Right now, I can tell you from my own experience that rural hospitals in Arizona are feeling the pinch. An increase in their uncompensated care could cause severe financial distress or potentially ruin many of them.

If Arizona does NOT restore Medicaid coverage, Arizona employers will be subject to $45 Million to $60 million in higher taxes under Obamacare according to the Jackson Hewitt Tax Service.  The higher taxes are in the form of higher “shared responsibility” penalties for employees who are from 100% to 138% of the Federal Poverty Level and enroll in the premium assistance tax credits on the Obamacare health exchanges. Employers that offer health coverage and have 50 or more full-time equivalent employees must generally pay up to $3,000 penalties for each employee who enrolls in the premium assistance tax credits. The “shared responsibility” provision also caps an employer’s total liability at approximately $2,000 multiplied by the total number of employees.  These tax increases don’t occur under the Medicaid restoration plan because those persons will be eligible for Medicaid.

The arguments made by opponents to expanding AHCCCS generally fall into two categories: The first consists of philosophical arguments centered on the idea that any change to AHCCCS that would bring it in line with new federal standards for Medicaid is ipso facto support of Obamacare. The second category consists of arguments based on the premise that any expansion of Medicaid will cost more and Arizonans will pay higher taxes.

The philosophical arguments raised at many Republican legislative and county districts meeting remind me of the old Yogi Berra quip, “this is like deja vu all over again.” We heard similar arguments from conservatives and think tanks like the Goldwater Institute and Americans for Tax Reform in 2009 that the idea of a temporary sales tax increase of one cent to balance the budget during the recession would hurt the State’s economy, cause more unemployment and once a tax was imposed it would never be rescinded. Well, these dire predictions turned out not to be true as the state is running a surplus, unemployment is less than it was and the tax will expire in June as promised. The same is true now with Obamacare. It is not likely that Medicaid will go away even if Obamacare is repealed. AHCCCS is here to stay and it is the responsibility of our elected officials to provide the best and most cost effective Medicaid system possible in Arizona.

The arguments based on the assumption that all Arizonans will pay higher taxes when Medicaid is expanded next year are very likely true.  What they are not saying is this will be true regardless if AHCCCS is expanded or not.  The fact is that the federal government is expanding Medicaid up to 138% of the Federal Poverty Level.  If we participate, the total cost will be less to us in Arizona.

There are of course risks that the Federal government will pull back funding and leave the State(s) to pay for it on their own.  The new law as proposed would have a reset provision that would allow the State to rescind and go back to the Proposition 204 levels. There is also the possibility that the courts would rule that the assessment on hospitals is a tax and falls under Proposition 108 and requires a two-thirds vote of the legislature. This is not likely as the State has enacted all kinds of “fees” for different reasons over the past few years including a provider tax on nursing homes in 2012.

So where do you go from here? In 2010, Republicans in Arizona made tough choices. As Chairman of the Arizona Republican Party, I supported our Governor in passing a temporary sales tax increase, reforming spending programs and balancing the budget. The angst over the sales tax turned out to be not true and the voters rewarded us by electing Republican super majorities to both houses of the legislature – the first time that had ever happened. Every Republican in the legislature who voted for the sales tax initiative was reelected in 2010. We also captured every statewide office.

We now are presented with a similar situation with AHCCCS.  Republican leadership needs to step forward and make another smart choice – follow the Governor’s lead. She’s been proven right before!

Sincerely,
Randy Pullen
Former Chairman of the Arizona Republican Party

“Arizona’s Governor Jan Brewer, like some other Republican governors who say they oppose ObamaCare, is pushing for implementation of a key feature of the Affordable Care Act: an expansion of Medicaid.

“The media campaign features the standard formula of presenting hard-luck stories. An upstanding, hard-working citizen has, through no fault of her own, a serious illness, and has lost her insurance, right in the middle of treatment. The only answer: Enroll her in AHCCCS (pronounced ’access,’ the Arizona Health Care Cost Containment System, the Arizona 100-percent managed care Medicaid system).

“We should be asking a couple of questions. First, will she get the treatment she needs from AHCCCS? Answer: not necessarily. She might not be able to find a doctor, or the system might not approve the treatment-or approve it soon enough.

“Second: what will happen if her income rises above the threshold of 133% of the federal poverty level? Answer: she will become ineligible for AHCCCS, possibly right in the middle of treatment.

“While ‘job lock’ ties people to a job because they fear losing health insurance, Medicaid is a poverty trap that locks people out of getting a job.

“A spokesman for Gov Brewer claimed that, according to the New England Journal of Medicine, a previous expansion of Medicaid saved lives. This study looked at death rates from all causes before and after expansion in three states (New York, Maine, and Arizona). Only in New York did a decline reach statistical significance. Less than 15%
of the study population was on Medicaid, and Medicaid may have had nothing to do with the slight decline in mortality rate.

“The federal government promises to cover added costs, at least at first. Gov. Brewer proposes a ’circuit breaker’ if funds are not available. If the federal government allows this, what happens to the program’s new dependents?

“The governor didn’t mention that the state might be able to seize the amount paid into AHCCCS on a person’s behalf after age 55 from his estate, even if no actual services were received. For older patients, AHCCCS enrollment is a loan.

“Only one effect is certain: some $2 billion would flow into the coffers of program contractors-managed care plans-and maybe 25% would trickle down to hospitals.”

The Association of American Physicians and Surgeons (AAPS) , which was founded in 1943, is a national organization representing physicians in all specialties.

ACA will drive up the cost of insurance and medical care; reduce the availability of care, intrude into the patient-physician relationship, and damage the economy.

States could prevent the implementation of ACA by declining to set up Exchanges or to expand Medicaid. We are disappointed that Gov Brewer, despite her expressed opposition to ACA, now supports a Medicaid expansion, and respectfully ask her to reconsider.

Instead, Governor Brewer and Arizona legislators should consider innovative and proven solutions that empower patients instead of bureaucrats and cut waste such as the Volunteer Physician Health Care Act under consideration in New Jersey.  This act is based on a real life charity care clinic where the cost per patient visit is $13 compared to $160 at a federally funded facility.

It’s like a game of Prisoner’s Dilemma: If all (or enough) states “cooperate,” meaningful reforms could be achieved. However, if too many “defect,” those who remain true to their principles will be disadvantaged (i.e. get less federal money) compared to those who defect.

The Medicaid expansion has been compared to the gift of a baby elephant plus hay for a few years. The Governor believes that if the federal government reneges on promised support, we can undo our decision. That would probably be as hard as shooting an elephant. But we would be dealing with real human beings who are now dependent on the program.

Tax revenues intended to pay for medical care for the poor are instead a cash cow to pad the salaries of administrators, managed-care companies, and hospital executives.

Looking at the 2010 Care1st Health Plan combined statement for Arizona and California, revenue was $651 million, expenses for “healthcare services” were $554 million, taxable income was $24 million, and “selling, general and administrative expenses” were $69 million. While it is not known exactly what is included in “healthcare services,” it is clear that at least $100 million in taxpayer funds went to just one plan for things other than patient care. (AAPS News, January 2013).

Betsey Bayless, the CEO and president of Maricopa Integrated Health System (MIHS) earlier in 2013 received “a hefty $125,000 raise. Her base salary soared 33% overnight, from $375,003 to $500,000 — excluding benefits.” (Seeing RedAZ Blog).

While the Arizona Medical Association has endorsed the expansion of AHCCCS, there is no evidence that the majority of physicians support it or, more importantly, would be willing to provide the promised medical services. Many physicians decline to participate because of:

• Costly, burdensome administrative demands
• Difficulty in getting patients the services they need
• Ever-increasing threats of audits or even prosecution because of errors that are called “waste, fraud, or abuse”
• Payment that does not cover their costs.

Many eligible patients also decline to enroll, but may be forced to do so to avoid the mandate/penalty/“tax.” This may swell the rolls owing to the “woodwork effect.” Some persons may even be enrolled automatically. Reasons for nonenrollment include:

• The burdensome process of enrolling, and repeatedly re-enrolling
• The difficulty in finding a doctor
• Covert rationing by managed care of services that are “covered” but not approved
• The estate recovery process that means that enrollees age 55 or older are receiving a collateralized loan that can be recovered from their assets after death

Materials supplied by AHCCCS make it plain that the estate may have to pay back the total provided to the AHCCCS program contractor even if that is much greater than the value of any services that were received. This is comparable to a 100% “death tax” on the middle class and poor with no threshold.

Questions that legislators need to answer include:

• While many Arizona hospitals may need funds, hospitals receive only about 25 % of the funds that go to AHCCCS. Why not fund hospitals directly, without AHCCCS overhead?
• The AHCCCS expansion is claimed to create jobs. What jobs? And how many jobs will be lost from taxes, crowding out private insurance, loss of facilities owing to AHCCCS regulatory costs and poor payment, and so on? Is the model for predicting jobs different from the one that inaccurately predicted that ARRA (the “stimulus”) would bring unemployment below 6%?
• Is the bed tax a tax or not? How can it be a “tax” to meet requirements for attracting federal dollars, and “not a tax” for meeting requirements for raising taxes? If it is argued that hospitals aren’t really paying the tax because more dollars come back from Washington than are sent, how does this dollar multiplier work despite the administrative losses? And do the same people get the revenue as paid the tax? If hospitals don’t pass along the tax to patients, where does the money to pay it come from?
• Should the State of Arizona engage in systems gaming and word play to extract more dollars from federal taxpayers? Is this a form of fraud? Aren’t accounting gimmicks like the bed tax likely to be prohibited in the future?
• If the State of Arizona supports the principle of systems gaming to get more tax dollars back than it puts in, it can hardly complain if other states beat us at the game. How can we be sure that we will stay ahead and be a tax recipient rather than tax donor, especially given this Administration’s history of actions damaging to Arizona? Why should we send any optional taxes, on the gamble of getting a bigger return?
• People who earn a little too much lose their Medicaid benefits, the equivalent of a greater than 100% marginal tax rate. How does this affect work incentive and tax compliance?

Please read this important message from our friends at Americans for Prosperity about what you can do today to help STOP the planned Medicaid expansion in our state.

~AAPS

ACTION ALERT

To all Arizona Taxpayers and Health Care Consumers:

Gov. Jan Brewer and powerful lobbyists are pushing Arizona to impose statewide taxes, including a hospital bed tax, to fund an expansion of Medicaid (AHCCCS) under ObamaCare. It is vitally important for Arizona to stop the proposed Medicaid expansion, because the human and fiscal costs of that expansion would be enormous.

The most important issue in the Medicaid expansion is the human cost.  If Arizona were to expand Medicaid, it would railroad 250,000 Arizonans into a low-quality, government-managed health insurance system. Medicaid patients not only have worse medical outcomes than patients other low-income people without insurance — even when they had the same medical conditions.

But here is another crucial issue: The proponents of the expansion are trying to do an end-run around Prop 108, the most important taxpayer protection in the Arizona Constitution. Under Prop 108, it is supposed to take a two-thirds majority of the Legislature to raise taxes. But Medicaid expansion proponents want to allow unelected bureaucrats at AHCCCS to raise state taxes (mainly hospital bed taxes) by $369 million over the next three years — without a two-thirds vote of the Legislature!  If the Legislature delegates to bureaucrats the authority to impose gigantic taxes on hospital patients, Prop 108 will be a dead letter and will no longer protect Arizona taxpayers.

Gov. Brewer told Arizonans to “do the math” on the Medicaid expansion. With all due respect, she should do the same. According to Brewer’s projections,the Arizona Medicaid expansion would cause the federal government to spend $3.6 billion over the next three years alone. The people who will pay those taxes include most of the people of Arizona and — thanks to the federal debt — our children and grandchildren. 

TAKE ACTION!

Please send a quick email note to Gov. Brewer, asking to reconsider her support for the ObamaCare Medicaid expansion. She changed her mind on the ObamaCare insurance exchange, so we know that she can do the right thing — but we must confront her with the evidence against the Medicaid expansion. 

REGISTER FOR THE DEBATE!

Please register now for AFP-Arizona’s debate on the ObamaCare Medicaid expansion, which will take place from 11:30 am to 1:30 pm on Thursday, February 21 at the Goldwater Institute. At the event, Michael Cannon of the Cato Institute, Goldwater Institute health care policy analyst Christina Corieri, and Phoenix surgeon Jeff Singer will take on any three pro-expansion advocates who want to debate these issues publicly. We have extended the invitation to debate to Brewer adviser Chuck Coughlin, AHCCCS director Tom Betlach and members of the hospital and insurance lobbies. All concerned citizens who wish to attend the debate should RSVP to Shane Wikfors at swikfors@afphq.org

LEARN MORE!

For more about the problems with the proposed Medicaid expansion, read our line-by-line refutation of Gov. Brewer’s pro-expansion arguments in her January 14 speech.

DONATE!

Please help AFP-Arizona fight the battle for economic freedom in Arizona by going to www.aztaxpayers.org  or clicking on the Donate button to the right.  A contribution of $10, $25, $50, or $100 would be a huge boost to our efforts, and would enable us to mobilize more activists and put more pressure on elected officials.  Every little bit counts, and we can’t do what we do without great people like you standing with us.  Thank you for your support, financial and otherwise!  Let’s make 2013 a great year for free enterprise in Arizona!

For Liberty, Tom

Tom Jenney

Arizona Director

Americans for Prosperity

www.aztaxpayers.org

How ObamaCare affects YOU!

Join the Pima County Republican Women’s Club to hear health care authority

Dr. Elizabeth Lee Vliet!

The 2010 healthcare law, known as Obamacare, will bring many new rules, regulations, and cut backs to Medicare – come and hear how the new law affects you and your family:

How do the NEW Obamacare TAXES affect your pocketbook?

Obamacare cuts 716 BILLION dollars from Medicare – what does this mean for you getting the medical services you need?

Tuesday, September 18th

5:30pm social/6pm dinner and meeting
Sheraton Hotel and Suites
5151 East Grant Road
Tucson, Arizona
RSVP to Lauren Blevins
886 8232 or 403 7973
or laurenb3025@gmail.com

*Note the meeting day change to Tuesday!

You can also reserve your place using our PayPal option! Go to http://www.PCRWC.com

How do the new healthcare insurance “exchanges” affect your freedom to decide what you and your family can buy for medical insurance?

You hear about Obamacare paying for contraceptives and abortions…but what are the REAL women’s health issues Obamacare will cut?

How does Obamacare affect your medical privacy?

Why are health insurance premiums INCREASING under Obamacare?

Elizabeth Lee Vliet, M.D. is an independent physician with medical practices in Tucson AZ, Dallas TX, and Virginia. Dr. Vliet is the 2007 recipient of the Voice of Women award from the Arizona Foundation for Women. Dr. Vliet is the author of six books on women’s health and a national speaker on healthcare reform issues and how the new healthcare law–”Obamacare”–affects patients and their doctors. Dr. Vliet has appeared on national radio and TV, and an invited speaker for healthcare Town Halls, national and international conferences. Dr. Vliet is a member of the Board of Directors for the Association of American Physicians and Surgeons (AAPS), the voice of independent physicians and patients since 1943.

Sept 1, 12:30-2:30 pm, Coco’s Restaurant, 6095 E. Broadway Blvd

Senator Frank Antenori and Dr. Elizabeth Lee Vliet, M.D.

The recent U.S. Supreme Court rulings on Obamacare will have a significant impact on the financial and economic health of AZ. Obamacare affects your medical care and choice of treatment options, prescription medicine, your medical privacy, and the personal relationship you currently enjoy with your doctor.

To many the Supreme Court ruling is complex and confusing. To help clarify the rulings and their impact on the State of Arizona and your family please join Senator Antenori and Doctor Vliet.

Please join

ObamaCare Exchanges Undermine Liberty  5 ratings 34 views

This email is paid for by AAPS and is not approved by any candidate or political committee.