PHOENIX - Saying they are being crushed by the cost of patients unable to pay, hospital executives rallied this week to back a plan by Gov. Jan Brewer to expand the state's Medicaid program.

"We've seen our uncompensated care close to triple in the last 18 months," said Judy Rich, president and CEO of Tucson Medical Center. "And other hospitals across the state have also struggled under the weight of the dramatic increases of bad debt and charity care."

The governor's plan would impose a tax on hospitals to raise $220 million a year. That would pay the costs for the state to expand eligibility for the Arizona Health Care Cost Containment System, or AHCCCS, the state's Medicaid program, to 138 percent of the federal poverty level from its current 100 percent.

That, according to the governor, would add about 240,000 to the AHCCCS rolls, paid for largely with up to $1.6 billion a year the state would get from the federal Affordable Care Act.

Brewer acknowledged that details of the hospital tax plan, first announced Monday in her State of the State address, are still being worked out. Even as those details are being worked out, though, the governor is rallying hospital executives and business and economic-development officials to build support for the plan, which drew a decidedly cool reception from Republican lawmakers.

The governor said she believes GOP legislators will come around once they understand the impact on Arizona of refusing to become part of what has been called "Obamacare."

"They can do the math; it's pretty simple," she said: more uncompensated care, which, she said, is passed on to businesses and consumers as a $2,000-a-year "hidden tax" on families, or taking the federal dollars to relieve the hospitals.

That shift is part of what's behind the backing for the plan from business groups.

Julie Engel, president and CEO of Greater Yuma Economic Development, said less uncompensated care at hospitals should translate to lower costs for companies that provide health insurance for their workers. And that, she said, will have ripple effects.

Todd Sanders, CEO of the Greater Phoenix Chamber of Commerce, said the problems of unpaid bills are not simply those of the affected hospitals.

"The reality is when some people receive free care, these costs don't disappear," he said, but are passed on to someone else.

But Tom Jenney, the state director of Americans for Prosperity, disputed savings to business, saying uncompensated care results in "negligible cost shifting" to those who purchase health insurance.

Jenney acknowledged his organization, founded with money from brothers David and Robert Koch, who bankroll conservative causes, opposes the federal Medicaid program entirely and, in fact, all government-run health programs.

Brewer said her support for Medicaid expansion doesn't signal a change in her opposition to the Affordable Care Act, but an acknowledgement that "it's the law of the land" and it's not going away.

"Our decision is whether we will take the action that most benefits Arizona's families and businesses," she said.

"We've seen our uncompensated care close to triple in the last 18 months."

Judy Rich,

president and CEO of Tucson Medical Center