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\nAPACHE JUNCTION, Ariz. \u2013 In a low-slung building in the vast desert expanse east of Phoenix, a small school of tropical fish peer out, improbably, from a circular tank into the waiting lounge of the Apache Junction Health Center. The hallways of the nursing home are still. Only half of the rooms are filled, and the men and women who live here seem surely in life\u2019s final season. \u201cThese are folks that have chronic cognitive and physical disabilities that are not going to improve,\u201d said George Jacobson, administrator of the nursing home. <\/p>\n
That this nursing home is sparsely filled with residents too disabled in mind or body to return home is a stunning achievement for Arizona\u2019s public health insurance agency. A decade ago, 60 percent of Arizonans covered by Medicare and Medicaid, and deemed sick, frail or disabled enough to live in a nursing home, resided in a skilled nursing facility. Today, only 27 percent of them do, and the rest \u2013 nearly three out of four\u2013 live in assisted living facilities or at home with the help of nurses, attendants and case managers provided by government-paid health plans.<\/p>\n
As Congress debates an ambitious and far-reaching effort by the Obama administration to streamline medical care and rein in spending for the nation\u2019s sickest and most expensive patients, Arizona \u2013 with its finger-wagging Republican governor and Tea Party enthusiasts \u2013 is occupying an unusual place<\/a> in the national landscape: as a model for how a generously-funded, tightly regulated government program can aid vulnerable, low-income patients.<\/p>\n<\/blockquote>\n