PHOENIX - In a historic move, a group of Republican senators united with Democrats Thursday to approve the plan by Gov. Jan Brewer to sharply expand Arizona's Medicaid program.

The preliminary vote came after supporters beat back more than a dozen amendments by foes, each of which sought to weaken or neuter the proposal. But there were changes from what Brewer pitched.

One key change would have the plan self-destruct at the end of 2016, three years after implementation. Even Senate Majority Leader John McComish, who spearheaded the push for expansion, conceded it is a good idea because it will force future lawmakers to revisit the whole issue. Brewer aide Matthew Benson said his boss is "open to a potential sunset date."

Still, Thursday'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 he wants changes, some technical and some to add what he said are cost-containment provisions.

Looming even larger, 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 $19,530 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 would 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.

Brewer's plan - and the Senate measure - propose an "assessment" on hospitals to raise the state's $240 million-a-year share.

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 supermajority.

Biggs told colleagues the hospital tax all but guarantees a lawsuit that could wipe out the entire Medicaid expansion plan.

Sen. Steve Farley, D-Tucson, said the requirement for a two-thirds vote does not apply to fees levied by the director of a state agency. This measure would let the director of AHCCCS set the amount due from each hospital.

But Sen. Steve Yarbrough, R-Chandler, said calling the fee anything other than a tax is bogus.

Thursday's vote came after a contentious Republican caucus where foes of expansion actually outnumber supporters. Sen. Rick Murphy, R-Glendale, was particularly miffed at McComish for working with Democrats, saying he betrayed his party.

"I didn't think it was appropriate for the majority leader of the caucus to 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," Murphy said.

McComish rejected claims he is a traitor to the Republican cause. "I'm no more a traitor than those who are opposing our Republican governor," he said. Even party leaders are allowed to go their own way on "issues of conscience," he said.

But Murphy said, "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."

Much of the GOP opposition was focused not on expanding the health-care program itself but that it is a part of the Affordable Care Act, or "Obamacare."

Even if the plan is approved, and even if it survives a lawsuit, the measure still has what amounts to an escape clause. It says the law is automatically repealed if federal reimbursement for the expansion falls below 80 percent of the cost.

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