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Updated Jun 17, 2013 - 3:32 pm

Arizona Gov. Brewer signs Medicaid expansion law

PHOENIX — Republican Gov. Jan Brewer on Monday signed a law expanding the
state’s Medicaid program to 300,000 more poor Arizonans following her victory
over conservatives in her own party opposed to embracing a key part of President
Barack Obama’s health care overhaul.

Brewer gathered key lawmakers from both parties who voted for the law at the
late-morning ceremony. Conservative Republicans in the Arizona House and Senate
fought the proposal bitterly for months but a coalition of the Legislature’s
Democrats and some Republicans teamed up to approve the law.

“You put people in front of politics and you stood firm in the face of
personal attacks,” Brewer said of the lawmakers who supported her.

Opponents are planning a citizen’s referendum that would block the law that
could be filed as early as Tuesday. A lawsuit is also possible. To block the law
with a referendum, opponents will need to gather more than 86,000 signatures in
three months. A successful effort would prevent expansion from going into effect
in January and put it on the Nov. 2014 ballot.

“I don’t believe it’s going to be very difficult at all,” said former state
Sen. Frank Antenori, a Tucson Republican who is working on the referendum
effort. “That’s statewide, it’s all 15 counties. The Republican party alone
has 1.1 million registered voters.”

“It wouldn’t be Jan Brewer’s life if it wasn’t for challenges,” the governor
said after the ceremony. “Today we are celebrating what we’ve been able to
complete and I am very, very grateful for the people that stood with me. And we
will just take each day as it comes. I think that overwhelmingly the people of
Arizona support us and they will continue to support us in our efforts.”

Brewer’s staff has said a previous appeals court decision prevents such
referendums on appropriations laws, so a court battle could erupt if Antenori’s
group is successful.

The conservative Goldwater Institute is also considering suing to block the
law, arguing that the state constitution requires a 2/3 vote to raise taxes.

Brewer’s proposal will impose an assessment or “bed tax” of about $250
million a year on hospitals to pay for the state’s share of expansion costs.
Neither the House or Senate votes reached that threshold. Goldwater attorney
Christine Sandefur said Monday the group may also challenge on a separation of
powers argument because the state’s Medicaid director is given power to set the
assessment and exempt some hospitals.

“In other words, a hospital that has political clout and can get to the
director might have that luxury and others will not,” Sandefur said.

Any suit could only be filed after the law takes effect in 90 days, she said.

Brewer, an early critic of the Affordable Care Act, surprised the nation when
she acknowledged the Medicaid expansion as the law of the land in her State of
the State address in January. She noted that rejecting an expansion would mean
Arizona taxpayers would subsidize care for those in other states while receiving
no benefits themselves.

The expansion is expected bring in $1.6 billion a year in federal funding and
help reduce the amount of uncompensated care hospitals must absorb and help cut
what Brewer called a hidden health care tax that people who buy insurance pay,
through higher premiums, to cover others’ care.

Conservatives in the Legislature blocked expansion for months, with the Senate
finally approving it last month. But the House speaker delayed bringing it up
for a vote, and Brewer ran out of patience. She called a special session last
week and forced the Legislature to act on an $8.8 billion budget and Medicaid.

At Monday’s ceremony, most of the 14 Republicans who backed expansion stood
with Brewer and Democrats.

“We will provide health care to hundreds of thousands of Arizona’s most
vulnerable citizens,” said Rep. Heather Carter, R-Cave Creek, who chairs the
House health committee and backed the law. “And this care will not be in the
overcrowded hospital emergency room but in clinics and doctors’ office and
community health centers across our great state. This is cost-effective
medicine, at the right time, in the right setting, saving money and saving
lives.”

But one member of the coalition noted that their efforts have brought backlash
from conservatives. Sen. Steve Pierce, R-Prescott, called the expansion “the
right thing to do for Arizona.”

“It’s a shame that those who disagree with those of us up here are so
disagreeable,” Pierce said. “We’re getting used to it. It’s a shame that you
can’t disagree and disagree honorably and still have discourse. And that’s
important. That’s one thing that’s lacking I believe in our Legislature.”

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