Some Americans who urgently need organ transplants face a life-and-death struggle following Medicaid cuts in states that are refusing to pay.

In Arizona, lawmakers stopped paying some kinds of transplants, including livers for people with hepatitis C.

The cuts to Arizona's Medicaid program for the poor and uninsured will save about $1.4 million US a year for a state that faces a $2 billion deficit US that is nearly 25 per cent of its budget.

Medicaid benefits and cuts

Medicaid costs are shared by the federal and state governments.

It's not just the poor and disabled who benefit. Middle-class families with elderly parents in nursing homes are relieved of financial pressure after Medicaid starts picking up the bills.

Different states are choosing to cut different services. In California, Medicaid no longer pays for many adult dental services. But it still pays for tooth extractions. The unintended consequence: Medicaid patients tell dentists to pull teeth that could be saved.

States may consider lowering payment rates to nursing homes or home health agencies or further reducing payments to doctors, said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.

Prescription drug coverage in states is an optional benefit and another possible place to cut, Rowland said.

Source: Associated Press

"It's not like we're disapproving a dermatologic procedure for somebody who's going to have itching for the next year and we feel bad about them," said Dr. Michel Moulton, who performs heart transplants in Tucson. "I mean, these are people who are gonna die."

Randy Shepherd, a 36-year-old plumber and father of three was at the top of the list for a new heart last year. He was taken off the state's list in the fall. Doctors say without a new heart he could die in a month.

"I feel like a political football, like I'm being held up as the champion of 'What's wrong with Arizona?,'" said Shepherd, whose heart was damaged by rheumatic fever as a boy, a preexisting condition that prevents him from getting private insurance coverage.

"I hate that it reflects upon the state so poorly."

Political critics say the Arizona legislature has become a kind of "death panel."

But the cancelled patients were high risk with typically poor outcomes, said budget chair John Kavanagh.

"You can't give everybody everything. So death panels? It's a politically hot word. But we're simply making decisions that everybody has to make in the real world."

The legislature may return some of the 97 patients to the transplant list next month, Kavanagh said.

In the meantime, patients like Shepherd are trying to raise the money themselves. He's collected $57,000 US so far for the transplant that costs 10 times that, if he lives long enough to receive the surgery.

With files from The Associated Press