Gov. Jan Brewer is determined to expand Arizona’s Medicaid plan, Senate President Andy Biggs has vowed to prevent it, and House Speaker Andy Tobin is somewhere in the middle.

The debate over whether Arizona will accept billions in federal dollars to expand its Medicaid program will come down to how the state’s three most powerful elected officials handle the issue in the coming weeks and months.

The Ninth Floor claims Brewer has enough votes in each chamber to pass her plan, and that the only thing standing between her and Medicaid expansion is Biggs’ and Tobin’s unwillingness to bring it up for a vote. But skepticism abounds as to whether there are seven House Republicans willing to vote for it, even if Tobin brings Medicaid expansion to the floor. And in the Senate, where Brewer almost certainly has the votes, Biggs has pledged to do all he can to prevent the proposal from coming up for a vote.

Biggs can block the proposal in the Senate, but maybe not forever. A handful of restive Republicans who support the plan may vote with the Senate’s 13 Democrats to force the issue, and could potentially vote to depose Biggs and install a Senate president who is more amenable to Brewer’s plan.

Tobin is the bigger question mark and may be the key to getting Medicaid expansion past the finish line. Biggs won’t be able to stop the expansion if at least 16 senators are determined enough to force the issue, but it’s unlikely to get through the House without the speaker’s approval.

If Tobin green lights a vote on Medicaid, it’ll likely bring enough Republican votes. But no one is quite sure what will get Tobin to drop his opposition, or what Brewer will have to give him, let alone the numerous House Republicans who are on the fence, to secure enough support to pass the governor’s plan.

Biggs
When Biggs told a robust crowd at an anti-Medicaid expansion rally on April 25 that he was unequivocally opposed to Brewer’s plan, chatter at the Capitol immediately shifted toward ways to move the governor’s proposal through the Senate without Biggs’ approval.

Sen. Anna Tovar, D-Phoenix, said Senate Democrats are determined to get expansion approved by any means necessary, and while they hope there’s another way, the minority party would be willing to join a move to oust Biggs as Senate president, if that what it comes to.

Biggs’ position on Medicaid expansion appears to have backed him into a corner.  It leaves him little room to negotiate with Brewer on expansion and the budget, and leaves him at odds with at least some members of his own caucus in the Senate, where most agree that at least 16 lawmakers are ready to vote in the governor’s favor.

But Biggs can’t be ruled out of the game so easily, said lobbyist Stan Barnes, a Republican who served in the House in the 1990s.

“If it looks like he’s in a corner, I would say he is purposefully self-directed in that corner,” Barnes said. “Biggs is a recognized, seasoned and very smart player in this very important story, and I have no doubt that he has a sense of why he’s doing what he’s doing and has a plan.”

Essentially, reports of Biggs’ demise have been greatly exaggerated.

Biggs may be using the next few weeks to set a tone of defiance in order to get a message across to his constituents that he’s done everything in his power to stop Medicaid expansion, which the Senate president said he fundamentally and philosophically opposes.

“He wants his constituency to know that he’s doing what he can to follow his own philosophy in terms of what’s right for Arizona,”

Barnes said. “That’s not merely a ‘letter to my constituents’ kind of thing. That takes time and weeks of coverage and public positioning.”

But it’s not as if Biggs is posturing, said lobbyist Barry Aarons.

“Andy Biggs doesn’t posture. When Andy Biggs says something, he believes it,” Aarons said.

What’s likely happening behind the scenes is a negotiation on the mechanics of getting both Medicaid expansion and the budget through the Legislature while protecting the Republican caucus — crafting a legislative process that secures 31 and 16 votes for the budget in the House and Senate, respectively, while also allowing Medicaid expansion to move through the Senate without Biggs’ consent.

“Andy will figure out a way to maintain his legislative integrity, and yet, at the same time, the governor may very well figure out a way to get the Medicaid expansion passed,” Aarons said. “I don’t think the two things are mutually exclusive.”

Tovar, too, said the ideal method for passing Medicaid expansion in the Senate would not involve ousting Biggs — a notion Aarons said is without basis.

“I don’t think it’s necessarily the way it needs to happen,” Tovar said. “Medicaid expansion needs to pass and needs to go through, but I think there are other viable, less nuclear options that people are seeing. If cooler heads would prevail we’d be able to get through the session and pass it, pass our budget and sine die.”

Once the mechanics are worked out, Biggs can maintain his presidency without fear of losing a Republican majority in the Senate or losing his job. Fears of primary challenges from the far right of the GOP are overblown, Barnes said, even though Biggs himself said a vote for Medicaid expansion in his district would prove fatal.

“It’s a genuine fear, but it’s ill placed,” Barnes said. “For the most part, this issue is going to come and go and all you’ve got to do is act with integrity and move on, not make it a Shakespearean drama.”

Brewer
Brewer’s best option may be to stay the course, at least for the time being.

Since announcing her expansion plan in January, Brewer has kept up a steady drumbeat. To build up support for her proposal, she has held rallies at the Capitol, met with groups of Republican lawmakers and has starred in television commercials from the Arizona Chamber of Commerce and Industry-led Restoring Arizona campaign.

Barnes said passing a proposal of this magnitude takes time. And while some complain that the session is dragging on without any end in sight on Medicaid expansion, Barnes said Brewer simply needs to give GOP leadership the time and space they need to talk to lawmakers in their chambers, mull over the issue and ponder the alternatives.

“I think the governor is on track. And whether we realize it or not, it’s all happening the way it’s supposed to happen,” Barnes said.

“Communication over time has a way of softening the rough edges, educating those who care to be educated about it, and creates and environment of which a compromise to move Arizona forward can be made.

We are in the midst of that. For all the hand-wringing about delay and slow action, this is the way it always is on these kinds of substantive issues.”

Time is on Brewer’s side, Barnes said, and eventually the Legislature and governor will have to work out a budget deal. “Time and money are going to press down on everybody,” he said.

Tobin, too, said the best thing Brewer can do for her cause is to continue educating lawmakers and the community at large.

“I think that’s fair. I think it’s probably the best thing she could be doing is trying explain the process, maybe get deeper into the weeds on some of the intricacies of Medicaid and the expansion, and see if she can do maybe some one-on-one education on the issues with the members,” Tobin said.

Brewer spokesman Matthew Benson said the governor plans to continue making her case with lawmakers and the public. He said she’ll hold more events with supporters at the Capitol and will continue her involvement in the Restoring Arizona campaign, which both Benson and the campaign said is having an impact.

“The governor can and will continue to make the case. She will continue to talk with lawmakers, leaders and rank-and-file. She will continue to keep the pressure on,” Benson said. “You’re going to be seeing and hearing a lot from the governor and a lot from the Restoring Arizona coalition in the days and weeks ahead. They will be actively engaged in the legislative districts.”

Biggs’ efforts to prevent Medicaid expansion from coming to the Senate floor have led some Senate supporters of the plan to contemplate an end-run around the Senate president.   But Benson said the governor won’t get involved in or support any attempt to replace Biggs. He said it’s too early to tell whether she would get involved in any procedural move to bypass Biggs, but said any such move would have to emanate from the Senate itself, not from the Ninth Floor.

“That’s not an action that we’re going to lead. If that ultimately happens, it will be led by the members of the body,” he said.

Eventually, Barnes said he believes Tobin and even Biggs will compromise on the issue. But Brewer will have to cut some deals and figure out what she can trade for the votes she’ll need.

“I think the most likely result … is that the governor gets what she wants and the Legislature gets most of what they want on the rest of the multi-billion dollar Arizona budget. I think that’s where the compromise space is,” Barnes said. “I don’t know what she’ll have to give up. She’s a seasoned veteran who knows that no one gets all that they want on multi-headed complicated political issues.”

Tobin
With Biggs staunchly opposed to putting Medicaid expansion up for a vote and Brewer not backing down from her demand that the Legislature pass it, House Speaker Andy Tobin is in one of the most politically advantageous positions in the Legislature: He is a free agent; a man with options.

Tobin has consistently been hard to nail down on what it will take for him to schedule an expansion bill for a vote in his chamber.  Even some of his close allies and those charged with passing a bill don’t seem to know exactly what Tobin wants.

But because he hasn’t unequivocally said he won’t put the issue up for a vote, the prevailing sentiment at the Capitol is Tobin may be willing to make a deal with the Governor’s Office to let the plan move forward.

One fact that Tobin has been very clear on, however, is that the draft bill Brewer heralded as her plan for expansion will never see the light of day in his chamber.

“Not that bill, no way,” he said.

Tobin has consistently said any bill that comes through the House must have protections for insurers and consumers to ensure prices of health care procedures do not continue to rise.

“That’s the problem I’m trying to solve, I don’t want the price rising on health care,” he said.

Though the governor’s draft legislation had a few lines stating that hospitals shall not pass on the cost of the assessment to pay for the state’s portion of expanding coverage to businesses or consumers, Tobin lamented that the language has no teeth.

He also has a problem with giving the director of AHCCCS the authority to levy the hospital assessment and reimbursement rate. And finally, he believes the assessment would require a two-thirds vote in both chambers to comply with Prop. 108, a voter approved measure requiring any bill that would result in a net increase in state revenues to pass the legislature with two-thirds of lawmakers in support.

Tobin has also said that he will not schedule a vote on the bill unless a majority of his fellow House Republicans want to vote on the bill.

Brewer’s spokesman Benson said he believes the votes to expand Medicaid are there in the House, and the only thing left is getting the bill on the board, which must go through Tobin — and he has seen progress toward getting Tobin on board.

“You haven’t seen the House leadership rule it out. It’s a different dynamic than what you’ve seen with Senate leadership, I think it’s an open dialogue with the House, which is good. It’s all we can ask for, ” he said.

As of latest count, the House has eight Republican lawmakers who have either said they support the governor’s plan, or have strongly suggested that if the bill makes it to a vote from the full House, they would vote in favor. If all 24 House Democrats vote in favor of expansion, as is expected, the plan could be approved by a majority of the House.

A count of eight Republicans remains 10 votes short of a majority of the 36-member Republican caucus in the House. But as the legislative session drags on, other House Republicans may be willing to take a vote on the matter, just to vote against it and end the legislative session.

Tobin also has several pieces of high-priced legislation that are near and dear to his heart still moving through the process, which insiders suspect may be rolled into the budget as part of the negotiations to win his support on Medicaid expansion.

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