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 Dalrymple succeeded in getting it past lawmakers so far.
Ohio Gov. John Kasich, a first-term Republican, tried to get Medicaid expansion passed as part of the state's two-year budget bill. The Republican-controlled House removed it from the measure last month.
Kasich has said he hasn't given up on legislative approval. If that fails, his administration is negotiating with federal authorities to develop an alternative plan that would allow it to use Medicaid dollars to help poor residents buy private health coverage. Advocates for the poor and mentally ill have also proposed a statewide ballot issue for expansion.
"I'm for whatever it takes to get this done because I think it's important for our state," Kasich told reporters May 7 in Columbus.
In Florida, Gov. Rick Scott's pitch to expand Medicaid was rejected by legislative committees in both the House and the Senate in March; lawmakers adjourned May 3 without passing an alternative plan.
The defeat was a setback for Scott, who started his political career by financing a tea party group that opposed Obama's health law and faces re-election next year. His support for Medicaid upset tea partyers and didn't move his 36 percent approval rating, according to a March 20 poll from Quinnipiac University in Hamden, Connecticut.
Florida Democrats, including U.S. Sen. Bill Nelson, have asked Scott to force lawmakers back to the capital to address the issue. Scott told reporters May 3 that the legislature "made their decision" on Medicaid.
Brewer, like Scott and Kasich, was no fan of the president's health law. Arizona was among the 26 Republican-controlled states that sued to stop it. She also declined to create a state health exchange, joining 26 other states that are ceding control to the federal government.
Her announcement supporting Medicaid expansion in her January State of the State address surprised the political establishment and kicked off a war with Republican legislative leaders and party officials.
The head of the Republican Party in Maricopa County, which includes Phoenix, compared Brewer to Judas in remarks to the legislature. Republican lawmakers, who helped her pass the strictest immigration law in the nation in 2010, are publicly questioning her conservative stripes.
"All of us Republicans have spent the last five years bashing Obamacare. Now some us have done 180s on it," Rep. John Kavanagh, a Republican who chairs the House appropriations committee, complained in the Capitol courtyard last week. Like other opponents, Kavanagh, who has threatened to block Medicaid expansion in his committee, cited his concern about the federal deficit and opposition to the health law.
While state lawmakers might want to stand on principle against the law, the reality is that states need the money that expansion brings -- as do hospitals and other health care providers, powerful interest groups for whom Medicaid is "lifeblood," said Julian Zelizer, a political historian at Princeton University in New Jersey.
Brewer "became a symbol for many of a tea party Republican who was not willing to be flexible, who was going to stand up for red states," Zelizer said. "This kind of position challenges that and suggests she may be more politically pragmatic than she appeared to be."
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