PHOENIX — Gov. Jan Brewer brought supporters Tuesday to the state Capitol
to rally behind her plan to expand Medicaid to about 300,000 more Arizonans.
The move was meant to ramp up pressure on lawmakers to vote for the expansion that she fought tooth
and nail up until last year’s Supreme Court decision upholding the federal
health care overhaul.
The rally of health care professionals is the latest effort by the Republican
governor to sway lawmakers to back her plan. She held a series of press
conferences with health care providers after announcing in January that she
wanted to expand Medicaid.
But Brewer likely will have major problems getting her way, based on recent
interviews with the top leaders in the Republican-controlled Arizona Senate and
House Speaker Andy Tobin and Senate President Andy Biggs said the governor’s
reliance on the hospital assessment, which she hopes to impose as a fee, is a
tax that requires two-thirds votes in the Legislature to approve. That raises
the bar substantially for passage.
To get Tobin’s support, issues such as lawsuit reform and assurance that
hospitals don’t pass on the so-called “bed tax” costs to insurance companies
will be on the table.
“I’m not on board with this the way it’s written,” Tobin said last week.
“I’ve made that clear.”
Biggs is even more adamant.
“I’ve been up front with the governor all along, I said, ‘Look, I personally
oppose it, I’m not going to go back on something I campaigned for,’ ” Biggs said
Brewer’s plan would take advantage of $1.6 billion in new federal funding by
assessing hospitals about $250 million a year to pay for the state’s share of
costs. She has lined up support from health care providers and the business
community as well.
Surrounded by dozens of doctors and nurses at the rally in the shadow of the
House of Representatives on Tuesday, Brewer touted the benefits of expanding
Medicaid to those making up to 138 percent of the federal poverty line and
restoring insurance to more than 100,000 childless adults who’ve lost coverage
since the recession caused the state to scale back its program. She spoke of a
“hidden health care tax” she estimated at $2,000 a year for families that all
Arizonans pay in extra premiums to cover providers’ uncompensated care.
Speaking to reporters after her speech, Brewer said “elections have
consequences” and that she’s implementing President Barack Obama’s health care
law in the way she believes is best for Arizona.
“It passed, it was upheld as unconstitutional and now we’re faced with
resolving the issues that Arizona needs to resolve in regards to all that,”
Brewer said. “I never liked the Affordable (Care) Act. But, we don’t cut off
our nose to spite our face.”
When asked how she was going to win over members of her own party in the
Legislature who are opposed to the expansion, Brewer said she hopes they look at
the numbers and see them as she does.
“They haven’t exactly told me that, that they’re against it,” Brewer said.
“I feel as we move through the process we have a lot of educating to do, I’m
hopeful that they will listen to their constituents, because indeed it is the
right thing to do.”
If the assessment is considered a tax, the two-thirds vote required by 1998’s
Proposition 108 could be insurmountable.
“If it’s a 108, I think it would be pulled, it would never pass,” Rep. John
Kavanagh, head of the House Appropriations Committee, said Monday. “It’s shaky
it can pass with a majority.”
Like Biggs, Kavanagh is opposed to any expansion. He said he was pleased to
hear Tobin’s suggestions for making an expansion more palatable, but that the
federal government can’t afford the added burden of nationwide expansion. The
federal government would pay for most of the expansion.
“Seventeen billion in national debt and climbing, and this Medicaid expansion
and Obamacare keep fueling the national debt, and I don’t believe in making my
grandchildren pay my bills,” he said, referring to the federal Affordable Care
The governor’s proposal included some revenue in her budget from the hospital
tax, so that part will likely be included in the state budget currently being
negotiated. But some lawmakers believe any expansion of Medicaid, called the
Arizona Health Care cost Containment System, or AHCCCS, would be done in a
The Legislature has raised revenue repeatedly in recent years by allowing
agencies to raise fees, but never on the scale envisioned by Brewer this year.
In the budget year of 2015-2016, her budget expects $256 million in revenue from
the bed tax.
To pass with 50 percent, the expansion requires 31 votes in the House and 16 in
the Senate. If it’s considered a tax, it will require 41 votes in the House and
21 in the Senate.
Halfway into the legislative session, there’s still no clear picture of
legislation allowing the expansion. Kavanagh thinks the proposal is losing
ground among members.
“I think the momentum is in the opposite direction, and Republican district
committees are voting against it,” he said. “I see momentum shifting against
it, not for it.”