While they were buoyed by the bipartisan passage of Medicaid expansion in Arizona Thursday, Tucson medical leaders say achieving better community health will still require work.

Expanding the state-run insurance program for low- income people, combined with an anticipated rise in people with insurance due to health reform, will give more people access to health care, leaders say. But it's also going to put more pressure on the medical system.

"Even though it's a good day, it carries with it a big responsibility for stepping up in the future, particularly in the area of primary care. We have a relative provider shortage in some areas in Arizona," said Dr. Charles Katzenberg, a Tucson cardiologist who is president of the Pima County Medical Society. "There will be pressure on primary care practices to accommodate extra patients."

Still, Katzenberg and others said approving Medicaid expansion was a good first step, especially in a state where support for the expansion was not always obvious. Arizona Gov. Jan Brewer surprised many earlier this year when she announced support for expanding Medicaid, a proposal that was part of the federal Affordable Care Act but was left up to individual states by a U.S. Supreme Court decision. Brewer has long been a vocal opponent of the federal health law.

"Gov. Brewer gets a lot of credit for crossing party lines and doing the right thing," Katzenberg said. "I have great admiration for her."

Passions on both sides of the debate ran high, noted State Rep. Ethan Orr, a Tucson Republican who supported the expansion.

"I'm very excited, not only because Medicaid expansion passed but because it passed with Democrats and Republicans working together," Orr said.

Orr said the expansion was "absolutely essential" to local hospitals like Tucson Medical Center and both University of Arizona Medical Center campuses because of the number of low-income patients they serve.

Dr. Michael Waldrum, chief executive officer of the University of Arizona Health Network, called Thursday's expansion approval "a great decision for citizens who need care. We are excited and appreciate the hard work of the governor, Senate and House."

Opponents of the expansion, meanwhile, include many who want to repeal the federal health law. Others said Arizona's Medicaid program is rife with problems and needs reforming before any expansion can take place.

State Sen. Al Melvin, a Republican from Tucson who has announced he's running for governor, tweeted his displeasure after the Senate vote. He said Brewer should have led Arizona "away from Obamacare" rather than expanding Medicaid in Arizona. She should have followed the example of Texas Gov. Rick Perry, he wrote. Texas will not be expanding its Medicaid program.

"#azright Today is truly a sad day for the GOP & AZ with all Dems + a small number of so called GOP legislators passing Medicaid expansion," Melvin tweeted.

The state froze Medicaid enrollment for childless adults in 2011, leaving an increasing number of people without health insurance.

Hospitals say their bad debts skyrocketed.

As the issue was debated in recent months, doctors on both sides held news conferences, hospital executives began speaking out, and Tucson Medical Center even hosted a "pep rally" for the expansion with Brewer in attendance.

"It's been a really hard-fought battle and we've been very supportive of the governor throughout the process," Tucson Medical Center chief executive officer Judy Rich said after the expansion passed the final Senate vote. "The hospital community has really struggled with the fact that we are leaving people without any form of payment for services. Patients don't like it any more than the providers."

Rich said the expansion is a great "first step" in getting coverage for approximately 300,000 low-income Arizonans who would have been left without health insurance in 2014 when most provisions of the federal health-care law take effect.

"There are people who have been either avoiding, foregoing or delaying needed care," Katzenberg said.

"Even though it's a good day, it carries with it a big responsibility for stepping up in the future, particularly in the area of primary care. "

Dr. Charles Katzenberg, Tucson cardiologist and president of the Pima County Medical Society

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 573-4134.