When it comes to governing, Gov. Jan Brewer is a rather strange governor.
On Monday, she stood before members of both houses of the Legislature and their assorted guests to give her State of the State address and did her best Gomer Pyle impersonation– Surprise! Surprise! Surprise!
She caught everyone flatfooted by announcing she wanted the state to expand its Medicaid program in accordance with the Affordable Care Act, more commonly known as Obamacare.
Among those with WTH looks on their faces were the two men she most needs on her side, The Two Andys – Speaker of the House Andy Tobin and Senate President Andy Biggs, both Republicans.
The infamous finger-wagging Brewer is supposed to be no fan of the president or his landmark health care legislation. She had the state join in the various lawsuits challenging the legality of the law and just a few months ago Brewer rejected having the state create a health insurance exchange, saying there were too many risky unknowns with Obamacare for the state to participate in exchanges. The federal government will run Arizona’s exchange instead.
The Medicaid expansion was supposed to be mandatory but the Supreme Court struck down that part of the law, which means states have to agree to do it. Brewer can’t expand the state’s Medicaid rolls by fiat; she needs the Legislature. Despite Democratic gains in both houses in November, Republicans still hold commanding majorities. Democrats are all for Obamacare. Republicans, not so much.
That led most of the state’s political cognoscenti to assume she would reject the Medicaid expansion.
Pouring a cold bucket of water over Republican legislators’ heads on the biggest show day of the Legislative term is a strange way of going about rounding up votes.
But maybe that’s how scorpion eaters think politics works?
The Medicaid expansion is critical for the health of the state’s health care industry. During the recent recession and state budget crisis, the Legislature capped Medicaid enrollment and let other programs expire, tossing off the rolls or preventing from joining about 150,000 poor people.
But those people still need health care and they’re getting it in emergency rooms that they can’t afford to pay for.
Judy Rich, the head of Tucson Medical Center, said at a press conference Brewer arranged Wednesday that the number of people unable to pay their hospital bills has tripled since the state started booting people out of Medicaid in 2011.
The expansion increases the qualifying income for enrollment in state health care to 133 percent of the federal poverty line. That’s roughly $14,800 a year for a single person.
The expansion will not only add back the 150,000 or so who would already be on the rolls if not for the Legislature’s cut backs, but add probably another 150,000.
That will cost the state about $150 million a year, putting the total state Medicaid bill at about $2.3 billion, according to the Joint Legislative Budget Committee.
But in return, the federal government will kick in about $5.6 billion a year to help pay the health care bills of all those on the state’s Medicaid rolls, which includes $1.6 billion for the expansion match.
That’s a huge boon to the state’s health care industry and a boon to the overall health and welfare of Arizonans.
It only makes sense to do the expansion.
But many Republicans oppose Obamacare on principle. Brewer is asking those legislators to surrender their principles for economic pragmatism.
And their principles involve more than just resistance to adding to the national debt through Obamacare. To pay for the enrollment increase, Brewer is proposing the state adopt a hospital “bed tax” similar to the one Phoenix assesses. A good argument can be made that the “assessment” is a tax and all tax increases require a two-thirds vote of the legislature. That’s a lot of Republicans who will need to surrender their principles (not to mention their anti-tax pledges).
One doesn’t abandon one’s principles willy-nilly. It takes convincing. A slap in the face is a dumb way to go about starting the persuasion.
If the Medicaid expansion is to pass this year, it will likely be because the health care industry and its chamber of commerce allies flex their economic muscles and make it clear to Republicans that this decision is vital to the state’s economy and that they won’t look kindly upon principled votes that put it in peril.
If Brewer wants to ensure the Medicaid expansion passes the Legislature she’s better off retreating to her 9th floor office and letting adults who don’t eat scorpions for breakfast take it from here.