GOP split on Medicaid expansion

The next few weeks could prove critical in determining the direction of Arizona's debate over Medicaid expansion, setting the stage for months of interparty rancor or a relatively smooth transition into a critical phase of federal health-care reform.

State lawmakers have the framework of Gov. Jan Brewer's proposal to expand eligibility for the state-federal health-insurance program for low-income and disabled people, but Republican leaders still must decide how -- or whether -- to amend the legislation to get the governor's top legislative priority through the House and Senate and to her desk.

Brewer signaled this week that she wants legislators to slow their work on routine bills and shift their attention to the session's thorniest issues, including the fiscal 2014 budget, Medicaid expansion and simplifying the state sales-tax code.

With regular daily committee hearings at the Legislature winding down, attention invariably turns to the budget, and those negotiations are expected to ramp up in the coming weeks. The Medicaid debate is intertwined with budget talks because the governor's expansion plan would add money to the general fund, and failing to do so could be a net loss.

The discussions between legislative leaders, the Governor's Office and staff also will include the usual haggling over amendments and horse-trading over other unrelated bills that lawmakers want passed, or at least considered, in exchange for their votes.

While those talks will be behind closed doors, there may be opportunities for additional public testimony on the issue.

House Appropriations Committee Chairman John Kavanagh, R-Fountain Hills, said he tentatively plans to schedule a hearing next week with presentations from state Medicaid officials, the Goldwater Institute and hospital administrators.

Kavanagh, a firm opponent of expansion, presided over the first public hearing on Medicaid last week, a sometimes-bitter debate that included testimony from dozens of patients, business leaders and health-care officials in favor of Brewer's plan and Republican Party loyalists who oppose it.

House Health Committee Chair Heather Carter, R-Cave Creek, said she wants to talk with House Speaker Andy Tobin this week about scheduling an informational hearing in her committee. Brewer's office wanted Carter to host the first hearing, but Tobin decided to put the matter before the Appropriations Committee.

At this point in the session, additional committee meetings, with the exception of appropriations committees, must get approval from Tobin, R-Paulden, or Senate President Andy Biggs, R-Gilbert.

"I'd like to dive into the health policy about why this makes sense for Arizona," Carter said. "We've talked about the economics in Appropriations. Maybe the next step is to look at the health policy in Health."

After headlining two Capitol rallies earlier this month, the governor is expected to spend the coming weeks in budget negotiations with legislators and traveling across the state selling her Medicaid plan, which provides health coverage to an additional 400,000 people by 2015 with an infusion of $1.6billion in federal funds.

Supporters include the state's heaviest hitters, from the health-care industry to top business leaders, as well as more than 100 other organizations. They've been raising money to run a pro-expansion campaign that includes radio and TV spots, and to support GOP legislators in the next election.

Opponents are led by conservative Republicans, particularly people within the GOP apparatus, who are sending e-mail blasts and passing resolutions likening expansion to socialism and, at the Appropriations hearing last week, comparing Brewer to Judas for betraying the party over federal health-care reform.

The GOP split is putting increasing pressure on more than a dozen Republican lawmakers who remain undecided and who are being heavily lobbied by their local hospitals, precinct committee members and fellow legislators on both sides of the issue.

The Republican loyalists have threatened recalcitrant legislators with their jobs, saying they will face GOP primary opposition in the next election if they support expansion.

But the coalition backing Brewer's plan has been assuring these same legislators that they'll provide the campaign funding to beat back any primary challenge.

Another player that could turn critical votes toward the plan is the AARP, which is looking to Arizona as a bellwether for other states where Republican governors have backed the plan but face opposition from their GOP-led legislatures. Lawmakers representing districts with large retiree populations, including constituents on fixed incomes but not yet old enough to qualify for Medicare, are hearing from local AARP members encouraging their support for Medicaid expansion.

Two other factors that could work in Brewer's favor are her veto pen and time. By all accounts, the governor is willing to wait as long as she has to -- long after lawmakers' daily allowances get cut in half next month -- to get Medicaid expansion through the Legislature.

"We'll just continue to beat the drum," said Jaime Molera, a lobbyist for the pro-expansion forces. "I believe that when they start seeing the ramifications of (not expanding Medicaid) … it becomes harder and harder to say with a straight face that nothing important is going to happen."

Reach the reporter at maryk .reinhart@arizonarepublic.com.

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