State health care budgets have been relying on a sort of practical magic. On the practical side, prevailing state legislators have argued that the state can’t afford broader coverage through the Arizona Health Care Cost Containment System (AHCCCS) for people who themselves can’t possibly afford it on the open market. On the magic side, they expect that the costs of care for those uncovered people will simply disappear.

Of course, nothing could be further from the truth. In reality, what could have been handled in a timely fashion at a family doctor’s office for the cost of a $25 prescription is deferred and transforms into a hospital intensive care stay at 20 times the expense – and all of it falling into a category called “uncompensated care.” There’s nothing magical about what happens next, which falls into a category called “cost-shifting.” In order to keep the doors open and lights on, your unpaid local hospital and care providers have little choice but to raise prices for paying customers.

On the other hand, there is some practical magic potential in combining the public-private model of AHCCCS with the federal government’s offer to pay as much as 90 cents on the dollar to create an Arizona solution. Read more about it in CEO Fred Karnas’ Arizona Republic editorial.