Arizona Senate passes budget, Medicaid growth

Associated Press
Rep. Macario Saldate, D-Tucson, rubs his eyes during a special session budget battle for Medicaid funding on Wednesday, June 12, 2013, in Phoenix.  The Arizona Legislature is on track to pull an all-nighter and work into Thursday to finish a state budget and approve Medicaid expansion. (AP Photo/Ross D. Franklin)
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PHOENIX (AP) — The Arizona Senate has passed an $8.8 billion state budget Thursday that includes the Medicaid expansion sought by Republican Gov. Jan Brewer as she embraces a signature part of President Barack Obama's health care overhaul law over the opposition of most GOP legislators.

The vote Thursday saw a newly formed coalition of Democrats and moderate Republicans push back against the conservative leaders who run the Legislature and expand health care to 300,000 more low-income Arizonans after months of stalled negotiations, tense debates and political maneuvering. The House had passed the budget and Medicaid plan hours earlier, after working through the night Wednesday.

With Brewer's top priorities secure, the Legislature was expected to adjourn the 2013 legislative session by late Thursday after six months of debate that saw tea party Republicans sidelined from a driving force to an angry minority.

During debate Wednesday and Thursday, conservatives railed against Brewer, a onetime ally, and accused members of their party who supported the Medicaid expansion of being turncoats. The expansion is optional under last year's Supreme Court decision upholding the law, and many Republican governors rejected it.

Brewer was one of the most vocal governors opposing the Affordable Care Act but acknowledged in January that it was the law of the land and would help Arizonans get care, lower the amount of uncompensated care hospitals must absorb and help cut what she called a hidden health care tax people who buy insurance pay in higher premiums to cover others' uncompensated care.

Her proposal was met with derision from conservatives and Republican leaders in the Legislature who argued that it was a massive expansion of government, would drive the federal government deeper into debt and that the government promises of paying for the expansion would turn out to be false.

"This is the biggest mistake we've made in the Arizona Legislature this year and maybe ever," said Republican Sen. Kelli Ward of Lake Havasu City during debate Thursday. "It's going to decrease the quality of care in Arizona, it's going to decrease access of care in Arizona and it's going to increase cost for all of us."

Republican Sen. Michele Reagan of Scottsdale questioned conservative business leaders who sided with Brewer in the health care debate.

"I wonder how many businesses would make a decision to fund something so large and so unknown for an indefinite amount of time without a check and balance guarantee in place?" she said.

In all, 23 states plus Washington, D.C., are moving ahead with the expansion, while 15 states have turned it down. Another 12 states are still weighing options.

Nearly all the states refusing are led by Republicans. Several of the states accepting have Republican governors, but most are led by Democrats. Washington will pick up the entire cost of the expansion for the first three years, and 90 percent over the longer haul. It's estimated that less than $100 billion in state spending could trigger nearly $1 trillion in federal dollars over a decade.

In Arizona, opponents led by the Senate president and House speaker had blocked actions for months, with the Senate finally adopting it in May. Speaker Andy Tobin continued to stall as he tried to get Brewer to compromise, and she finally had enough Tuesday and called the Legislature into a surprise special session. Both chambers started afresh Tuesday evening.

As the debate progressed, Brewer's allies refused to so much as answer questions on the floor or discuss provisions in the proposed budget. Instead, lawmakers exchanged barbs and policy rebuttals on Twitter long into the night as Republicans ranted on the floor.

"How are you not embarrassed for yourself?" asked Republican Rep. J. D. Mesnard, of Chandler, an opponent of the expansion, during the House session Wednesday. "Is anyone going to stand up and give a defense?"

Republican Rep. Eddie Farnsworth, of Gilbert, said the unannounced special session was unprecedented.

"I've never seen the case where a governor has rolled over her own party because she was throwing a temper tantrum," he said.

Republicans control the Legislature and all statewide elected offices in Arizona, but the Medicaid fight has highlighted internal fractures between those who want smaller government and others who, like Brewer, say broader health care access is good for the state.

"The bottom line here is greed," said Sen. Al Melvin, a Tucson Republican who is running for governor and voted against the Medicaid expansion. "The people who want this know in their hearts that Obamacare is going to collapse under its own weight."

Senate President Andy Biggs said lawmakers had little information about what was in the budget before passing it. He said he only learned of the special session after a reporter called him Tuesday.

"I am deeply and profoundly disappointed at the manner at which this came done," he said.

Brewer's office released a statement striving to distance her from the federal health care law that allows for the Medicaid expansion.

"Arizona's Medicaid program, known as AHCCCS, has existed for three decades ... going back to President Obama's college days," wrote spokesman Matthew Benson in an email. "AHCCCS is not the Affordable Care Act. It is not Obamacare. It is the nation's gold standard in terms of cost-effective Medicaid programs."

The Medicaid plan would cover people making between 100 percent and 138 percent of the federal poverty level and restore coverage to more than 100,000 childless adults who lost Medicaid coverage because of a state budget crunch. About 1.3 million Arizonans already are covered by the state's plan.

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