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Fri, Nov. 22

Brewer rolls out Medicaid expansion bill

Matt York/The Associated Press<br>Arizona Gov. Jan Brewer holds a copy of the Medicaid Restoration Plan draft bill Tuesday at the Capitol in Phoenix. Gov. Brewer is proposing the expansion of Medicaid to about 300,000 low-income Arizonans.

Matt York/The Associated Press<br>Arizona Gov. Jan Brewer holds a copy of the Medicaid Restoration Plan draft bill Tuesday at the Capitol in Phoenix. Gov. Brewer is proposing the expansion of Medicaid to about 300,000 low-income Arizonans.

PHOENIX - Gov. Jan Brewer appealed to fellow Republicans Tuesday to back her proposed expansion of Arizona's Medicaid program by citing the party's opposition to abortion and painting the issue as another way to protect the sanctity of life.

Brewer, who fought President Barack Obama's healthcare overhaul law but now is embracing one of its key provisions, said expanding the insurance to about 300,000 low-income Arizonans will save lives and prevent 50,000 childless adults now enrolled in the state program from losing coverage at the end of the year.

Her comments came as she released draft language of a bill authorizing the expansion that will go to the Republican-controlled Legislature, with a core group strongly opposed to the expansion.

"With this legislation, we're talking about people's lives," Brewer said at a press event packed with supporters, including a handful of Republican lawmakers. "I'm a pro-life governor - I refuse to stand by and allow this many people to needlessly suffer, especially when we have a solution."

Brewer surprised many observers nearly two months ago by announcing she backed an expansion after years of staunch opposition to Obama's health care overhaul. Arizona had joined other states in an unsuccessful effort to get the U.S. Supreme Court to overturn the Affordable Care Act.

Brewer is relying on a new hospital bed tax to pay the state's share of the cost of expanding Medicaid to Arizonans who make up to 138 percent of the federal poverty level. The draft language gives the director of the state's Medicaid program, known as the Arizona Health Care Cost Containment System, or AHCCCS, the ability to levy what Brewer calls an assessment.

It also carves out exceptions to the tax for a small number of hospitals that don't treat a significant number of patients without insurance and object to the assessment. Those facilities include the Mayo Clinic and Scottsdale Healthcare.

Brewer faces strong opposition from many Republicans who don't support the Affordable Care Act. Senate President Andy Biggs said there's virtually no chance he'll vote for it.

House Speaker Andy Tobin of Paulden said the draft bill needs several additions. Hospitals shouldn't be able to raise their rates on insured people as long as the special assessment is in effect. The AHCCCS director shouldn't have the sole authority to raise the assessment and cut doctor reimbursement rates. The bill should demand regular audits of the program, and tort reform also is on the table, he added.

"It doesn't include enough safeguards," he said of the draft bill.

He and other legislators believe the assessment would require a two-thirds majority vote that's needed for new taxes.

"I don't believe we have the votes to get that out, I've made that clear from the beginning," Tobin said.

The House is conducting small caucus meetings this week, then the Appropriations Committee will conduct an informational hearing next Wednesday, he said.

"This is the largest single component of the governor's budget," Tobin said. "As such, our members need to be informed of the fiscal impact the plan will have, which is why it will be vetted in the Appropriations Committee."

Among the Republican lawmakers joining the governor at the press event were Sen. Steve Pierce of Prescott, Rep. Heather Carter, chair of the House health committee, and Sen. Kate Brophy McGee, who predicted passage.

Pierce also joined Brewer alongside local health care and chamber officials in January in Prescott to stump for the Medicaid expansion.

"It's a bold move to do what she's doing," Pierce said. "Rural hospitals are dying, and we have to do this to help rural hospitals." The governor's plan also will help mental health providers and patients, he noted.

Brewer has staged a two-month effort to sell the proposal, winning over many in the business community and a number of powerful health care officials.

She has touted the financial benefits of getting more people insured. And she has rallied doctors at the Capitol.

Brewer said the state can expect $1.6 billion in new federal funding a year by assessing hospitals about $250 million a year to pay for the state's share of an expanded Medicaid program.

"This will get through. This is going to happen," said Glenn Hamer, president of the Arizona Chamber of Commerce and Industry.

The draft legislation Brewer released includes a promised "circuit breaker" to pull Arizona out of the program if federal funding falls below 80 percent.

Under the federal legislation, Washington would pay the entire cost of the Medicaid expansion for the first three years, gradually phasing down to 90 percent of the cost after that.

Courier reporter Joanna Dodder contributed to this story.

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