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Will Medicaid matter in 2014? Potential candidates for governor offer their thoughts

The intraparty battle raging in Republican circles over Gov. Jan Brewer’s Medicaid expansion plan has not yet extended into the race to succeed her.

Some Republican candidates and operatives question whether it will even matter by the time GOP primary voters cast their ballots in August 2014. The Legislature may decide the issue in the coming weeks, while the primary is still more than a year away. Several candidates who are expected to run haven’t yet announced their plans.

Potential candidates’ positions on the issue vary. Some have been very up-front with their opinions, while others are laying low on the issue.

Sen. Al Melvin, who has an exploratory committee open for the race, is an ardent opponent of Brewer’s plan. The SaddleBrooke Republican boasts on Twitter that he’s the only potential candidate to have voted against it. Former Maricopa County Attorney Andrew Thomas opposes expansion as well.

“It’s part and parcel of Obamacare,” Melvin said. “This flies in the face of so many things that Republicans believe in.”

On the pro-expansion side, former Tempe Mayor Hugh Hallman offered his position in March when he penned an op-ed in The Arizona Republic supporting Brewer’s plan as the best of several bad options. The plan stinks, he wrote, but is the best option available.

Mesa Mayor Scott Smith, who is considering a run and is widely expected to be one of the leading contenders, took a similar position in favor of the plan as well.

“I always ask those who want to make a stand, what’s the alternative? I don’t know that I ever got a clear answer,” Smith said when contacted by the Arizona Capitol Times. “I think this was one case where the governor took a bold stand. I agree with her that I think Obamacare is horrible. I think the alternative to not expanding was even worse.”

Straddling the fence

Others have straddled the fence. Secretary of State Ken Bennett, who opened an exploratory committee two years ago, has voiced concerns with the expansion proposal, but hasn’t taken a definitive position on it. State Treasurer Doug Ducey, who is expected to run and is the subject of a “Draft Ducey” campaign, hasn’t voiced any opinions on the plan.

In early April, Bennett told the Arizona Capitol Times he was still examining the issue and hadn’t yet taken a position. But he seemed wary of the proposal, which would expand Medicaid coverage to all Arizonans earning up to 133 percent of the federal poverty level, using a new hospital tax to trigger hundreds of millions in federal funding per year.

For 2013, the U.S. Department of Health and Human Services puts the poverty guideline for a single adult at $11,490.

“I don’t think the primary role of government is to provide health care. We’ve provided some safety nets at the federal and state level,” Bennett said. “I clearly favor doing things that help people afford their own health care and not be dependent on government. So to me, it’s not a badge of honor to say we have more and more people on a government program. We ought to be looking at ways to reduce the number of people on a government program by finding ways to help them purchase those types of programs.”

More recently, Bennett did not return messages on the issue. Spokesman Matt Roberts said Bennett is concerned that the federal government will not live up to its promises, and has voiced those concerns at meetings and events across the state.

Ducey, whom many view as the prohibitive frontrunner in 2014 primary, did not return messages or emails from the  Capitol Times.

Some, such as GOP consultant Sean Noble, say Medicaid will only play a role in the Republican primary if the issue hasn’t been resolved by the time the race gets underway.

“My guess is there’s going to be more of a focus on what’s happening in Arizona specifically. I think the expansion is to some degree viewed as a fight for right now. But if it goes into place, then it’s going to be in place. So I don’t know how it really affects how the governor’s race plays out,” said Noble, whom some expect to run Ducey’s gubernatorial campaign. Noble said he hasn’t decided whether he’ll be involved in the governor’s race.

Lobbyist and consultant Chuck Coughlin, who represents a group of health care organizations pushing for Medicaid expansion, agreed that Medicaid won’t be a factor if the issue is done with. If it’s unresolved, though, it’ll have a dominating role in the race.

“If it’s been done and digested and we’ve moved on, I don’t believe it will be a significant role in the Republican primary. If it’s not been done, I think it will be a great peril to our party and be a substantive discussion in a Republican primary,” said Coughlin, whose firm, HighGround, worked on Smith’s mayoral races and is expected to handle his gubernatorial campaign as well.

On the other hand, Republican consultant Chris Baker said Medicaid will probably be an issue in the primary. Arizona still faces the possibility that federal funding will dry up in a few years, Baker said, which means the next governor will still have to deal with Medicaid expansion.

If nothing else, it will be an issue that candidates use to establish their conservative bona fides.

Leadership vs. followship

“It’s a very clear, simple issue that’s really going to separate conservative candidates for governor from, shall we say, less conservative candidates, because this really comes down to a core issue, especially on the Republican side, which is the size and cost of government,” Baker said.

For now, Baker said he doesn’t think candidates gain anything by taking a position on the expansion of the Arizona Health Care Cost Containment System.

Hallman, however, said the candidates’ position, and their willingness to take a stand, sends a message to the voters.

“These are issues of great import to the state and those who seek the office of governor ought to have the courage to state what their position is on these kinds of issues. That way, we’ll have a better understanding when crises occur — and they do occur — how someone will handle it,” Hallman said. “That’s the test of leadership. Waiting until the polls come in is called followship.”

Melvin disagreed strongly with Hallman’s position on Medicaid, but agreed that candidates should make their position known.

“I can’t see how any serious candidate for governor could waffle on this subject, of all subjects. You’re either for it or against it. These people owe it to the voters in Arizona to be cut and dry on the issue,” he said.

Melvin plans to keep Medicaid expansion on the front burner next year if the governor’s plan passes.

“I hope it remains front and center. My first desire is to defeat the Medicaid expansion, and then if it goes through I vow to do everything to dismantle it,” he said.

Holding candidates accountable

Conservative grassroots activists will almost certainly help keep the issue alive. Maricopa County Republican Party Chairman A.J. LaFaro, who made headlines in March for comparing Brewer to the biblical figure Judas, said grassroots Republicans will hold gubernatorial candidates accountable if they support AHCCCS expansion.

“If an Arizona GOP gubernatorial candidate (or any GOP candidate for that matter) supports the governor’s ridiculous proposal to expand Obamacare and Medicaid, then they will face the same intense fight the governor is in. The precinct committeemen, grassroots conservative activists and the re-energized Tea Party members are very good at vetting the candidates they eventually support and get elected,” LaFaro said in an email.

Coughlin said the conservative grassroots activists who oppose expansion are overestimating their strength. He said that wing of the party constitutes 25 to 30 percent of the base.

“I believe an aggressive campaign can recruit Republican women and hold a majority of Republican men. And it leaves a very narrow part of the party for those people to attempt to exploit,” Coughlin said. “The belief of the opponents here is that their segment of the party is much bigger than it is. And it’s not.”

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