Gov. Jan Brewer led a lively "pep rally" for Medicaid expansion at Tucson Medical Center on Wednesday morning, drawing cheers, shouts of support and a standing ovation from about 250 local health-care executives, business leaders and other citizens.
Without the expansion, about 60,000 Arizonans now enrolled in Medicaid will immediately lose health coverage at the end of 2013, including an estimated 5,000 cancer patients and 2,000 with serious mental illness, state officials say. And hospitals and insured Arizonans will end up shouldering the cost, Brewer said.
She said the state will also lose out on millions of dollars in federal matching funds to cover health care.
"We cannot let that happen," the Republican governor said to loud applause. "And I know that we won't."
The Arizona House of Representatives could consider the expansion as early as next week.
Medicaid is a federal insurance program for low-income people that currently covers 1.3 million Arizonans. Many of the Arizona critics of the expansion are Republicans opposed to the new federal health law. Some say Medicaid is inefficient, needs major reform and that expansion shouldn't be done without an overhaul.
"Now, I am no big fan of the Affordable Care Act. In fact I led Arizona's efforts to defeat it. But the question for Arizonans today is not whether the law should exist. It does. The Supreme Court upheld it," Brewer said of the federal health law, which she calls Obamacare. "The question is whether we will take decisive action in a way that most benefits Arizona's families, businesses and hospitals."
The expansion received a significant boost last week when the Arizona Senate approved the plan, but it still needs support from the state House of Representatives. House Speaker Andy Tobin, a Republican from Yavapai County, has said he wants expansion to be subject to voter approval, which the governor opposes.
"Now we move to the House of Representatives and the road doesn't get any easier," Brewer said. "We just need everybody on board, to get their facts straight. Call your legislators and tell them: 'We elected you to do your job. Now do it,' " she said.
State Rep. Ethan Orr, a Catalina Foothills Republican, told the group that he is among eight Republicans in the House who support the governor's plan for Medicaid expansion, a plan he calls preventive and prudent.
"I'm highly optimistic that the House of Representatives will be able to answer the governor's call, so to speak," Orr said. "This is about math. The impact on our state budget will be hundreds of millions of dollars. And this decision could infuse billions into our state economy. In fact, over the next four years it will infuse $8 billion into our state and local economies. That is a lot of money."
Without the expansion, Arizona tax dollars will go to Washington and "simply disappear," he said. Like Brewer, Orr does not think that putting the issue to voters is wise. The Legislature should not avoid making difficult decisions, he said.
Brewer said the state cannot move forward with its budget without the expansion.
Expanding Medicaid is one of the new health-care law's provisions. While the law calls for expanding Medicaid to people who earn up to 133 percent of the federal poverty level, the U.S. Supreme Court last year left the question of whether to expand Medicaid up to individual states.
The Arizona Legislature froze childless adults from enrolling in Medicaid in 2011 because of $2.5 billion in annual budget cuts to the program. Since then, the number of Arizona childless adults with Medicaid has shrunk by more than 60 percent, leaving about 240,000 childless adults in Arizona without health insurance. As a result, hospitals say their costs for uncompensated care have skyrocketed.
"These are Arizonans without health insurance who live day to day knowing they face disaster if they get sick, or if they are injured," Brewer said.
When hospital costs rise, the result is a "hidden tax" on insured patients, the governor said.
The expansion would cover an additional 57,000 Arizonans. But more significant, the expansion would give what state officials say is enough federal matching funds to cover those 240,000 childless adults and continue coverage for about 60,000 others.
In Arizona, Medicaid is available to people who earn up to 100 percent of the federal poverty level, which works out to an annual income of $19,530 for a family of three. Taking that cap up to 133 percent would work out to nearly $26,000 in income for a family of three.
The Republican governor surprised many people earlier this year when she announced that she would support expanding Medicaid, a program that in Arizona is also called the Arizona Health Care Cost Containment System or AHCCCS.
"Illness doesn't wait until it's convenient or when you save enough money to pay for medical care," said Judy Rich, president and chief executive officer of Tucson Medical Center. "Hospitals have served as a vital safety net as the state has struggled through our great recession. Now it's time to invest in the health of our community, support Tucson and Arizona hospitals and the broader health safety net."