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The state is proposing to require that 30,000 low-income and disabled people in Pima and Santa Cruz counties find a new health-care plan. The reason: Other plans offered lower-cost care.

Pima Health System, a nonprofit arm of Pima County, has been a contractor with the Arizona Health Care Cost Containment System since 1982. It was passed over last week when AHCCCS, Arizona's Medicaid system, awarded new five-year acute-care contracts. Pima Health System's monthly rate per member was higher than the bidders who were selected.

This decision will create unnecessary hardship and risk for 30,000 low-income families, disabled people and children.

At the very least, the state should allow these patients to stay with Pima Health. Better: The state should reconsider or rebid the contracts.

There are three major problems with AHCCCS's decision:

● Many of the 30,000 patients who are soon to be displaced are ill-equipped to cope with researching and enrolling in a new health-care plan and thus may actually suffer as a result of the change.

"Effectively they're dumped out of the system," said Marian Lupu, for 40 years the executive director of the Pima Council on Aging. "There will be time delays for many of them who won't get care again until others in the community come forward to assist them.

"The state is asking those who are most ill and least sophisticated in manipulating the system to figure out how to navigate a new, complex problem."

● Three of the plans chosen are for-profit entities: Health Choice, which is owned by Iasis Healthcare, whose largest single stockholder is Texas Pacific Group, a private equity firm managing over $13 billion in assets; Arizona Physicians IPA, which is managed by AmeriChoice, which in turn is a business unit of UnitedHealth Group; and Phoenix Health Plan, which is owned by Vanguard Health Systems Inc., out of Nashville. The fourth is University Family Care, which is operated by the nonprofit University Physicians Healthcare, the practice group for the University of Arizona College of Medicine faculty.

While we are heartily in favor of profits, it is hard to argue with those who believe that in health care there is always a risk that the incentive to preserve a profit for investors may be at war with the need to spend money on care.

Furthermore, we believe that funds earmarked for the care of our community's patients should stay in the community, as Pima Health funds now do.

The acute-care contract totals about $100 million a year, according to Pima Health Executive Director Karen Fields. Of that, there is typically $1 million in surplus ("In government we call it 'revenue over expenditure,'" Fields said) that is funneled to Pima County's Community Services System, which serves more than 2,000 clients who need assistance but don't qualify for AHCCCS — thus expanding Pima Health's benefits beyond its own patients.

"They need home-delivered meals, transportation to medical appointments, housekeeping help, home health care," said Jo Ann Siemsen, the chief public information officer of Pima Health.

● Pima Health provides good care to its patients.

"Pima Health's costs are higher because they're giving quality service," Lupu said. "And if their bid was a little higher, then that money goes into keeping people from becoming so debilitated that they qualify for AHCCCS."

Fields has a statistical marker that she says makes the case for the plan's quality of care.

"Pima Health System has always prided itself on services to our members and the way you can tell this is that our medical expense ratio is consistently above 90 percent. The AHCCCS standard is 84 percent."

That means 90 percent of the AHCCCS contract is spent on behalf of the plan's members, she said.

Pima Health has asked the state to grant an enrollment cap. If granted, Pima Health would be allowed to continue to serve its enrolled patients but not accept new ones.

Fields said she was to meet Tuesday afternoon with county attorneys to discuss filing a protest. The county may decide to ask the state to reconsider its decisions or to put the contracts up for bidding again.

We hope the county will go forward with a protest and that AHCCCS powers that be will see the error of their decision. If not, we believe the state should grant the cap.

Pima Health's 30,000 acute-care AHCCCS patients deserve continuity of care.