PHOENIX — In an historic move, a group of Republican senators united with Democrats this afternoon to approve the plan by Gov. Jan Brewer to sharply expand the state's Medicaid program.
The preliminary vote came after supporters beat back a dozen amendments by foes, each of which sought to weaken or totally undermine the proposal. That pretty much keeps the plan close to what Brewer proposed in January.
But not exactly.
One key change has the plan self-destruct at the end of 2016, three years after implementation. Even Senate Majority Leader John McComish, who spearheaded the push, conceded it is a good idea because it will force future lawmakers to revisit the whole issue.
"The governor is open to a potential sunset date,'' said Matthew Benson, her press aide.
Even with that, though, today's Senate vote does not mean Medicaid expansion is a sure thing. The measure still needs House approval
House Speaker Andy Tobin said he's willing to expand Medicaid — but just not in the form proposed by Brewer or approved by the Senate.
Some of what he wants is technical. Some involves his desire for what he said are cost-containment provisions.
But the key difference is that Tobin wants to make the plan subject to voter approval. And at least part of the reason for that goes to another hurdle that awaits the plan.
Arizona provides care for most individuals who fall below the federal poverty level, about $15,390 a year for a family of three.
This proposal taps a provision in the federal Affordable Care Act to provide care for those up to what equals 138 percent of the federal poverty level. The federal government would fund most of the expansion which will add 300,000 or more to the 1.3 million already on rolls of the Arizona Health Care Cost Containment System, the state's Medicaid program
But there is a cost to the state. So Brewer's plan — and the Senate measure — proposes what the governor calls an "assessment'' on hospitals to raise $240 million a year.
Senate President Andy Biggs, a key foe of Medicaid expansion, said this is really a tax. And the Arizona Constitution requires a two-thirds vote of both the House and Senate, a margin of support the measure does not have.
Tobin's plan to send the measure to the ballot would eliminate the need for that super majority.
The Senate, however, passed this plan only by a simple majority. And that, Biggs told colleagues, portends a lawsuit.
Sen. Steve Farley, D-Tucson, pointed out the constitutional requirement for a two-thirds vote does not apply to fees levied by the director of a state agency. And, technically speaking, it would be up to AHCCCS Director Tom Betlach to determine the ultimate amount to be sought from each hospital.
Biggs, however, said that is a legal fiction. And Sen. Steve Yarbrough, R-Chandler, warned colleagues they will regret this decision.
"This is a stunning example of our ceding power to the executive branch that will serve as a terrible precedent,'' he said.
Even if the plan gets final approval, and even if it survives a lawsuit, the measure still has what amounts to an escape clause. It says the law is repealed if federal support for the expansion falls below 80 percent of the cost.
Today's vote came after a contentious Republican caucus where foes of expansion pointed out that they outnumber supporters.
Sen. Rick Murphy, R-Glendale, was particularly miffed at McComish.
"I didn't think it was appropriate for the majority leader of the caucus to be participate in -- and particularly to lead -- a rolling of his own caucus when the vast majority of his caucus doesn't want to do what he wants to do,'' he said.
McComish, however, said he did nothing wrong. And he rejected suggestions by some GOP colleagues that he is, in effect, a traitor to the Republican cause.
"I'm no more a traitor than those who are opposing our Republican governor,'' he said.
McComish also said his election last fall by Republicans as their leader does not require him to always advance what the majority of them want. He said even party leaders are allowed to go their own way on "issues of conscience.''
Murphy rejected the contention that the vote on Medicaid falls into that category.
"This is too big of an issue and too big of a policy shift to be something that the majority leader goes against his caucus on and, particularly, leads the opposition,'' he said. "If they didn't want to be in majority leadership then they shouldn't have run for the position.''
Much of the GOP opposition is not so much to having the state provide care for more but that is it part of what Sen. Al Melvin, R-Tucson, called "this monstrosity of a bill, Obamacare.'' He argued that the amount of federal spending that will be required is unsustainable.
"Fifty cents on the federal dollar is borrowed from the Chinese or generational theft,'' he said. "We have to stop it and we have to stop it now.''