PHOENIX - Parting ways with her own Republican Party, Gov. Jan Brewer on Monday proposed expanding Arizona's Medicaid program to take advantage of the federal Affordable Care Act.
In her fifth State of the State speech, Brewer detailed how she opposed what's been dubbed "Obamacare," joining with other states in fighting it in court, and refusing to have the state set up its own health insurance exchange. But she said the reality is that it's not going away: The Supreme Court upheld the law; Obama was re-elected; and his Democratic Party controls the U.S. Senate.
So Brewer told fellow Republicans they should support her in agreeing to expand Medicaid with an eye on getting more federal money and saving hospitals from the financial burden of uncompensated care.
In her 36-minute speech, Brewer also:
• Asked lawmakers to fund 200 more caseworkers for Child Protective Services, including 50 immediately.
• Pushed to simplify the state sales tax system, which she said is overly complex for businesses.
• Promised to seek more police officers for schools to help prevent an incident like what happened in Connecticut, though she provided no dollar figures.
Brewer also vowed to seek more money for public education overall.
"Whatever your point of view, we should all agree that it's time we start funding the academic results we want to see," she said. But Brewer's plan has a twist.
Under current law, schools essentially are funded on a per-capita basis: Each student translates into a set amount of state aid. There are add-ons for special needs, like learning disabilities and limited English proficiency.
Brewer said she's not suggesting scrapping that. But she wants to provide additional dollars - and not on a per-student basis.
"What I am proposing is the nation's first comprehensive performance funding plan for our districts and charter schools," the governor said. "This plan will reward schools that earn high marks or see real improvement in performance."
Brewer provided no details other than to say what she has in mind will augment existing funding "with an innovative approach to promoting school performance while maintaining local control."
On the issue of Medicaid, the governor pointed out that Arizonans have voted twice to require the state to provide free care for everyone up to the federal poverty level. That is about $19,000 a year for a family of three.
The federal government picks up about two-thirds of the cost.
Under the Affordable Care Act, if Arizona boosts eligibility to 138 percent, Washington would initially pick up virtually all of the extra cost, eventually scaling back to about 90 percent. Brewer told Republican colleagues who control the state House and Senate it makes no sense to pass up those dollars.
Participating will protect rural and "safety net" hospitals from the threatened financial disaster of uncompensated care for the uninsured, while at the same time creating enormous economic benefit by injecting $2 billion in federal funds into the Arizona economy, saving and creating thousands of jobs and providing health care to hundreds of thousands of low-income individuals.
Arizonans will save money, she said, because hospitals are now passing the cost of uncompensated care on to other patients.
"Health-care premiums are raised year after year to account for expenses incurred by our hospitals," she said. "This amounts to a hidden tax estimated at nearly $2,000 per family per year."
It won't raise taxes, she said, because the state's share will be paid for by a "bed tax" on hospitals. And if Washington cuts funding, the state law would include a provision to automatically roll back enrollment.
GOP lawmakers remain skeptical.
"There's a lot of questions that need to be answered," said Senate President Andy Biggs, questioning assurances that taxpayers won't end up on the financial hook.
Rep. John Kavanagh, R-Fountain Hills, who chairs the House Appropriations Committee, said he does not like the idea of a hospital bed tax. He said it amounts to a shift of consumer and hospital money from middle- and upper-income-class communities to poor ones because Medicaid patients are all in hospitals in poor areas, while the tax will be collected on admissions in all hospitals statewide.
Among Democrats, House Minority Leader Chad Campbell was cheered by the governor's proposal, but like Briggs is concerned about the ability to roll back eligibility if federal money dries up.
"Saying 'no' to this plan would not save these federal dollars from being spent or direct them to deficit reduction," she said. "No. Arizona's tax dollars would simply be passed to another state."
Brewer's call for 200 more caseworkers for Child Protective Services, on top of the current approximately 1,075 caseworkers, does have a cost.
Still, she said, "Arizona's abused and neglected children need help."
Further, Brewer promised to seek additional funds to boost foster care, adoption services and emergency placement of children needing rescue.
"We cannot strike evil from the hearts of those who would harm an innocent child," the governor said. "But these common-sense steps will help at-risk children get the assistance they need before it's too late."
Despite repeated clashes with the federal government over immigration, Brewer also promised to work for immigration reform, but only once the border is secure.
She said the steep decline in illegal crossings in the Yuma Sector through fencing, manpower and technology shows it can be done. Now she wants the same for the rest of Arizona's border with Mexico.
"Fulfill your promise to the American people, and I'll make good on mine," she said rhetorically to President Obama.
The governor also established a new Natural Resources Review Council to provide input on how to best use the state's resources located on federal land.
Brewer last year vetoed legislation that would have required the state to demand the federal government turn over its holdings to the state, suggesting it was over-reaching. The council she is forming is instead designed to provide input into what the federal government does with the lands.
Brewer said she will also issue an executive order setting up a task force to fight human trafficking.
"This is truly a crime against humanity, a modern-day slavery in which men, women and children are sold into forced labor or prostitution," the governor said.
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