Unable or unwilling to take on Medicaid expansion at the Capitol, House speaker Andy Tobin wants to ask voters in the state whether they want to expand Medicaid coverage. He is working on a resolution to send the question to the ballot in a special election this year.
Tobin’s proposed constitutional amendment would ask voters whether to expand the AHCCCS system to cover people at 133 percent of the federal poverty level. Tobin said the resolution is the best option because he believes any provider assessment – or self-imposed tax on hospitals to pay the state’s portion for expanded Medicaid coverage – would need a two-thirds vote from both chambers of the Legislature under the voter approved Proposition 108.
Similar to Brewer’s plan, Tobin’s proposal would direct the AHCCCS director to assess hospitals with a fee that the state can then use to draw down federal funds. In essence, Arizona would not pay for the Medicaid expansion out of its general fund. There are, however, key differences between the two plans. Tobin’s proposal, for one, would cap the assessment at six percent and it would require the AHCCCS director to establish a tiered system for determining the hospitals’ assessment rates.
Governor Jan Brewer has repeatedly said the Legislature should deal with the issue itself and that she will fight against any attempt to send the Medicaid expansion to the ballot. Tobin offered his proposal as the Senate began considering its own budget proposal. That plan would seek a federal waiver to continue the freeze on the Medicaid population. If the waiver were rejected, the plan calls for the Prop 204 population to be funded entirely by the state at a cost of $808 million, including baseline funding, over three years.
Tobin said he hasn’t received any indication from the governor whether she would go along with a plan to put Medicaid expansion to the voters.
“How can she say no to the (resolution) if she hasn’t seen it,” he said.
He said the resolution, which hasn’t yet been introduced, would include oversight from the Joint Legislative Budget Committee on the hospital assessment, and provide additional oversight and protections not offered in the governor’s proposal.
The proposal would offer a stronger circuit breaker provision than the proposal put forward by Brewer, and would cancel the expanded coverage level if the federal government dropped its portion of the payment by 5 percent. Brewer’s proposal allows for a 10 percent drop in those matching funds.
Tobin also said he has been left in the dark about the Senate budget introduced today, and said this afternoon that he hasn’t seen the proposal or spoken with Senate President Andy Biggs about it.
“I haven’t seen the budget. I have no idea what’s in it,” he said this afternoon, noting that he and Biggs have offered Gov. Jan Brewer several budget proposals that didn’t include Medicaid expansion, and she has so far shot them down.