Feds say no to funding a leaner Ariz. Medicaid

Federal health officials dealt a blow to opponents of Medicaid expansion Thursday, saying they're unlikely to fund a slimmed-down version of the state's indigent-health-care program as the political battle over the issue intensified.

Gov. Jan Brewer declared the federal announcement a game-changer in the debate, which is holding up a new state budget. She told GOP legislative leaders to stop delaying a vote on Medicaid expansion and move swiftly to present her expansion plan to lawmakers.

Senate President Andy Biggs rejected the governor's calls, and during a rally on the House lawn, expansion opponents played down the news from the federal Centers for Medicare and Medicaid Services.

Local Republican Party officials and "tea party" members cheered as GOP lawmakers pilloried Brewer's plan and said Arizona can do better on its own.

"We don't have to expand," said Biggs, R-Gilbert, who has vowed not to bring Brewer's proposal to the Senate floor for a vote. "We have an alternate plan, a plan that will not unfairly burden our children and grandchildren to pay for medical care today."

Thursday's developments, which included a significant increase in legislative cost estimates for rejecting expansion, served only to further entrench both sides, with rumors flying about everything from the potential collapse of budget negotiations to a Senate coup to bypass Biggs.

Brewer spokesman Matthew Benson said nothing will change the governor's mind on Medicaid expansion.

"She's committed to this proposal and is prepared to see it through, regardless of how hot it gets," Benson said. "This is life and death. … It's not some petty political problem."

In a memo released Thursday, Centers for Medicare and Medicaid Services officials indicated federal matching funds would not be available to continue Arizona's enrollment-capped Medicaid program for childless adults. The federal officials said, "We do not anticipate that we would authorize enrollment caps or similar policies" under the program, which would mean no federal funding.

Brewer and lawmakers froze the childless-adult program in 2011, and it will be eliminated entirely on Dec. 31 barring federal approval of a new application. That would end health coverage for an estimated 60,000 Arizonans.

Biggs wants to maintain the freeze and use state funds to cover those people, who include thousands with serious mental illnesses and other chronic diseases.

Under the GOP leadership's alternative, people above 100 percent of the poverty level could get subsidized health coverage through online insurance exchanges set up through the federal health law.

Under Medicaid expansion as part of the Affordable Care Act, the federal government would pay all the costs of insuring people between 100percent and 133 percent of the poverty level.

Brewer seized on the federal memo to renew her push for her top legislative priority, saying it eliminated the leading alternative to broadening Medicaid eligibility.

"Today's clear guidance from CMS makes it apparent that there is really only one viable option," the governor wrote to Biggs and House Speaker Andy Tobin, R-Paulden. "It is time for us to complete the people's work."

But Biggs, Tobin and other GOP Medicaid-expansion opponents viewed the federal guidance as a "maybe" and refused to be deterred by it.

"Whether the feds chip in or whether they don't chip in, this is the best option that we have," Biggs said of forgoing expansion, continuing the freeze and insuring the poorest Arizonans with state money. "At bare minimum, we have three years to watch 'Obamacare' implode around the nation while we don't have to suffer."

Biggs and Tobin, who have become the main roadblocks to Brewer's expansion plan, say their GOP members oppose broadening Medicaid eligibility as fiscally unsustainable and politically poisonous.

They don't trust the federal government to keep its promise of covering nearly all the expansion costs, and members fear voter backlash in the 2014 primary if they support it.

Brewer, a longtime opponent of the Obama administration's health-care overhaul, is among eight GOP governors to support expanding Medicaid, the state-federal program that covers more than 1.2 million poor and disabled Arizonans.

Her plan would add roughly 400,000 people to the Arizona Health Care Cost Containment System, the state's Medicaid program, with $1.6billion in federal funding by fiscal 2015 and a tax on hospitals to cover the state's additional share.

She is backed by business leaders, non-profit organizations and the health-care industry, including hospitals caring for a growing number of uninsured Arizonans. But she is facing stiff opposition from legislative leaders and grass-roots GOP loyalists.

While Tobin has not ruled out an eventual vote on Medicaid expansion, Biggs said he will not bring any legislation to the floor of the Senate if it includes the federally funded expansion.

In an interview with The Arizona Republic, Biggs said it's his responsibility as the Senate leader to stand firm against a policy that fellow Republicans oppose.

He said beyond his own objections to the federal health law, recent polls, constituent communications and conversations with lawmakers prove it is wrong for Arizona and for the GOP.

"I'm not going to put (Medicaid) expansion on the floor. The Republican Party in this state has said, 'Don't do this,'" he said. "Republicans hate this, and they're not going to vote for a Republican in a primary who's (supported) this."

Biggs said even GOP senators who support the expansion -- and there are at least three and perhaps as many as six or seven -- aren't eager to vote on it. But he conceded that there are other ways for a Medicaid bill to come to the floor, and he expects that it will.

"At this point at least, I'm not ready to give up," Biggs said. "At the bare minimum, we have an obligation to rationally discuss with the executive branch … (our) position and why."

Brewer's office, however, said Biggs' alternative is neither financially nor politically viable.

"He doesn't have the votes for that," Benson said. "There are enough votes in the Senate for the governor's plan. … But if legislators would prefer to do this later as opposed to sooner, that's their option."

Brewer met with 15 to 20 Republican House and Senate members last week. Many GOP lawmakers say they're undecided, but there appear to be just enough votes for a simple majority in the House, where Tobin said he isn't ready to advance Brewer's plan.

"I don't like her bill," he said this week.

Tobin said he is open to alternatives but conceded it would be difficult, if not impossible, to find a middle ground between the governor's proposal and the concerns raised by opponents.

"If there's a middle, it would be the first in the country," he said.

But Tobin said there must be changes to Brewer's plan, both to win GOP support and to ensure an expanded Medicaid program won't run out of control.

At the Capitol rally, physician and Sen. Kelli Ward, R-Lake Havasu City, said she supports good quality, accessible health care for as many people as possible, but she believes that Medicaid offers "substandard care" and that expanding it reduces the incentive for people to improve their circumstances and get off the public dole.

Ward said she doesn't know exactly what alternative Medicaid legislation would look like, but it would include funding to keep childless adults insured. Voters in 2000 expanded AHCCCS to cover everyone living below the poverty level, but more than 150,000 people have fallen off since the program was capped.

Also Thursday, legislative budget analysts significantly increased their estimates of the cost to insure poor, childless adults without using federal funding, surpassing Brewer's cost projections.

The Joint Legislative Budget Committee now estimates it would cost $266million to cover 55,800 people who would remain on the program Dec. 31, compared with the governor's estimates of $200million and 60,225 people for fiscal 2014.

Lawmakers had been working with much smaller numbers, projecting coverage for just 35,000 people at a cost of $83million in fiscal 2014.

Under the new JLBC estimates, keeping the freeze on the childless-adult program would cost $880million through fiscal 2016. Brewer's budget office puts that number at $863million.

The cost of expansion has been a sticking point, with opponents maintaining the state can afford to reject federal funding and supporters saying infusion of billions of federal dollars would be a boon to the economy.

While Biggs and Tobin have the authority to decide what bills are voted on, there are ways around them.

Brewer's proposal isn't officially a bill yet, but several parliamentary strategies are being discussed behind the scenes to turn Medicaid expansion into formal legislation, including adding it to an unrelated health-care measure as an amendment during floor debate or combining it with bills in a conference committee.

Biggs could not prevent those moves, but he likely would refuse to schedule the amended bill for a formal vote of the full Senate. That's when a majority of senators could vote to suspend the rules, insist that the bill be brought forward for a vote or even replace the president.

A majority vote in the House also is required to force a vote on a bill that hasn't been scheduled by the speaker.

Barry Aarons, a longtime lobbyist who doesn't have a client on either side of the debate, said there are "so many moving pieces," including Medicaid's connection to the budget, that the endgame is difficult to predict. "This is not a policy issue anymore. This is a mechanical issue," he said. "This is not a monolithic up-or-down vote on Medicaid expansion."

Republic reporter Mary Jo Pitzl contributed to this article.

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FACT CHECK: GOP lawmakers spin funding tall tales (AP)

WASHINGTON – It's an outrageous tale: The federal government spends one out of every $10 in transportation aid on wasteful projects such as refurbishing a giant roadside coffee pot and constructing turtle tunnels.

That's what Republican lawmakers have said repeatedly in recent weeks in the Senate, in public appearances and in news releases. They are trying to eliminate a requirement that states use a portion of their highway aid for "transportation enhancements," 12 categories of projects from bike and walking paths to scenic overlooks and landscaping.

But it's not exactly true.

To make their case, lawmakers have exaggerated and misrepresented some projects that have received aid.

Sen. Tom Coburn, R-Okla., raised the issue last month when he temporarily blocked action on a transportation bill. He said he wanted to allow state transportation departments to use all their federal aid on basic needs such as roads, bridges and tunnels, instead of setting some aside for enhancements.

"We are not pouring asphalt, we are not laying concrete, we are not decreasing congestion, and we are not increasing safety," Coburn complained. He produced a list of 39 projects that he said exemplify extravagance at a time when states don't have enough money to repair structurally deficient bridges.

Coburn picked his examples from the more than 25,000 projects that have received money since Congress established the enhancement set-aside nearly two decades ago.

First on the list: the Lincoln Highway 200-Mile Roadside Museum in south-central Pennsylvania. It was described as receiving $300,000 in 2004 for signs, murals, colorful vintage gas pumps painted by local artists and refurbishing of a former roadside snack stand from 1927 that's shaped like a giant coffee pot.

Sen. John McCain, R-Ariz., was apparently working from Coburn's list two weeks ago when he offered an amendment to narrow the types of projects eligible for enhancement funds.

"Pennsylvania ranks first out of all states for deficient bridges. Yet it seems to be more important to furbish large roadside coffee pots," McCain said.

But no transportation aid was spent on the coffee pot's $100,000 restoration, said Olga Herbert, executive director of the Lincoln Highway Heritage Corridor. The money was raised entirely from preservation and civic organizations and local supporters.

"We did not use any of this $300,000 award for anything to do with the coffee pot," she said. "It's interesting that nobody from Senator Coburn's office called me about this."

Also on Coburn's list was a lighthouse renovation in the harbor of Toledo, Ohio, that would be partly funded with $500,000 in federal money. Actually, no transportation dollars have been authorized or awarded. The lighthouse renovation is among projects community officials tentatively hope to get around to in 2019.

Coburn's list includes a 1996 grant for preservation of a "factory used to make saddletrees" — the foundation of a riding saddle — in Madison, Ind. Not mentioned is that the grant wouldn't qualify for enhancement money under current program rules, according to Transportation Department officials.

The Texas Department of Transportation is described as spending $16.2 million in enhancement money to restore the Battleship Texas, docked in the Houston Ship Channel. If so, they weren't federal transportation dollars. U.S. transportation officials said an application for the money was turned down.

The list cited landscaping to screen a junkyard in Aiken, S.C. After checking with state and local authorities, federal officials said the project was canceled years ago and again, no funds were awarded.

"We picked some of the more interesting and exciting ones to get our colleagues' attention," McCain acknowledged during his effort to pass his amendment.

McCain said he was reluctant to mention a $198,000 grant in 2007 to the National Corvette Museum in Warren County, Ky., to build a simulator theater because he fondly remembers owning a Corvette once. But then he mentioned it anyway.

"Since a National Corvette Museum simulator theater has very little to do with transportation enhancement, I felt compelled to add this," he said.

The simulator theater is really a driver-education classroom for free driving classes for older people and teenagers, not a chance to pretend to be behind the wheel of a Corvette, museum officials said.

But what has provoked the most scorn from enhancement critics are the "turtle tunnels" near Tallahassee, Fla.

"Don't tell the people of Kentucky they need to finance every turtle tunnel and solar panel company on some bureaucrat's wish list in order to get their bridges fixed," Senate Minority Leader Mitch McConnell, R-Ky., said last month in a speech decrying President Barack Obama's request for $50 billion for highways, bridges and airport runways.

Kentucky's other senator, Republican Rand Paul, protested last week: "Something is seriously wrong with government when we are forcing state governments to spend 10 percent of their transportation money on turtle tunnels, white squirrel parks, and movie theaters."

Florida transportation officials federal aid to build mile barrier walls on either side of U.S. 27, a busy four-lane highway along the shore of Lake Jackson, and three culverts that run underneath the road. The lake is teeming with wildlife, but the critters were getting flattened by cars as they tried to cross to the vegetation on the other side.

While turtle deaths prompted the project, the culverts are being used by many other species, including beavers, otters, alligators and snakes. They make driving safer for motorists who were swerving to avoid turtles and alligators, said Matt Aresco, the former Florida State University Ph.D. student who led a grassroots campaign for the project.

"It's a significant safety issue," he said.

The project used economic stimulus funds rather than regularly budgeted transportation money. Coburn's list, provided to reporters and posted on his Senate website, said Florida plans to spend $3.4 million on the project, but it will require $6 million more to finish "and it was unclear how long it will take to get the project built."

Actually, the project was finished in September 2010 and came in under budget at $3 million, according to the Transportation Department.

GOP members of Congress also have said repeatedly that states are required to spend 10 percent of their transportation aid on enhancements. Actually, the set-aside for enhancements is equal to 10 percent of the aid states receive through one transportation program, not their total federal aid. Enhancement funds amounted to $927 million in the past year, 2 percent of the $46 billion the government spent on highway programs.

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Online:

National Transportation Enhancements Clearinghouse http://www.enhancements.org/projectlist.asp

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Associated Press writers Travis Loller in Nashville, Tenn., Peter Jackson in Harrisburg, Pa., and Michael Schneider in Orlando, Fla., contributed to this report.

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Follow Joan Lowy on Twitter at http://twitter.com/AP_Joan_Lowy

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Bachmann's Hurdles: Historical Errors, Obscurity, Funding (ContributorNetwork)

COMMENTARY | Michele Bachmann officially announced her candidacy during this week's GOP debate in New Hampshire. While some see her as a serious contender, she faces as many challenges as she has strengths in accomplishing her goal of becoming the first female president. First is her awkward versions of U.S. history.

Her intimation that New Hampshire was "the state where the shot was heard around the world," according to Politico, was interesting considering the Revolutionary War began in Massachusetts. Her presentation that John Quincy Adams "would not rest until slavery was extinguished" was equally strange being that Adams died almost two decades before the 13th Amendment was ratified. Her suggestion that Obama defer to Gen. David Petraeus on the situation in Libya was also quite curious. As a member of the House Intelligence Committee, she should have known that Petraeus is the commander of American forces in Afghanistan and has nothing to do with military decisions in Libya.

Where the political history of challengers like Mitt Romney and Newt Gingrich is quite familiar, the national obscurity of the Minnesota representative will be a hindrance in that she must spend some of her campaign time playing catch-up. Bachmann's poll placement is also a cause for concern. According to data compiled by Real Clear Politics, Bachmann has consistently trailed in every poll since her name was added to the list of potential GOP contenders.

A third challenge will be funding. While she has had little trouble garnering contributions to fund her congressional re-election campaigns, convincing people to open their wallets for an unfamiliar presidential candidate is quite different. According to Talking Points Memo, Bachmann's inexperience is to blame. For example, when Bachmann attempted her first money-bomb in March, the goal was to raise $240,000 in 24 hours. She only managed to bring in just over $165,000. Mitt Romney, on the other hand, took in over $10 million in 24 hours using a nationwide phone bank. Where Bachmann used a spur-of-the-moment approach, Romney promoted his event heavily in the days before.

As for her strengths, while firm In her own beliefs, Bachmann would not use the presidency to impose those beliefs on others. During the debate, when asked if she would campaign to overturn New Hampshire's law allowing same-sex marriage as president, while admitting she would support a constitutional marriage amendment, she didn't believe it is a president's role "to go into states and interfere with their state laws."

Second, unlike Obama and some of her GOP challengers, Bachmann is unafraid to challenge members of her own party. Specifically, her identification of the Environmental Protection Agency during the debate as a "job killer" is already being criticized by left-wing advocacy groups. The problem is their clarification that the EPA was proposed by Republican President Richard Nixon simply verifies her position that she will risk favor within the party establishment to represent the will of the people. Additionally, she opposed TARP and raising the debt ceiling when the GOP leadership in Congress supported it.

Lastly, where many say Bachmann's affiliation with the Tea Party portends some liability in her efforts as a GOP candidate, they may want to consider the facts. Against popular claims that the Tea Party is simply a "right-wing media creation" or some conglomerate of white racists, according to World Socialist Web Site, as Bachmann clarified during the New Hampshire debate, the Tea Party is actually a collection of "disaffected Democrats, independents, libertarians" and "people who have never been political a day in their lives," which "is why the left fears it so much."

So, "familiarity breeds contempt" or "to know me is to love me"? Only the American voters can decide.

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