Tobin: Senate's Medicaid plan is dead in House

Says Senate's version won't gather enough Republican votes
2013-05-18T00:00:00Z Tobin: Senate's Medicaid plan is dead in HouseHoward Fischer Capitol Media Services Arizona Daily Star

PHOENIX - The Medicaid expansion plan approved by the Senate late Thursday is pretty much dead on arrival across the courtyard, House Speaker Andy Tobin said Friday.

"I do not believe the Senate plan, as passed, is going to be voted out," said Tobin, who has his own alternative. He believes that, unlike the Senate, not enough House Republicans are willing to buck the wishes of the GOP majority and leadership, to align with the Democrats and provide the necessary votes.

Senate Majority Leader John McComish, who put together the coalition of Republicans and Democrats that pushed the bill through his chamber, said the ideal situation would be if Tobin allows a vote on that plan.

McComish said he and the other four Republicans who went against the wishes of the Senate GOP majority would not have done so, and exposed themselves to political risk, if they thought the plan would wind up in the House trash bin.

"I believe that it's not a secret that there's a coalition (in the House) that has enough numbers to vote that out," McComish said, just as they did in the Senate.

Matthew Benson, press aide to Gov. Jan Brewer, notes that if all 24 Democrats remain in support, it would take just seven of the 36 Republicans to break ranks to approve the measure.

Benson said Brewer does not want it to come to that.

"She's going to continue to work with the speaker of the House to address his concerns and those of his members," Benson said.

That's also the preference of Rep. Kate Brophy McGee, a Phoenix Republican who supports the governor's Medicaid expansion program and said she'd like a chance to vote on it. She wants to work with the speaker, not around him.

Rep. Heather Carter, R-Cave Creek, who is carrying the governor's measure in the House, said the dynamics in the House are different from the Senate, where President Andy Biggs essentially drew a line in the sand and said he would do everything in his power to block any Medicaid expansion plan from coming to the floor for a vote, which Carter said forced expansion supporters to go around him.

That's not the case here, she said.

"The speaker has a plan of his own and I give him kudos for that," Carter said. She said Tobin should be given a chance to try to line up the votes for his plan.

The biggest difference between Tobin's plan and the Brewer plan passed by the Senate is a requirement for expansion to be approved at the ballot.

Carter said if Tobin falls short, the votes are there to approve what Brewer wants without referring it to voters.

Brewer and Tobin want the same thing: Tap into the federal Affordable Care Act to expand coverage to everyone up to an adjusted figure of 138 percent of the federal poverty level. The current state program, known as the Arizona Health Care Cost Containment System, includes most individuals below the federal poverty level, about $19,530 a year for a family of three.

Arizona would impose a tax on hospitals of about $240 million a year to cover the state share. But that would bring in about $1.6 billion in federal dollars, adding 300,000 or more to the current 1.3 million on AHCCCS rolls.

Putting the issue on the ballot might prove more politically palatable to some Republicans than approving Medicaid expansion and the hospital levy themselves.

A public vote also circumvents a virtually certain lawsuit over whether the hospital assessment is a tax. The Arizona Constitution requires a two-thirds vote of both the House and Senate for any new tax, tax hike or increase in state revenues.

Brewer contends the levy on hospitals, which would be set by the AHCCCS director, is a fee, not a tax.

Tobin said he's no lawyer.

Biggs, a foe of expansion, said trying to get around the constitution by calling the tax a fee will almost certainly result in a lawsuit.

Tobin said he isn't positive how a judge would rule on the tax question. But it would be prohibitively risky to adopt something that is overturned in court after the Legislature adjourns.

But putting the issue to a public vote is also risky because it could turn into a referendum on the Obama health plan, rather than a debate over what to do about Medicaid.

"I think Arizona voters are smarter than that," Tobin said. And he said he thinks he can convince voters that his plan is really a good deal.

"We get our taxes back that we sent to Washington," he said. And Tobin said Arizona can use those dollars, in effect, to pay down the state's debt.

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