Gov. Jan Brewer's proposal to expand Medicaid coverage to more Arizonans is smart and pragmatic, and Republicans should follow her lead.

Like it or not - and Brewer is definitely on the "not" side - the Affordable Care Act is law. And if Arizona doesn't secure its share ($1.6 billion) of federal dollars, the money will be used to help uninsured people in other states instead of keeping rural hospitals open and helping our own residents stay healthy.

Getting our fair share isn't the only, or even the best, argument for getting about 240,000 low-income Arizonans who don't have children back on the Medicaid program (it's called the Arizona Health Care Cost Containment System, or AHCCCS). The federal money would also allow about 50,000 adults into the program.

One in five Arizonans have no health insurance coverage at all. Even setting aside the question of basic human decency in caring for those who need help, it's wrong to assume that members of this unfortunate group don't get sick or that when they do, they don't seek care.

Leading Republican lawmakers and organizations are mobilizing to fight Brewer. Opponents point to high health care costs and a belief that government programs shouldn't be expanded.

This isn't a theoretical discussion. Arizonans pay a heavy price in health and dollars for our high numbers of uninsured.

Sick people without insurance show up at hospitals, usually in much worse medical shape and requiring more treatment because they haven't had regular access to a primary care doctor. That's because they don't get treatment for ongoing health problems, like diabetes, or take medications so a bad cough doesn't turn into pneumonia.

Hospital treatment is given, even if the patient can't pay the bills. It goes under "uncompensated care," and it eventually gets covered through paying customers' bills and their insurance premiums. The cost doesn't evaporate, nor does the need.

Roughly 1.2 million Arizonans use the AHCCCS system now. The federal money would allow Arizona to include adults who make 133 percent of the federal poverty level, which for a single person means a maximum annual income of $11,170. The expansion would boost that to $15,282 for a single adult. Many of these people work, but at jobs that don't pay enough to buy health insurance, or for companies that don't offer it.

The coverage expansion would cost about $256 million, but Brewer's proposed legislation would allow AHCCCS to "establish, administer and collect" a hospital assessment that would cover the cost.

Hospitals, such as Tucson Medical Center, are on board with Brewer's plan. That's because they know that hospitals, and by extension insurance companies and ulimately policy holiders, end up paying for uninsured people's medical bills anyway. It's better to get in front of the financial situation with a good plan than to keep the status quo.

We disagree with Brewer's stand on reproductive rights, but she made a cogent point that should help her fellow conservatives see health care in a different light.

"I've always been proud to be a member of a pro-life party. With this legislation, we're talking about people's lives," the governor said at a recent press conference. "I refuse to stand by and let this many people needlessly suffer, especially when we have a solution."

Brewer's Medicaid plan makes sense and should have bipartisan support. It's the best thing to do for Arizona.

Arizona Daily Star