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The perils of voting yes to Medicaid expansion

Republican renegades face political war with air of optimism

Long before casting their votes for Medicaid expansion and a bipartisan budget proposal, Republican lawmakers who chose to support Gov. Jan Brewer had been issued a warning: Vote yes at your own risk.

The actions of five Arizona senators in May to help Democrats approve the expansion had drawn the wrath of party leaders, including Maricopa County Republican Committee Chairman A.J. LaFaro, who vowed to oust those who supported “Obamacare” at the Capitol.

“Their egregious actions will have consequences,” LaFaro wrote in a May 22 email blast to lawmakers. “Their political careers are all but over and their days are numbered.”

With the 2013 session behind them, a faction of Arizona Republicans are now ready to launch political war against those 14 GOP lawmakers who joined Democrats in one of the most contentious votes on Arizona policy in recent memory.

Already, some new Republican candidates have filed the paperwork to challenge them in 2014.

As in 2010 and 2012, the struggle against “Obamacare” will likely fuel the hardline conservative wing of the Republican Party. Except now, every member of the Legislature has either voted for or against the plan to implement one part of it, and their vote can be used to attack them.

Moderate Republicans may face a more difficult challenge defending their voting record in primary races, where candidates typically run to the right to earn the votes of the more conservative members of their party.

Senate President Andy Biggs, R-Gilbert, said, “The liberals in the Democratic Party and the conservatives in the Republican Party nominate their candidates because they come out more than the more moderate folks. So you may see a change.”

General election risks

Running more ideologically rigid GOP candidates against incumbent Republicans who supported the Medicaid expansion comes with risks. In some districts, right-wing Republicans could beat incumbents in the primary, but go on to lose in the general.

“It’s a double-edged sword,” said Rep. J.D. Mesnard, R-Chandler. “You might successfully knock off folks that you felt didn’t act like they should, but then if the (primary winner) loses to a Democrat, you have to think about which is worse.”

If that scenario were to play out six times in the House, three times in the Senate and all other seats keep their current partisanship, both chambers would end up with Democratic majorities.

The risk is greatest in the state’s competitive districts, including six of the nine GOP House members and two of the five in the Senate who supported Medicaid expansion.

And because every one of them – Sens. Adam Driggs and John McComish and Reps. Kate Brophy-McGee, Jeff Dial, Ethan Orr, Frank Pratt, Bob Robson and T.J. Shope – had uncontested primaries in 2012, their ability to withstand a challenge from the right wing of their party is untested.

Reps. Heather Carter, Douglas Coleman and Doris Goodale, and Sens. Rich Crandall and Bob Worsley, all hail from more Republican-heavy districts and faced more far-right primary challengers in 2012 than other candidates.

But at the time, their challengers were not able to send campaign mailers impugning them for a vote to support the implementation of a component of “Obamacare.”

Running on the merits

Carter, who helped lead the Republican pro-expansion contingent, was one of four Republicans vying for two spots on the general election ticket in Legislative District 15. The Cave Creek Republican came out far ahead of any other candidate, taking nearly 40 percent of the GOP primary vote, with the remaining three hardline conservatives receiving 15 per cent to 23 percent of the vote.

Although her district is firmly Republican, Carter said she’s confident in her ability to educate voters during her campaign on the merits of expansion.

She said she doesn’t think the opposition to Medicaid expansion will play well in her district. Carter said she’s confident that she’ll be able to explain to voters why Medicaid expansion was the best move for the state.

Goodale, R-Kingman, faces the most solidly GOP district of all House Republicans who supported the Medicaid expansion. The northwestern Arizona district that includes Kingman, Bullhead City and Lake Havasu City, has been known for hardline conservative politicians, with former Republican Sen. Ron Gould standing as its vocal mascot for most of the past decade.

Gould, who left the Senate in 2012 to run unsuccessfully for a U.S. House seat, was portrayed shooting a copy of the Affordable Care Act with a shotgun in a 2012 congressional campaign commercial, and is now part of the effort to stop the Medicaid expansion with a citizen referendum.

And Republicans considering a challenge to Goodale don’t need to look far for a parallel.

In 2012, Sen. Kelli Ward, R-Lake Havasu City, relatively unknown at the time, beat then-Rep. Nancy McLain in the district’s Senate primary, using as a main pillar of her campaign McLain’s support for hearing an “Obamacare”-style, interstate insurance exchange bill in a House committee.

But among the House Republicans who voted for the expansion, Goodale also did the best in her 2012 primary election. She took

43 percent in the four-way Republican primary, with now-Rep. Sonny Borelli, R-Lake Havasu City, coming in second, nearly 17 points behind. Two other Republican candidates received 17 percent and 13 percent of the vote.

Goodale said she’s already aware of a growing primary field and that she expects to include the same four candidates from 2012, plus another who unsuccessfully ran in 2010. She said she even heard that a voter from her district called the Secretary of State’s Office to inquire about having her recalled.

Like Carter, as well as other Republicans who supported Medicaid expansion, Goodale said she thinks the potential attacks from primary challengers can be overcome with strong voter education on the merits of the plan.

“Was it the best way to provide for people? No, but it was the option we had available to us,” Goodale said. “I have small hospitals, one in Parker, another in Page, Lake Havasu City, Colorado City, that were desperate for the help they’ll get from it.”

Low-hanging fruit

Coleman, a freshman representative from Apache Junction, also is in a solidly Republican-leaning district in the East Valley.  He only survived the 2012 primary by a margin of 57 votes in a four-way race with no incumbent running.

Coleman’s seatmate, Mesa Republican Kelly Townsend, who got the most votes in the primary, was among the most vociferous opponents of Medicaid expansion, nearly coming to tears during her explanation of her opposition to the plan.

Townsend said Coleman is often talked about in Republican circles as “the low-hanging fruit” when it comes to GOP lawmakers who could be replaced.

“We have a single-dominant party out here,” Townsend said. “I had people coming to me in the district saying we wanted jobs, we didn’t want welfare, and that tends to be the majority of our district. Votes speak louder than words, and no matter how he campaigns, he won’t be able to deny his voting record.”

Coleman said those who supported him in 2012 weren’t surprised by his vote for Medicaid and will still be in his corner in the 2014 primary. And he hopes to rely heavily on the rest of his voting record, not just Medicaid.

Townsend credited Coleman, a former mayor and councilman in Apache Junction, for his work to help pass the transaction sales tax privilege bill.

Crandall comes from the same solidly GOP?district as Coleman, and barely beat then-Rep. John Fillmore, who tried to unseat him in one of the most heated legislative primaries of 2012.

But with Crandall, R-Mesa, leaving Arizona soon for a job in Wyoming, his seat will be filled temporarily by appointment.

Worsley comes from the neighboring LD25, which is an even more Republican-leaning district, but which is also closely aligned with the Mormon community. Worsley beat former Sen. Russell Pearce in the 2012 primary after Pearce had been recalled the year before. Pearce’s extreme politics led to heavy involvement by Mormons in selecting more moderate candidates during the 2011 recall and the 2012 primary.

Worsley, R-Mesa, said he “fully intends” to run again in 2014, and is not in any way deterred by the threat of a primary challenge.

“I’m not worried about it,” Worsley said. “Those I’ve met with that are disappointed, we’ve had conversation and they’ve left educated on the more complex subtleties of that vote. It’s an easy one liner in the media but it’s a much more difficult subject.”

A safe bet

Sen. Steve Pierce, R-Prescott, is the only one of the Medicaid supporters who comes from a non-competitive district and didn’t face a primary challenge in 2012.

There was, however, a primary over his district’s House seat, where three incumbents had been redrawn into the same district in 2011. During that primary, then-Sen. Lori Klein, who allied herself with the more extreme end of her party, lost decisively. The two she lost to, though, both opposed the Medicaid expansion this year.

Despite calls from LaFaro to oust him, McComish is considered by most political observers a safe bet to hold on to his seat in a moderate district. The Phoenix Republican and Senate majority leader observed that in 2011, the Arizona Capitol Times ran a story wondering if 12 Republican lawmakers who voted against some or all of the stricter state-level immigration laws proposed in 2011 would face the wrath of voters in 2012.

“And what it in fact cost them was nothing,” McComish said. “Not one of those people were bounced because of their votes.”

Could this time be different, more costly to those runaway Republicans?

“(If) that’s the price I have to pay for what I’m convinced was the right thing to do, then so be it,” McComish said. “It’s not what I want. But you have to make those stances every once in awhile.”

— Evan Wyloge & Ben Giles

Legislative District 1
Overall Republican Favor* Possible primary targets
65.8% Sen. Steve Pierce
2012 Senate Primary
Candidate Votes Percent
Sen. Steve Pierce 29,362 100.0%
Legislative District 5
Overall Republican Favor* Possible primary targets
64.5% Rep. Doris Goodale
2012 House Primary
Candidate Votes Percent
Rep. Doris Goodale** 14,056 43.4%
Rep. Sonny Borelli 8,672 26.8%
Wyatt Brooks 5,369 16.6%
George Schnittgrund 4,315 13.3%
**Overperformed an even primary split by 73.5%
Legislative District 8
Overall Republican Favor* Possible primary targets
51.1% Rep. Frank Pratt**
  Rep. T.J. Shope
**Has an exploratory committee for Corporation Commission, so likely will not seek office again
2012 House Primary
Candidate Votes Percent
Rep. Frank Pratt 7,944 58.5%
Rep. T.J. Shope 5,646 41.6%
Legislative District 9
Overall Republican Favor* Possible primary targets
46.4% Rep. Ethan Orr
2012 Housee Primary
Candidate Votes Percent
Rep. Ethan Orr 15,879 98.9%
Cynthia Miley (Write-in) 185 1.1%
Legislative District 15
Overall Republican Favor* Possible primary targets
61.5% Rep. Heather Carter
2012 House Primary
Candidate Votes Percent
Rep. Heather Carter** 13,196 39.6%
Rep. John Allen 7,813 23.5%
David Burnell Smith 7,397 22.2%
James Bearup 4,895 14.7%
**Overperformed an even primary split by 58.5%
Legislative District 16
Overall Republican Favor* Possible primary targets
61.1% Sen. Rich Crandall**
      Rep. Doug Coleman
**Will not seek office again
2012 Senate Primary
Candidate Votes Percent
Sen. Rich Crandall 9,493 52.4%
John Fillmore 8,614 47.6%
2012 House Primary
Candidate Votes Percent
Rep. Kelly Townsend 9,398 31.5%
Rep. Doug Coleman 8,021 26.9%
Jeff Davis 7,064 23.7%
Judy Novalsky 5,326 17.9%
Legislative District 18
Overall Republican Favor* Possible primary targets
51.7% Sen. John McComish
      Rep. Jeff Dial
      Rep. Bob Robson
2012 Senate Primary
Candidate Votes Percent
Sen. John McComish 17,615 100.0%
2012 House Primary
Candidate Votes Percent
Rep. Jeff Dial 15,677 51.5%
Rep. Bob Robson 14,780 44.1%
    Legislative District 25
Overall Republican Favor* Possible primary targets
64.6% Sen. Bob Worsley
2012 House Primary
Candidate Votes Percent
Sen. Bob Worsley 17,200 56.0%
Russell Pearce 13,534 44.0%
Legislative District 28
Overall Republican Favor* Possible primary targets
54.8% Sen. Adam Driggs
2012 Senate Primary
Candidate Votes Percent
Sen. Adam Driggs 20,247 100.0%
2012 House Primary
Candidate Votes Percent
Rep. Kate Brophy-McGee 17,971 55.9%
Amanda Reeve 14,179 44.1%


A look at the 14 House and Senate Republicans who supported Medicaid expansion

As the new chair of the House Health Committee, Rep. Heather Carter of Cave Creek knew the battle over Medicaid was on the horizon, and spent a lot of time studying up on the issue.

Long before Gov. Jan Brewer urged lawmakers to “do the math,” Carter had done exactly that. She came to the same conclusion as Brewer: Expansion was the best option for Arizona. When Brewer unveiled the draft language for expansion, she pointed to Carter as the woman who would quarterback the bill through the House, and Carter accepted the challenge.

“I knew that one way or the other we were going to have to make a decision for Arizona. So simultaneously while the governor was studying the issue, I was doing my homework. And we obviously reached the same conclusion. I was excited when I heard her State of the State address.”


Rep. Kate Brophy McGee, a central Phoenix Republican, was one of the few early supporters who stood with Brewer from day one. But even before Brewer announced she would seek expansion, Brophy McGee was advocating the restoration of the population covered under Proposition 204. She said the decision to push for expansion wasn’t that difficult, because she had strong background knowledge of the issue after three years on the House Health Committee.

“With the loss at the Supreme Court, the failure to take back the White House and the Senate and with Obamacare becoming the law of the land, it became very clear to me we needed to work within the parameters of what is, as opposed to what we might want it to be.”


Rep. Doris Goodale of Kingman came to the discussion late. Hailing from a very conservative district, she put her career on the line to stand up for Medicaid expansion. She said she waited until the end to make her decision, and was swayed by Kevin McCarthy, president of the Arizona Tax Research Association, and Brewer policy director Michael Hunter’s support for the expansion plan. After talking with officials of her local hospital and health clinics, and looking back on the cuts to AHCCCS in 2009 that were understood to be temporary, she made up her mind and voted for the governor’s proposal.

“I look at this whole process differently. As a legislator in ’09, we were the ones who froze the childless adults. That was created by legislative action because of serious budget woes. That has nothing to do with Obamacare.”


Rep. Doug Coleman, a freshman Republican from Apache Junction, was one of the original lawmakers standing with Brewer when she unveiled her plan for Medicaid expansion, and quietly supported the plan ever since. He said the decision wasn’t that hard for him, because he came to the Legislature hoping to restore the childless adult population covered under Prop. 204.  With the changing rules in the federal funding, the only affordable way to cover that population was to expand coverage for people at

133 percent of the federal poverty level.

“It wasn’t for me that hard of a decision because I looked at the numbers and agreed with the governor. The other budgets that were being put forth I didn’t feel were really viable or good for the state. Well, politically, it’s a tough decision. I mean, I consider myself a fiscal and social conservative and I’m being called a socialist, so that’s a little bit rough.”


Rep. Ethan Orr, who was the only supporter who didn’t stand with Brewer at her announcement but later came openly on board with Medicaid expansion, said his argument boiled down to two factors: The other options drained the budget, and didn’t provide services for those in need. Orr runs a Tucson nonprofit for the developmentally disabled, and has had to help people who lost their health care coverage due to the Legislature’s cuts in recent years.

“I ran a nonprofit during the last round of cuts and I had to look dozens of people in the eyes and tell them, ‘We don’t have the money for these services.’ And we had to scramble to help people who are seriously mentally ill.”


Rep. T.J. Shope, a freshman from Coolidge, said the governor’s plan was the only one that made fiscal sense, and a string of pro-expansion editorials by conservatives helped sell him on the fiscal side of expansion. But as the debate turned to abortion funding, it became more complicated for the practicing Catholic, and he reached out to his faith leaders to ask for their blessing before making his final decision.

“I’m more worried about looking myself in the mirror when I make a decision than I am worried about getting elected. I had my own personal questions that didn’t need to be answered in the context of a political debate.”


Rep. Jeff Dial of Chandler said he came on board with Medicaid expansion late after looking at all the other budget options, and after realizing the only fiscally conservative path was through expansion. The voters approved covering the childless adult population, and the only way to do that and not drain down the state’s rainy day fund was by going for full expansion to 133 percent of the federal poverty level.

“I found that people didn’t want to deal with a problem that had to be dealt with when it comes to the (AHCCCS) funding. That’s one of the things that pushed me toward it. This solves the funding problem and it leaves the state in the black within three years.”


For Rep. Bob Robson of Chandler it was more than a Medicaid issue — it was an entire budget issue. He said the coalition started forming around university funding concerns and only later morphed into a coalition around Medicaid expansion. After going through all the options, he found the governor was right: The only option that made sense was Medicaid expansion.

“Spending down the entire rainy day fund wasn’t an option. The 5 percent (across the board cut) plan wasn’t an option. And simply saying ‘no’ wasn’t an option, because I saw the feds would just be telling us they would literally discard the AHCCCS plan piece by piece as it came up for renewal.”


Rep. Frank Pratt of Casa Grande, who eventually sponsored all 10 budget bills in the House, didn’t come on board with expansion until the other options had been proved unrealistic. He said expansion is especially important to his rural district’s hospitals, and the only arguments against it were arguments against Obamacare, not AHCCCS expansion.

“All of the people who were talking against it were talking about federal issues. The people who were talking for it, were talking about an Arizona issue. I was totally open to listening to both sides, but over a period of time it seemed like it was the most reasonable option for Arizona.”


Sen. Rich Crandall of Mesa was considered an early supporter of Brewer’s Medicaid plan. He was looking at all the alternative proposals that were made during the session — but found them all wanting, he said.

“It was just an evolution over a few weeks of seeing, ‘Hmm, this really is the best option.’ When Florida said let’s find a different way of doing it, but still taking the federal money, I went up to the governor and asked if there’s an alternative, if there’s another way to do it. And the bottom line was no, this is the best solution for the time being. It’s not perfect by any means, but it doesn’t just leave things hanging out there and hoping for the best. These are people’s lives, and we can’t just leave them hanging out there.”


Senate Majority Leader John McComish of Phoenix took longer than others to become a vocal supporter of Medicaid expansion, in part because as leader of the GOP caucus in the Senate, it was unwise to get out in front of an issue that was so divisive within the party. But once he made the decision to back the governor, it was an easy choice to take the lead and sponsor the push for Medicaid expansion, he said.

“When the governor announced that she was behind it, I was open to the idea. I didn’t have a strong opinion one way or another at that point. So it was gradual, as I began investigating and you’re hearing arguments back and forth… gradually I was warming up to the idea. I can’t give you a point in time when it happened. The execution (of supporting the amendment) was uncomfortable, but the choice wasn’t difficult because I was convinced it was the best thing for the state of Arizona. And once you make that decision, you cross the line and don’t look back.”


Senate Majority Whip Adam Driggs, along with McComish, stuck his neck out as a party leader going against the will of the majority of his caucus. Driggs did not return repeated calls for a comment.


One of the most vocal supporters of Brewer from the moment she made her State of the State address, Sen. Steve Pierce of Prescott was at the governor’s side for her first Medicaid expansion rally and never wavered. To explain his support, Pierce borrowed some of what became a rallying cry for the governor’s push for expansion.

“I did the math.”


Sen. Bob Worsley of Mesa, a freshman well known in the business community as a founder of SkyMall, said he, too, was quick to support the governor’s proposal because of the money at stake for the private health care industry and local hospitals that for decades have been uncompensated for care.

“That just felt unfair to me that we made a mandate on the private sector without reimbursing them. So it’s really not a new entitlement, it’s an old entitlement that was given by Ronald Reagan. This was an opportunity to reimburse the private sector for this unfunded mandate, and my business sense tells me this was the right thing to do.”

— Hank Stephenson & Ben Giles

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