In an historic move, a group of Republican senators united with Democrats this week to approve the plan by Governor Jan Brewer to sharply expand the state's Medicaid program. Arizona Public Radio's Howard Fischer reports.
The measure taps a provision in the federal Affordable Care Act to provide coverage for those up to what equals 138% of the federal poverty level. The federal government would fund most of the expansion which will add 300,000 or more to the 1.3 million already on rolls of the Arizona Health Care Cost Containment System, the state's Medicaid program.
Senator Don Shooter said he supports providing care to those most in need. "But, I think the system has become far too expansive," Shooter said. "And we've gotten to a stage where the people that are having their health care provided for them are receiving better health care in some cases than the poor people out there paying the bills."
One issue is the fact that the state's share of the costs will be paid for by what the governor and supporters call an assessment on hospitals to be set by the state's AHCCCS director. That will raise $240 million. But Senator Steve Yarbrough said that's playing games. He said the only reason backers do not want to call it a tax is because the voter-approved Proposition 108 says a tax hike - versus a fee - requires a 2/3 vote - a margin of support this did not get. Yarbrough asked, "could we authorize the majority of the Corporation Commission to vote to set corporate income tax rates for Arizona corporations and not have Prop 108 apply? Well, I suspect we would all say, if we were honest, no, that's ridiculous."
And Yarbrough warned colleagues they should not rely on a so-called circuit breaker to automatically repeal expansion if federal support drops below a certain level or dries up. "The federal government will, within a few years, renege on their current level of Medicaid contribution," Yarbrough said. "There will not be the will, or probably even the authority to actually implement the circuit breaker when they do. Arizona taxpayers will be subjected to a huge tax increase to maintain the then-eligible Medicaid population. And Arizona will rue this day."
Much of the opposition from Republicans who voted against this was focused not on the issue of expanding the health care program itself, but as Senator Al Melvin reminded colleagues, how it came about. Melvin said, "this monstrosity of a bill, Obamacare, passed in Washington in the dead of night without one single Republican vote."
And he took a slap at the five Republicans who united with the 13 Democrats to provide the margin of support, saying they are - quote - "perpetuating this sorry situation". Much of the vitriol came out earlier during a caucus of Senate Republicans, where foes of expansion actually outnumber supporters.
Senator Rick Murphy was particularly miffed at Majority Leader John McComish for working with Democrats to line up the votes, saying he betrayed his party. "I didn't think it was appropriate for the majority leader of the caucus to participate in - and particularly to lead - a rolling of his own caucus when the vast majority of his caucus doesn't want to do what he wants to do," Murphy said.
But McComish rejected claims by some colleagues that he is, in effect, a traitor to the Republican cause. He said, "I'm no more a traitor than those who are opposing our Republican governor."
This week's vote sends the measure to the House where speaker Andy Tobin has his own ideas about Medicaid expansion, including a requirement for a public vote not in the Senate plan and opposed by the Governor.