Arizona Gov. Jan Brewer held the latest in a series of rallies at the Capitol on Thursday to show she has broad support for her proposal to expand Medicaid to about 300,000 more poor Arizonans. And her effort appears to be paying off.
A growing number of lawmakers in both parties seem to believe the Legislature will pass Brewer’s expansion.
That’s a change from earlier this year, when the main voices heard in the debate were those of conservative Republicans opposed to the expansion, a signature part of President Barack Obama’s heath care overhaul law.
“It’ll get passed,’ said Sen. Steve Pierce, a Prescott Republican who served as Senate president last year and is the most outspoken GOP supporter in the chamber. “She’s got the power of the veto and she will be there until she gets it.”
Democrats who broadly support the expansion hold 13 of the 30 seats in the Senate. Pierce believes the Senate vote could reach a two-thirds majority, meaning at least eight Republicans would have to vote in favor of the proposal.
“The governor’s sitting, as I see It, in the catbird’s seat, and she has tools at her command,” said Sen. Linda Lopez, a Tucson Democrat who serves as assistant minority leader.
The House has 36 Republicans and 24 Democrats, and the vote there may be tighter, especially considering vocal opposition from powerful tea party conservatives. But the House charge being led by Republican Rep. Heather Carter of Cave Creek is gaining traction.
“When we finally put together the package, I believe that we’ll have enough support to pass it,” Carter said Wednesday. “But I don’t know what the package is going to look like.”
Thursday’s event featured mental health professionals and patients who said expanding Medicaid will help a vulnerable population that badly needs ongoing treatment. Earlier events brought business leaders, who argued the expansion would boost businesses, and hospitals, doctors groups and patients who would benefit from the new insurance.
Some Republican House members privately say they’re backing the expansion and believe it will pass. They’re being cautious about making public pronouncements because there is strong conservative opposition.
House Speaker Andy Tobin doesn’t believe he has the votes to pass the bill, saying Wednesday that he thinks he has lost some member support since the Center for Arizona Policy, a powerful conservative group that opposes abortion, raised questions about whether the expansion will help subsidize abortion providers. The group has proposed amendments to block that use.
“The answer now is no,” said Tobin, R-Paulden. “And I’m not putting the governor’s language up on the board.”
The governor’s plan calls for an assessment on hospitals to bring in about $250 million a year to pay the state’s share of an expanded Medicaid program. The state can expect $1.6 billion a year in new federal funding to fund expansion and allow health care providers to avoid hundreds of millions of dollars in uncompensated care.
Brewer’s plan would add at least 300,000 poor Arizonans to the nearly 1.3 million now covered by the state’s version of Medicaid.
The general bill language to allow the expansion has been released by the governor’s office but not yet introduced in either chamber. The bill allows the director of the Arizona Health Care Cost Containment System, or AHCCCS, to levy the assessment and run the program.
The assessment would sidestep a constitutional requirement that tax increases be approved by two-thirds of the Legislature. That has raised concerns among many Republicans, and the governor’s office is negotiating with legislative leaders on changes to address some of their concerns.
The governor has agreed to changes involving concerns that hospitals might pass on costs of the new “bed tax” to insurers, Brewer’s spokesman, Matthew Benson, said Wednesday.
In addition, Brewer has tightened an automatic halt to the expansion if federal funding falls short.
The Affordable Care Act gives states the option of expanding coverage to people making up to 138 percent of the federal poverty level, up from 100 percent. Washington also will pay all costs for the first few years before dropping its share to 90 percent.
Tobin said there’s no agreement yet, and he’s pushing for other items such as lawsuit reform to be in the bill when it’s formally introduced.
A touchier subject is Republicans’ concerns that the expansion would help pay for abortions. Federal and state law bars tax money from being spent on abortions, but opponents say some groups that get money for services such as cervical exams use it to subsidize abortion services.
Benson said options to address Republicans’ abortion concerns are being discussed, although he wouldn’t disclose what they might be.
The Center for Arizona Policy circulated a proposed amendment to the bill language Wednesday that would bar Planned Parenthood from using any Medicaid expansion money to directly or indirectly pay for abortions or related administrative costs and require state audits.
The hospital assessment included in the Medicaid expansion proposal is expected to add cash to the state general fund, meaning it’s a key component of the state budget. For the fiscal year that begins July 1, the hospital tax adds $62 million, rising to $136 million in the 2014-2015 budget year and $155 million the next year.
That means negotiations on the state budget remain stalled until the Medicaid issue is ironed out, one way or another.
“This proposal is going to get over the finish line, the governor is committed to it, she has committed a lot of time and (political) capital in this initiative and she is going to see it through,” Benson said.