If Gov. Jan Brewer pushes for a state-run health insurance exchange or Medicaid expansion next session, there is little doubt that she’ll need more than just Republican votes.
And the Legislature’s Democratic leaders are offering to help fill the gap.
House Minority Leader Chad Campbell and Senate Minority Leader Leah Landrum Taylor said they are reaching out to the Ninth Floor in the hope that Brewer will give them a rare seat at the table on two major health care issues that are expected to dominate the 2013 session.
Brewer has not yet said whether she will fight to restore coverage that was cut from the Arizona Health Care Cost Containment System in the past few years or try to implement a state-run exchange under the Affordable Care Act. But many at the Capitol expect her to take up those causes.
Campbell, D-Phoenix, said he spoke with members of Brewer’s staff, and is still awaiting a response.
“Realistically speaking, if she wants to pass anything related to the exchanges or Medicaid expansion of any kind, it’s highly probable they’re going to need the Democrats to help work with them on this one,” Campbell said. “I just don’t see them getting a Republican-only vote out of either of the chambers around these issues. I just think they’re going to have to have some bipartisan support.”
Many legislative Republicans, including those in key leadership positions, are adamantly opposed to a state-run exchange. Despite a general preference for state control over federal control, GOP lawmakers are largely opposed to anything that would validate the Affordable Care Act or put Arizona on the hook for a policy they believe is destined to fail. And many are concerned about myriad unanswered questions about how a state-run exchange would work or how much it would cost Arizona.
Landrum Taylor, D-Phoenix, said she, too, is hoping to set up a meeting with Brewer or her top staff to discuss a possible coalition on health care issues. Considering the opposition to Medicaid expansion or a state-run exchange among legislative Republicans, Landrum Taylor said Democratic support will be critical for getting those measures to Brewer’s desk.
“We have a golden opportunity to craft something that can be tailor-fit just for our state. But it’s going to take all of us working together,” Landrum Taylor said.
Under the Affordable Care Act, states have the option of setting up their own exchange, an online marketplace where individuals and businesses can purchase coverage. The federal government will establish an exchange in any state that doesn’t do so itself.
The states have until Dec. 14 to inform the U.S. Department of Health and Human Services whether they intend to set up their own exchanges. If Brewer opts for a state-based exchange, it will require some type of legislative approval.
The federal health care law also provides increased matching funds for states that expand Medicaid coverage to include anyone earning up to 133 percent of the federal poverty level. Even if Arizona doesn’t opt for the full expansion, many in the health care and business communities are hoping the state will at least restore massive cuts made to AHCCCS during the recent fiscal crisis. About 160,000 people were cut from the AHCCCS rolls to help balance the state’s budget.
Campbell and Landrum Taylor’s proposal is full of hypotheticals. Brewer has not yet signaled what she will do on either issue. The Governor’s Office said Brewer’s decision on AHCCCS expansion will be included in her budget proposal in January.
But if Brewer decides to move forward on either issue, Campbell said Brewer needs to reach out early to the Democrats. If she tries to pass either with only Republican votes, then embraces the Democrats only as a backup plan if it doesn’t work, Campbell warned that the votes might not be there.
If Brewer fails to get Democratic input and proposes a poorly constructed state-run exchange that falls short of the standards Campbell expects from a federally run exchange, he said his caucus won’t vote for it.
“We need to start having these conversations now and not wait until the last minute, because we’re not going to support something that’s bad for Arizona just so we have a seat at the table,” he said. “We have no problem saying no to it because we know there’s going to be an exchange regardless.”
Landrum Taylor said Senate Democrats won’t turn down a good deal just because they weren’t included. But moving forward without including them will make it harder to round up the votes, she said.
“If it turns out she wants to meet with those in her party first, sometimes that’s just the way that that goes. I think the better way, if I were in her seat, would be a five-party talk,” Taylor said, referring to the Governor’s Office and the Democratic and Republican caucuses from each chamber. “Every vote will be needed.”
Democrats have little power at the Legislature, but slightly more than they had a few weeks ago. The Nov. 6 election broke GOP supermajorities in both chambers, leaving a 36-24 split in the House and a 17-13 split in the Senate.
Brewer spokesman Matthew Benson said it’s too early to discuss what negotiations might look like on those two issues.
“It’s just a little premature to speculate in terms of vote counting and that sort of thing,” Benson said. “The governor hasn’t made a determination whether she intends to seek a state-level exchange. But I think everybody’s aware of the political dynamic that exists in the Arizona Legislature on not just this but all issues related to the Affordable Care Act.”
Benson said a state-run exchange would require some type of legislative approval, and said Campbell “would have a chance to make his views known as part of that process.”
Brewer said she hasn’t made a decision on the exchange yet. But she has signaled possible support by accepting a $30 million federal grant to help lay the groundwork and hiring a state exchange director.
Some Republican lawmakers said it won’t matter whether Brewer sits down with the Democrats or not, because the Legislature won’t pass a state-run exchange either way.
Rep. John Kavanagh, who chairs the House Appropriations Committee, said only a small handful of Republicans, at most, would vote for an exchange. And it’s possible that a state-run exchange wouldn’t get a single GOP vote.
Kavanagh, R-Fountain Hills, questioned whether House Speaker Andy Tobin or Senate President Andy Biggs would even be willing to allow an exchange bill to move forward.
“I honestly don’t think that, regardless of how many Democrats and even a small number of Republicans (support it), that bill would be heard on the House or Senate floor,” Kavanagh said.
Kavanagh emphasized that Brewer has not yet made a decision on either issue.
“I’m not prepared to state that she’s going to support either of those things, particularly the exchange,” Kavanagh said. “But I don’t think she could pass it with the Ds and a couple of Rs, if she so chose to go down that road. And I don’t know if she would do that either. We’ve got two years of collaboration ahead. To do something like that would certainly chill the air. I don’t think the governor would go down that road with the Democrats.”
Sen. Nancy Barto, chair of the Senate Health and Human Services Committee and a steadfast opponent of a state-run exchange, said she doubted there would be many Republican votes for an exchange. Medicaid expansion could possibly get through, she said, but only with Democratic votes, and even then only if the state’s revenue forecasts are robust enough to support it.
But Barto, R-Phoenix, questioned whether Brewer would move ahead on either issue.
“I think she is going to carefully consider her Republican constituents. She’s a conservative Republican governor, and I think she wants to govern as a conservative. I think that will be foremost in her mind,” she said.
Barto said she would not hear any bill in her committee that would establish a state-run exchange.
Tobin, R-Paulden, said he has no idea whether the Democrats could bring enough votes to pass a state-run exchange.
“I don’t have a count sheet,” he said.