PHOENIX - The weekend before Arizona Gov. Jan Brewer made her State of the State address in January, she practiced two versions of her speech: one with a Medicaid expansion and one without.
The Republican governor ended up announcing during her Jan. 14 address that she wanted to expand the state's Medicaid program - known as the Arizona Health Care Cost Containment System - bucking many conservatives in her party to embrace Medicaid expansion.
Brewer had been an early and frequent critic of the president's health-care plan and joined 25 other states in trying to repeal the Affordable Care Act.
Despite the division within the GOP, the Arizona Senate on Thursday approved the governor's proposal. The Medicaid expansion plan faces an uncertain future in the House of Representatives.
Brewer's decision to expand Medicaid was a gradual one, reached in January as she prepared to unveil her proposed budget and legislative priorities. Even her closest aides believed at the time that there was "no way" an expansion of Medicaid would be seriously considered because of GOP disdain for federal health-care reform.
In early December, Brewer learned that a partial expansion of Medicaid would bring no additional federal benefit beyond the traditional share already paid to states. Days later, a budget analyst who was poring over the numbers told John Arnold, the governor's budget director, that expansion should be seriously considered. Arnold took the idea to Brewer's chief of staff, Scott Smith, who showed it to Brewer.
Under Medicaid expansion, the federal government would cover 90 percent of the costs of insuring the poor and disabled who are added to the rolls. Currently, Arizona receives two federal dollars for every state dollar spent.
Throughout December and early January, the governor met often with advisers and administrators to study every aspect of expansion and the arguments for and against.
"I knew it was going to be very difficult. I knew it was going to be a huge challenge, and I had to decide in my own mind to get right with it," Brewer told The Arizona Republic.
Opponents, led by conservative Republicans, say they will face GOP primary opposition in the next election if they support Brewer's expansion.
Republican Rep. John Kavanagh of Fountain Hills predicted Brewer's stance will taint how some Republicans remember her. Until now, he said, her legacy in the GOP was the state's landmark 2010 immigration law and "budget-cutting conservatism."
"Her Medicaid position, of course, for at least Republicans, makes the legacy somewhat mixed," Kavanagh said. "Republicans have spent the last five years bashing Obamacare, and this is an extension of Obamacare - you can't escape that. On multiple levels, the plan is adopting principles that Republicans have been criticizing. It's a 180, and that's tough to do politically."
Medicaid opposition underscores states' health-care disparities. / Page A10