AZ House Passes Medicaid Expansion in Brewer Win

The Arizona House passed an $8.8 billion state budget that includes Medicaid expansion early Thursday and puts Gov. Jan Brewer one Senate vote away from a huge political victory as she embraces a signature part of President Barack Obama's health care overhaul law.

A newly formed coalition of Democrats and GOP moderates forced the budget and Medicaid expansion proposal to move in the Arizona Senate and House during a day filled with debate. The Senate took a break after giving its initial approval Wednesday afternoon, while the House toiled into the night as conservative Republicans railed against the Medicaid proposal and accused members of their party who supported Brewer of being turncoats before taking a final vote that ended after 1:30 a.m. PDT.

The Senate is set to take up the budget and Brewer's contentious Medicaid proposal for its final vote sometime after 9 a.m. Thursday. Votes last month and Wednesday show it has more than enough votes to pass and a budget could be on Brewer's desk by the afternoon.

The action means Brewer, a Republican, is close to securing a huge victory that will provide health insurance to an additional 300,000 poor Arizonans by embracing a key part of the Affordable Care Act. The expansion is optional under last year's Supreme Court decision upholding the law, and many Republican governors rejected it.

Brewer was one of the most vocal governors opposing the Affordable Care Act but acknowledged in January that it was the law of the land and would help Arizonans get care, lower the amount of uncompensated care hospitals must absorb and help cut what she called a hidden health care tax people who buy insurance pay in higher premiums to cover others' uncompensated care.

But her proposal was met with derision from conservatives and Republican leaders in the Legislature who argued that it was a massive expansion of government, would drive the federal government deeper into debt and that the government promises of paying for the expansion would turn out to be false.

Opponents led by the Senate president and House speaker blocked actions for months, with the Senate finally adopting it in May. But Speaker Andy Tobin stalled as he tried to get Brewer to compromise, and she finally had enough Tuesday and called the Legislature into special session. Both chambers started afresh Tuesday evening.

During the floor debate Wednesday, Brewer's allies largely refused to answer questions or discuss provisions in the proposed budget, drawing rebukes from conservatives who warned of unchecked government. They proposed more than 50 amendments but got none of them adopted and didn't have the votes to stop the Medicaid expansion or the budget deal. Brewer's allies refused to so much as answer questions on the floor or debate provisions in the proposed budget. Instead, lawmakers exchanged barbs and policy rebuttals on Twitter, the social networking site, long into the night.

"How are you not embarrassed for yourself?" asked Republican Rep. J. D. Mesnard of Chandler, an opponent of the expansion, as the House began debate. "Is anyone going to stand up and give a defense?"

Republican Rep. Debbie Lesko of Peoria said the special session was unnecessary.

"I feel like I have been punched in the gut," she said.

Republicans control the state Legislature and all statewide elected offices in Arizona, but the Medicaid fight has highlighted internal fractures between those who want smaller government and others who, like Brewer, say broader health care access is good for the state.

Senate President Andy Biggs, who fought the Medicaid expansion throughout the regular session that began in January, implored Democrats and moderate Republicans to allow for debate after he was sidelined by Brewer's supporters.

"Some don't want to have discussion and think I am trying to embarrass them. I am not trying to embarrass them. This is a massive bill," he said on the floor.

As Republicans grew increasingly irate, Brewer's office released a statement striving to distance her from the federal health care law that allows for the Medicaid expansion.

"Arizona's Medicaid program, known as AHCCCS, has existed for three decades . going back to President Obama's college days," wrote spokesman Matthew Benson in an email. "AHCCCS is not the Affordable Care Act. It is not Obamacare. It is the nation's gold standard in terms of cost-effective Medicaid programs."

The Medicaid plan would cover people making between 100 percent and 138 percent of the federal poverty level and restore coverage to more than 100,000 childless adults who lost Medicaid coverage because of a state budget crunch. About 1.3 million Arizonans already are covered by the state's plan.

The special session allowed lawmakers aligned with Brewer to suspend normal rules that require committee hearings on bills and advance the budget with limited debate. They began voting on their budget bills and more than 50 hostile amendments from conservatives Wednesday afternoon.

Brewer's supporters adopted the $8.8 billion budget approved by the Senate last month but shifted some money around. It will not include a big "economic development" tax-cut plan House Speaker Andy Tobin wanted to add.

"We have a huge economic incentive in this budget — it's called Medicaid," democratic Minority Leader Chad Campbell said. "That's a $2 billion economic incentive program right there."

Biggs and Tobin have said the federal government is likely to go back on its promise to fund the Medicaid expansion and point to the huge federal debt.

After adjournment Tuesday, Biggs and Tobin released an angry statement rife with insults toward Brewer: "We are frustrated and bewildered by her overt hostility and disregard for budgetary process which was already well under way."

Rep. Bob Robson, R-Chandler, said the moderates had no choice but to act because state agencies need funding in place before the budget year starts July 1.