House Republicans on Tuesday began scrutinizing a Senate spending plan that includes Gov. Jan Brewer’s proposal to expand Medicaid, while their leader sought to build support for his plan to send the Medicaid question to voters.
House Speaker Andy Tobin, R-Paulden, was still smarting over Senate President Andy Biggs’ decision last week to jump-start stalled Medicaid negotiations and push his budget through the upper chamber. Six Republicans joined Democrats to amend the package with the governor’s Medicaid-expansion plan and about $35 million in additional spending.

Dueling rallies at the Capitol on Wednesday over expansion of Medicaid eligibility foreshadowed what’s expected to be a long, vitriolic fight today in the state Senate about the future of Arizona’s health-care program for the poor.
Gov. Jan Brewer’s Medicaid plan is expected to be offered as an amendment to a budget-related bill during debate on the fiscal 2014 spending plan, which is scheduled to begin this morning, officially putting the enormous health-care policy package in play and moving the governor one step closer to realizing her top legislative priority.

The state’s array of safety-net services must be reorganized around people, not programs, to help more Arizonans become self-sufficient, the director of the state’s social-welfare department said Friday at the launch of a new initiative.
Clarence Carter, director of the state Department of Economic Security, announced a demonstration project, beginning with 10 food-stamp recipients, that focuses on coordinating services and better evaluating family circumstances and barriers to employment, with the goal of reducing dependency on the state’s social-welfare system.

Democrats are growing frustrated over Gov. Jan Brewer’s struggle to get her Medicaid-expansion proposal into the Legislature and say efforts to appease reluctant Republican lawmakers with anti-abortion legislation threaten their support.

The governor’s team is working to craft abortion legislation under pressure from one of the state’s most powerful lobbying groups, which holds sway over GOP votes that Brewer desperately needs.

The abortion issue has added more uncertainty to sputtering negotiations over Medicaid expansion — Brewer’s top legislative priority — as talk about putting the question of expansion to Arizona voters has ramped up.

Democrats form the base of support for Brewer’s plan to expand health-care eligibility for Arizona’s poor and disabled under the state-federal program.

But House Minority Leader Chad Campbell, D-Phoenix, said their support is not guaranteed if expansion is weighed down with other policy issues.

Brewer’s office is preparing language, to be amended onto a separate bill, that would ensure no federal expansion funding goes to health-care providers that perform abortions.

The move is a response to lobbying from Cathi Herrod, president of the Center for Arizona Policy, who says Medicaid expansion would subsidize abortions — a claim that puts in a political vise anti-abortion GOP lawmakers who back the governor’s proposal.

“In response to some of the concerns raised by lawmakers, the governor has been willing to revisit this issue,” Brewer spokesman Matthew Benson said Tuesday. “It’s become clear that it would be difficult to move forward with Medicaid restoration until some of these legislative concerns about abortion are addressed.”

Brewer and other GOP governors who are backing expansion face stiff opposition from fellow Republicans, who see broadening Medicaid eligibility as an unsustainable, fiscally irresponsible endorsement of what they call “Obamacare.”

She has collected some GOP votes but needs support from every Democrat in the House and Senate to get expansion passed.

But although an abortion-related bill would be separate from Medicaid expansion, reaction from Democrats ranged from squeamish to furious. Some are angry that they weren’t consulted by Brewer’s office; others said their support depends on what ends up in the bill.

Campbell said the Governor’s Office didn’t warn him about the abortion measure, which rumors said would be added to a health-care bill in a conference committee Tuesday.

The committee never discussed the bill, however.

Campbell questioned whether Brewer and her supporters, which include the Arizona Chamber of Commerce and the health-care industry, have ever had a strategy to get expansion through the Legislature.

“It’s very hard for us to trust the Governor’s Office, at this point,” Campbell said. “She never had a plan for this. And now, to try to pander to Cathi Herrod, she’s jeopardizing Democratic support.”

Brewer and legislative leaders have said they oppose punting the Medicaid issue to a special-election ballot. But as the session drags on without an expansion agreement or a fiscal 2014 state budget deal, some lawmakers are saying they don’t see another way out.

“The way this will turn out all right, I think unfortunately, is if it’s a referral (to the ballot),” Campbell said. “I don’t see a pathway to (legislative) victory for this.”

Herrod first raised the abortion issue in late March in a letter to Brewer, using an opinion from a Christian legal-defense organization to argue that the draft Medicaid legislation should be amended to disqualify the non-profit women’s health provider Planned Parenthood and other abortion providers from receiving public money.

Brewer last year signed legislation to defund abortion providers, but Planned Parenthood and the ACLU filed suit and, in February, a federal judge put House Bill 2800 on hold.

In hopes of avoiding another legal challenge, Herrod has suggested language that would apply only to expansion funds, prohibiting those dollars from being used to “perform, assist or encourage abortion or to directly or indirectly subsidize abortions services or administrative expenses relating to abortions or to refer for abortions.”

It’s unclear whether such a bill would have much practical impact. Federal and state laws prohibit public funding for abortions except in cases of rape, incest or when the mother’s life is at risk.

And Medicaid expansion would not affect pregnant women, who are covered under a separate category within the Arizona Health Care Cost Containment System, the state’s Medicaid program.

But political observers say there could be a larger political risk in not placating Herrod, whose conservative, Christian-based group wields significant influence with GOP lawmakers.

The question becomes whether Democrats will be willing to vote against an abortion bill, in whatever form it takes, and still vote for expansion.

Rep. Eric Meyer, D-Paradise Valley, an emergency-room physician, said that, depending on how it’s written, the measure could jeopardize federal Medicaid funding for a hospital or any other health-care provider that performs an emergency abortion to save a woman’s life.

“You’re making a deal with the devil,” he said. “You put hospitals and providers in this position of making a choice between providing appropriate medical care that’s guaranteed under the U.S. Constitution and taking Medicaid dollars.

“The reality is, this is directly tied to the (Medicaid) restoration. We’re supportive of the restoration, but we don’t want all these strings attached. And this is one of those strings.”

Meyer, Campbell and others said Brewer should have acted more quickly on her top legislative priority, calling legislators into a special session months ago and forcing a vote on Medicaid expansion.

They say that the governor has lost momentum on the issue since her surprise announcement in her January State of the State speech and that the additional time has given expansion opponents more opportunity to work on undecided GOP lawmakers, who fear a political backlash in the 2014 primary election.

“I certainly think the votes were there early on. Which is why I’m grateful that we’ve taken so long,” said Rep. Paul Boyer, R-Phoenix, an early expansion supporter who has since peeled off because of the abortion issue.

Boyer, however, said he’s still talking with Brewer’s staff about possible amendments that could bring him back onto the expansion side.

Brewer could have called a special session months ago, but she couldn’t have forced lawmakers to vote, Benson said.

Florida GOP Gov. Rick Scott tried a hurry-up strategy that backfired, with a legislative committee spiking the proposal before the session even started. Expansion prospects there are looking dimmer.

In Ohio, GOP Gov. John Kasich is fighting a similar battle against his own party.

Like Brewer, the governors opposed the rest of the federal health-care overhaul and sued to stop it.

Benson said the strategy all along has been to help educate lawmakers and the public about the complicated issue so they could feel comfortable supporting it. “Even after 100-plus days, there are still legislators who don’t understand all of the aspects of this issue,” Benson said. “To call them into special session in January or February and ask them for a vote would’ve been asking them to vote on faith.”

Rep. Heather Carter, R-Cave Creek, who’s leading the Medicaid-expansion push in the House, agreed that a go-slow approach is warranted given that billions of dollars and thousands of lives are at stake.

But she said that as the impasse continues to hold up a new state budget, that makes life uncertain for teachers, state workers and others who depend on it.

Schools, in particular, need to complete their spending plans and let staff know if they’ll have jobs next fall, she said.

“When we’re looking at the most important decision that Arizona has made since the original Medicaid (was approved), this takes time. And it should take time,” Carter said. “(But) the rest of the state needs to continue to function.”

Though Carter said she’s confident lawmakers will reach an agreement on Medicaid expansion, others see striking parallels with the 2009 battle over a temporary 1-cent-per-dollar sales-tax hike. Brewer vetoed parts of two legislative budgets before GOP leaders agreed to put the tax hike before voters in May 2010.

Jim Drake, assistant secretary of state, said he has fielded a couple of queries from legislators and staff about a possible Medicaid ballot measure.

His office needs about 90 days and roughly $8 million to prepare for and conduct a statewide special election. It would require separate legislation to set the date, appropriate the funds and make other changes to allow consolidated polling places and other streamlining.

If possible, he said, it should be held on one of four dates already set aside for municipal, county and school issues.

It could piggyback, for example, on Phoenix city elections scheduled for November.

But Senate President Andy Biggs, R-Gilbert, a staunch expansion opponent, has said he won’t allow the Senate to refer the issue to the ballot.

And Benson said the governor also opposes the idea.

“The governor believes that legislators were sent to the Capitol to make the tough decisions,” he said.

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

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.

John Froneberger has been without medication to treat his depression and high blood pressure since last fall, when a cost-of-living increase in his disability benefit, to $970 a month, put him just above the poverty level and cost him his health insurance.
Froneberger’s monthly disability check helps pay for rent and food, but, as with hundreds of other Arizonans, it disqualifies him from the Arizona Health Care Cost Containment System, the state’s Medicaid program.

John Froneberger has been without medication to treat his depression and high blood pressure since last fall, when a cost-of-living increase in his disability benefit, to $970 a month, put him just above the poverty level and cost him his health insurance.
Froneberger’s monthly disability check helps pay for rent and food, but, as with hundreds of other Arizonans, it disqualifies him from the Arizona Health Care Cost Containment System, the state’s Medicaid program.

Two new reports from Arizona’s Child Protective Services show the number of children in foster care is increasing while the agency remains hundreds of workers short of state caseload standards and administrators are struggling with a record backlog of nearly 13,000 cases.
The numbers also show that the agency still is unable to investigate all the reports alleging child maltreatment that come through the state’s child-abuse hotline.

Legislation to protect the mentally ill and the public, including a bill — unofficially called Gabby’s Law — to better identify and respond to people in crisis, could be in trouble as state lawmakers enter final deliberations on non-budget-related bills.
Sen. Kimberly Yee, R-Phoenix, used a procedural maneuver to kill legislation to increase funding for a program that trains people to intervene when someone is suicidal or could pose harm to others. Supporters believe House Bill 2570 could prevent another shooting like the one outside Tucson that killed six people and wounded 13, including then-U.S. Rep. Gabrielle Giffords.

One of the Legislature’s most powerful lobbying groups says Gov. Jan Brewer’s Medicaid-expansion plan would subsidize abortions and is pushing for an amendment that complicates negotiations and threatens the proposal.

The Center for Arizona Policy is using an opinion from the Arizona-based Alliance Defending Freedom, a Christian legal-defense organization, to argue that the draft Medicaid legislation should be amended to disqualify the non-profit women’s health provider Planned Parenthood from receiving public money.

It’s the first in what is expected to be a long line of suggested changes to Brewer’s proposal to broaden eligibility for the state-federal health-insurance program for the poor and disabled, each with the potential to gain or lose votes for the governor’s top legislative priority with thousands of lives and billions of dollars at stake.

Democrats warn that piling on unrelated amendments could cost Brewer their support, and the governor still must find ways to win over Republicans.

The amendment suggested in a letter this week to Brewer from Cathi Herrod, the center’s president, is similar to a law signed by the governor last year to defund Planned Parenthood and other abortion providers.

Planned Parenthood and the ACLU filed suit, and a federal judge put House Bill 2800 on hold in February.

Herrod said her organization, a conservative Christian-based group that wields influence with GOP lawmakers, is not taking a position on Medicaid expansion and wouldn’t comment on the possibility that such an amendment could sink the plan.

“Our request is to include language guaranteeing that no funding to an abortion provider results from Medicaid expansion,” Herrod said. “Any dollar that goes to an abortion provider for any service frees up another dollar to subsidize abortion.”

Planned Parenthood gets a fraction of its funding from Medicaid but could pick up more patients if the state broadens eligibility. Although Herrod argues that funding to the clinics indirectly supports abortion, Planned Parenthood officials say they lose money on every Medicaid patient because of reimbursement levels.

Federal and state laws prohibit public funding for abortions except in cases of rape, incest or when the mother’s life is at risk. But Medicaid expansion would have no impact on pregnant women, who are covered under a separate category within the Arizona Health Care Cost Containment System, the state’s Medicaid program.

Brewer spokesman Matthew Benson said the governor must weigh the lives of all Arizonans, including the estimated 50,000 childless adults who would lose AHCCCS coverage when a federal waiver expires Dec. 31 unless lawmakers OK Medicaid expansion and the additional federal funding that comes with it.

“The state has done everything it can to keep public dollars out of the hands of abortion providers,” Benson said. “When the governor says she’s pro-life, that’s not just for the pre-born. She supports life for young people, the middle-aged and the elderly.”

Brewer and a broad coalition of expansion supporters, including the Arizona Chamber of Commerce, the health-care industry and advocates for the poor, are locked in a largely ideological battle with conservative Republicans who see the federal health-care law as an unaffordable government overreach.

The governor first couched Medicaid expansion as a “pro-life” issue at a Capitol rally this month.

Ron Johnson, executive director of the Arizona Catholic Conference, which represents the Phoenix Diocese and more than 1 million Arizona Catholics, said Herrod’s suggested amendment could pick up votes from GOP lawmakers who remain undecided on Medicaid expansion.

“There’s a case to be made that it actually picks up votes by having that kind of language,” Johnson said. “For us, it’s not one versus the other. We’re supportive of the governor’s Medicaid expansion and have been basically from the beginning. But before that, we were supportive of HB 2800.”

Brewer’s proposal has enough Democratic and GOP votes in the Senate to pass with a simple majority and appears close in the House. But House Minority Leader Chad Campbell, D-Phoenix, said that an abortion amendment “certainly doesn’t help” bring that coalition of lawmakers together and that other substantive amendments could cause additional problems.

“We’re not going to just vote for Medicaid if the governor and the GOP are also hurting us and hurting the future of the state with other policy measures,” Campbell said. “There are going to be things that could probably cause us to reconsider our position. The bottom line is (Medicaid) shouldn’t be used as a political football. Let’s just vote on this.”

Bryan Howard, president of Planned Parenthood Arizona, slammed Herrod and the Center for Arizona Policy for jeopardizing Medicaid expansion in favor of a “failed legislative strategy.”

“She has to know that she is putting health-care access for 400,000 people at risk,” he said.

The first public airing of Gov. Jan Brewer’s proposal to expand Medicaid was a four-hour, wide-ranging, sometimes- vitriolic debate Wednesday that offered a preview into how nasty this year’s biggest legislative battle could become.
The informational hearing before the House Appropriations Committee didn’t yield new information or formal action, but dozens of people testified about the perceived benefits and evils of expanding the Arizona Health Care Cost Containment System, the state’s Medicaid program, under the federal health-care overhaul.

Gov. Jan Brewer unveiled draft legislation Tuesday detailing her plans for expanding Medicaid, while putting a human face on the contentious issue in hopes of convincing skeptical GOP lawmakers whose votes she needs to get it approved.
During a rally at the state Capitol designed to kick-start legislative debate over the governor’s proposal to broaden eligibility under federal health-care reform, Brewer said expansion would bring in billions of federal dollars and save the lives of people who would otherwise be without health coverage.

Gov. Jan Brewer’s push to expand Medicaid is driving a wedge through Arizona’s Republican Party, with the governor and mainstream business interests battling grass-roots party loyalists.
The simmering Medicaid battle is expected to heat up early next week, when the governor and supporters unveil a draft of the bill to extend health insurance to thousands of low-income Arizonans under the federal health-care overhaul and legislative hearings spotlight the human cost of failing to do so.

Gov. Jan Brewer says Medicaid expansion makes sense once people “do the math.” But she may not be including the political calculus.
For some Republican lawmakers, the cost of supporting their governor’s top legislative priority this year may be too great. Local GOP officials have ramped up the pressure, passing resolutions that excoriate federal health-care reform and the expansion of “socialized medicine” and threatening the political careers of those who support it.

Surrounded by some of the state’s top medical professionals and trailed by a dozen placard-waving protesters, Gov. Jan Brewer made another pitch to expand Medicaid at a Capitol rally on Tuesday.
The Republican governor stuck to her talking points that broadening eligibility for the state-federal insurance program for the poor under federal health reform would save taxpayer money, save lives and ease the burden on hospitals caring for a growing number of uninsured patients.