With a deadline for gathering signatures closing in, foes of Medicaid expansion in Arizona say they are on track to force a voter referendum.

If successful, the group could derail a new state law that on Jan. 1 is supposed to add more people to Medicaid, a government insurance program for low-income people. Arizona’s Medicaid program, operated by the state, is called the Arizona Health Care Cost Containment System (AHCCCS) and as of July covered 1.3 million Arizonans.

Without the Medicaid expansion, the entire health-care system in Arizona will be in financial peril, many state health leaders say. Signature gatherers say voters should decide for themselves.

Festooned in American flags, members of a group called the United Republican Alliance of Principled Conservatives have been positioned around the Tucson area asking people to sign their petitions throughout the summer. With a looming deadline, volunteers are stepping up efforts.

The group is determined that voters be allowed to reverse the law signed by Republican Gov. Jan Brewer in June that expands eligibility for Arizona’s Medicaid program and allows the state to draw enough federal dollars to restore coverage to childless adults affected by an enrollment freeze. The GOP-led Legislature passed the expansion earlier this year after emotionally-charged debate within the Republican Party.

Passions remain high among those supporting the referendum. “This is a war, people,” says an Aug. 3 posting on the Pima County Republicans Facebook page. The post was written by Christine Bauserman, a Tucsonan who chairs the United Republican Alliance for Principled Conservatives.

“The people trying to stop you will attempt persuasion and then intimidation — they are the enemy and they will treat you like one — so be ready for it,” she continues. “Take it personally because it is.”

The group’s leaders won’t say how many signatures they’ve gathered but insist they are “on track” to hand in the 86,405 required by the Arizona Secretary of State’s Office by Sept. 11.

If enough valid signatures from registered Arizona voters are gathered, and the effort is not stopped by an anticipated legal battle, the group will force a referendum on the new law expanding the state’s Medicaid program that is set to take effect Jan. 1. The expansion start date would also be affected, putting it on hold until the referendum election. About 63,000 low-income Arizonans would immediately lose their Medicaid coverage on Jan. 1, even if they are in the middle of treatment. They are childless adults who already had Medicaid before the enrollment freeze, so they’ve been allowed to stay enrolled. But state officials say there’s no more money for that group come 2014 without tapping federal dollars available through the expansion.

A group opposing the signature gatherers and supporting Medicaid expansion is called Restoring Arizona. The group name refers to the fact that a large part of what’s being referred to as Medicaid expansion is in fact restoration of a voter-approved initiative that expanded eligibility to include childless adults in the program in 2000.

The actual Medicaid expansion will up the program eligibility from 100 percent of the federal poverty level to 133 percent. That increase will add about 57,000 people to Medicaid but more significantly, state officials say it will allow the state to take federal dollars to restore coverage to more than 200,000 childless adults who have been frozen out of enrollment since 2011 due to state budget woes.

Restoring Arizona members say that Medicaid expansion and its relationship to the Affordable Care Act is minimal and that the actual function the petition will have in Arizona may be lost on some of those signing it.

“It seems as though there’s an opportunity for people to believe that by signing they will overturn the Affordable Care Act,” said Tucson Medical Center spokeswoman Julia Strange.

“In fact, this is Arizona’s expansion of Medicaid, restoring the will of voters from previous elections. That is the part where it is easy to become confused about the extent of the impact.”

When the U.S. Supreme Court upheld the Affordable Care Act, it allowed states to decide one component of it for themselves — Medicaid expansion. As of July 1, 21 states had indicated they were not going to do an expansion, including Utah and Texas, the Kaiser Family Foundation says.

Brewer surprised many earlier this year, particularly her fellow Republicans, when she announced she would support Medicaid expansion in Arizona. She explained the decision as a difficult but fiscally necessary one.

Though she doesn’t like the federal health law, the federal dollars the law makes available through Medicaid expansion are too important to containing costs in Arizona’s health system, she has said.

Restoring Arizona supporters say some people may not realize the petition will hurt low-income Arizonans by taking away their health coverage.

Having fewer people covered by Medicaid will spike health costs for the state’s medical system, including individual premiums, they say. Bad debt at Arizona hospitals has soared since the state began freezing people out of Medicaid.

“We’re concerned about it, that would be a fair statement,” Strange said of the referendum effort.

Bauserman says some opponents to a referendum have been intimidating and aggressive. She calls them the “governor’s team” and says they are doing whatever they can to stop the referendum effort.

Restoring Arizona spokesman Jaime Molera countered that he finds many of the group’s claims ridiculous and even laughable, though he believes the threat they pose to health care in Arizona is serious.

Bauserman says people have been seeking her group out asking to sign the petition. Indeed, as the temperature crept past 90 degrees on Thursday morning, signature gatherers stationed in a south-side parking lot could not keep up with the number of drivers pulling up asking to sign the petition.

The signature gathering event had been promoted by Jon Justice, a local conservative radio personality.

Danny Mueller, 78, listens to Justice and decided to stop by.

“I’m actually kind of for Medicaid. A lot of people are hurting,” he said after signing his name. “But I believe in states’ rights. The feds are out of control with the deficit.”

With U.S. flags painted on her toenails, volunteer Pat Sexton moved from car to car, excited by the interest. Since July, Sexton has gathered more than 500 signatures. She’s passionate about showing some opposition to the Affordable Care Act, she said.

“They want to intimidate us, but they don’t know us,” said the 61-year-old mother and grandmother.

“This is so important to me. My husband hasn’t seen me in six weeks. The other side cannot understand how passionate we are about this country. People are seeking us out. One man drove eight miles just to find us,” she added.

Former State Sen. Frank Antenori, also a leader on the referendum effort, believes the state is underestimating when it says expanding eligibility from 100 percent of the federal poverty level to 133 percent will add about 57,000 people to Medicaid. Taxpayers are going to end up with a huge tab, he predicts.

“I call it the woodwork effect,” Antenori said.

Though supporters of expansion cite cost containment, Antenori predicts that any modest savings from reducing uncompensated care through the expansion will be far outpaced by overall state health-care spending, foisting more expenses on taxpayers.

Antenori says people on Medicaid receive health care for free, so they are not judicious about doing preventive care. It’s just as easy for them to go to the emergency room for a runny nose because they don’t have to pay for it, he says.

TMC’s Strange counters that people delay care when they don’t have Medicaid coverage, not when they do. Not only that, people without health insurance ramp up costs for everyone when they get sick, she said.

“It is a good thing for the health system we’re all dependent on,” she said of the expansion.

Antenori says given the size of Arizona’s population, there’s no question his group will be able to collect 86,405 signatures. He disputes Restoring Arizona’s claim that most Arizonans want Medicaid expansion.

Brewer spokesman Andrew Wilder doesn’t think the signature gatherers will succeed.

“With recent polling showing that 68 percent of Arizonans firmly support Governor Brewer’s Medicaid restoration plan, I think it’s pretty dubious that they’ll even make the ballot,” he wrote in an email, referring to a nonpartisan poll conducted by Restoring Arizona.

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 573-4134. On Twitter: @stephanieinnes