Deep split among GOP lawmakers to AHCCCS expansion

When Gov. Jan Brewer announced her proposal to expand Medicaid to the full amount advocated by the federal health care law, Republican leadership in the House and Senate received a fight they didn’t ask for, and one they didn’t know was coming.

The governor’s proposal sets up an intra-party fight between the more conservative lawmakers who don’t want to see “Obamacare” expanded, others who are willing to consider the proposal depending on the details, and those Republicans who see expansion as an economic generator and smart move.

Nearly across the board, Republican lawmakers said they wanted to see more details of the plan before making a concrete decision on how they would vote for expanding the Medicaid rolls to include people at 133 percent of the federal poverty level, as Brewer advocated in her fourth State of the State speech on Jan. 14.

But in the days following her surprise decision, some Republican lawmakers expressed more support for the measure than others.

Like other top-ranking Republican lawmakers, Senate President Andy Biggs said Brewer’s speech was the first he heard of her plan to cover more people under the Arizona Health Care Cost Containment System (AHCCCS).

Biggs, of Gilbert, has been a vocal opponent of expanding the AHCCCS rolls, but he said even though he opposes the measure, that doesn’t necessarily mean it’s dead on arrival.

“I’ve been down here a long time, and I thought things couldn’t get through that did get through, and things that I thought couldn’t get through did get through,” he said. “So I think we just have to play it by ear.”

An informal GOP caucus rule states that measures must have support from a majority of the Republican lawmakers to advance to the floor. That means nine Republican senators and 19 Republican representatives would have to support AHCCCS expansion for it to move through the Legislature.

The proposal would also have to move through the chambers’ Appropriations committees, and the chairs of both committees are staunchly against Obamacare.

Sen. Don Shooter of Yuma, chair of the Senate Appropriations Committee, said he has been studying the issue as thoroughly as possible, and while he doesn’t like expanding AHCCCS, the issue isn’t totally off the table.

“Philosophically, I think it’s a bad idea,” he said. “I think it’s a bad idea when the government gets involved in almost anything, especially health care, so philosophically that’s my basis. However, I am also pragmatic enough to realize that there are economic consequences.”

But Rep. John Kavanagh of Fountain Hills, chair of the House Appropriations Committee, said nothing could bring him on board with expansion of Medicaid through a tax increase, and he thinks his fellow Republicans will shoot the idea down.

“I haven’t polled the members, but having been here for six years, I’d be shocked if more than 20 percent of the caucus would be for something like this.”

Kavanagh said he doesn’t believe the Obama Administration will agree to the governor’s proposal to cut the state AHCCCS rolls in the future if there were any decrease in federal matching dollars.

Expansion will be a hard sell within the GOP caucus, he said, because Republicans are overwhelmingly opposed to Obamacare, and expansion would be going along with the law instead of fighting it.

He said that the hospitals’ voluntary fee that Brewer proposed to pay for expansion equates to a tax increase, which makes the deal a non-starter.

But House Speaker Andy Tobin first proposed a provider tax on hospitals to pay for keeping the childless adult population on the rolls during budget cuts in 2010, and he is still open to the idea, he said.
Not everyone is as amenable to the governor’s proposal. In the days following Brewer’s announcement, Rep. Carl Seel of Phoenix roamed the parking lot and House floor trying to round up signatures for a set of bills to stop the state from expanding the Medicaid rolls. Though he hasn’t introduced the bills yet, he said his legislation includes a bill to stop the state from expanding to 100 percent of the federal poverty level and another to prohibit expanding to 133 percent. Because the governor is sure to veto those bills if they made it to her desk, he is also working on a pair of ballot referendums to do the same thing.
“If the governor doesn’t want to stop Obamacare, let’s see what the people want to do,” Seel said.

House Majority Leader David Gowan said he personally had concerns about taking money from the federal government while it racks up huge deficits. He was coy about whether his caucus has an appetite to work with Brewer on the issue, but said that one way or another, they’ll have to hammer out a budget both sides can agree on.

Other Republicans said they don’t trust the federal government’s promises for matching funds, or that the plan can actually be carried out by a voluntary fee hospitals would impose on themselves.

Rep. Steve Smith said that he hasn’t made up his mind on expansion, but right off the bat, he’s wary that the federal government won’t keep up its end of the deal.

“I don’t know if any promises by the federal government can be revenue neutral,” he said. “I know the intent is to be (revenue neutral) of course, so I don’t fault the governor’s intent. Whether it happens or not, that remains to be seen.”

Some Republican lawmakers said they were open to listening to details from the governor before making a decision, but that they would have a hard time explaining to their constituents a vote that could be construed as supporting Obamacare.

Rep. Michelle Ugenti of Scottsdale, who sits on the House Appropriations Committee, said she’s not taking expansion off the table before even seeing the governor’s details, but scoffed when it was pointed out that her position could be interpreted by opponents in a primary election as supporting Obamacare.

“What? I’m opposed to Obamacare. I’m going to look at the budget, and I’m going to look at everything as it relates to the rest of the budget, it’s all intertwined, and I’ll make a decision at that point,” she said.

But Republicans might have some room to wiggle out of a promise they adopted in the 2012 campaign season to oppose all efforts to participate in or create the framework for participation in Obamacare.

Senate Majority Leader John McComish said the campaign platform many Republicans adopted wasn’t necessarily against expanding health care coverage to or past the level that voters mandated in 2000 with Proposition 204, and that the promise was more about opposing a state-run health care exchange, which Brewer decided against in late November.

“When some of those platform statements were made, I think they had an eye more towards the exchange than they did towards health care expansion. So we’ll see,” McComish said.

Despite the opposition from many within her party, Brewer may find support for her proposal in a large new class of incoming freshmen Republican lawmakers.

Freshman Republican Rep. Ethan Orr of Tucson said expanding the AHCCCS rolls makes economic sense, and the party should follow the governor’s lead on expansion.

“If she’s found a way to expand our Medicaid coverage while balancing our budget, I think as the leader of our party we need to really engage with her,” he said.

Orr said he wants to find a way to make sure disabled people covered under the expanded population who get off the AHCCCS rolls through job placement services can get back on the rolls if the job doesn’t work out. He would also like to see services stay in place for those people until they held down a job for a certain timeframe, which is one of the biggest barriers he sees to disabled people joining the workforce.

Freshman Republican Rep. Paul Boyer said he is 50-50 on expansion until he sees more details. But he noted it might sway his decision if the federal government agrees to the so called circuit-breaker provision Brewer mentioned in her speech – that the state will automatically reduce the AHCCCS rolls if the federal matching funds decreased beyond the already agreed upon amount and date.

Freshman Republican Rep. T.J. Shope of Coolidge agreed that Brewer made a solid economic argument for expanding the AHCCCS rolls – that it could provide jobs in the state and help struggling rural hospitals like the ones in his part of Arizona.

He said that if it didn’t cost the state general fund money, he might be able to back Brewer’s plan, and he thinks others could, too.

“If we can keep it as revenue neutral as possible as she described (in the speech), I think that’s something that the caucus could have a very good conversation about,” he said.

– Ben Giles contributed to this article.