Republican Gov. Jan Brewer has been known nationally as one of the
most outspoken foes of President Barack Obama: a Fox News regular, border hawk
and states' rights advocate who once wagged her finger in the chief executive's
face on a local tarmac.
Now Brewer, 68, is being called a traitor by members of her own party and heralded by advocates for the poor as she digs in for one of the toughest fights of her political career: expanding her state's Medicaid program under Obama's Affordable Care Act.
The proposal, which passed the Senate in an amendment to a budget bill last week and faces an uncertain future in the House, has pitted Brewer against Republican legislative leaders and given new relevance to the state's beleaguered Democrats. It has made for an unlikely alliance with advocates who vilified the governor in recent years for deep cuts that froze health coverage for children and temporarily cut off some lifesaving organ transplants for Medicaid patients.
"I think the governor has a little bit of a moral streak in her," said Tim Schmaltz, coordinator of the Protecting Arizona's Family Coalition, in the Senate lobby last week as lawmakers debated the proposal on the floor.
He ticked off past battles with Brewer. "All of that was really bad," he said and laughed. "We're just very grateful, frankly, that the governor had a conversion of heart, both economically and morally."
The Supreme Court's decision last year declaring the federal Affordable Care Act constitutional set the stage for state-by-state battles over Obama's signature legislative accomplishment. The high court made Medicaid expansion, key to the law's goal of expanding health coverage to at least 30 million more Americans, optional for states. Twenty states so far are opposing the enlargement of the joint federal-state health program to cover residents with incomes as much as $32,500 for a family of four, as called for in the law, according to the Kaiser Family Foundation, a not-for-profit health research group based in Menlo Park, Calif.
That includes Texas, the second-most populous U.S. state, where 24 percent of residents are uninsured, the highest proportion in the country, Kaiser says. Gov. Rick Perry, who was heckled by Medicaid proponents at luncheon this week, compared expanding the program to putting more people on a sinking Titanic in remarks earlier this month.
"Medicaid expansion, simply put, is just misguided," Perry, a Republican, said in a May 3 speech in Dallas. "It is ultimately a doomed attempt to mask the shortcomings of Obamacare."
Brewer's contrary stance on Medicaid "is about choosing pragmatism over ideology," said Matthew Benson, a spokesman for the governor.
"This was both a financial decision and a moral decision," Benson said, citing the return of billions of Arizona tax dollars to the state and the ability to maintain and expand existing Medicaid coverage.
Other Republican governors who opposed Obama's health care overhaul have said their states can't afford to reject the federal Medicaid money, which will cover the entire cost of expansion initially, falling to 90 percent in 2022. At least eight of the nation's 30 Republican governors have backed Medicaid expansion, including New Jersey Gov. Chris Christie. Of those who, like Brewer, have legislatures also controlled by their party, only North Dakota Gov. Jack
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