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Brewer proposes expanding Medicaid
PHOENIX – Parting ways with her own Republican Party, Gov. Jan Brewer on Monday proposed expanding Arizona's Medicaid program to take advantage of the federal Affordable Care Act.
In her fifth State of the State speech, Brewer detailed how she opposed what's been dubbed Obamacare, joining with other states in fighting it in court and refusing to have the state set up its own health insurance exchange. But she said the reality is that it's not going away: The Supreme Court upheld the law, Obama was re-elected and his Democratic Party controls the U.S. Senate.
So Brewer told fellow Republicans they should support her in agreeing to expand Medicaid with an eye on getting more federal dollars and saving hospitals from the financial burden of uncompensated care.
In her 36-minute speech, Brewer also:
• Asked lawmakers to fund 200 more caseworkers for Child Protective Services, including 50 immediately.
• Pushed to simplify the state's sales tax system which she said is overly complex for businesses.
• Promised to seek more police officers for schools to help prevent an incident like what happened in Connecticut, though she provided no dollar figures.
Brewer also vowed to seek more money for public education overall.
“Whatever your point of view, we should all agree that it's time we start funding the academic results we want to see,'' she said. But Brewer's plan has a twist.
Under current law, schools essentially are funded on a per-capita basis: Each student translates into a set amount of state aid. There are add-ons for special needs, like learning disabilities and limited English proficiency.
Brewer said she's not suggesting scrapping that. But she wants to provide additional dollars — and not on a per-student basis.
“What I am proposing is the nation's first comprehensive performance funding plan for our districts and charter schools. This plan will reward schools that earn high marks or see real improvement in performance.''
Brewer provided no details other than to say what she has in mind will augment existing funding “with an innovative approach to promoting school performance while maintaining local control.''
On the issue of Medicaid, the governor pointed out that Arizonans have voted twice to require the state to provide free care for everyone up to the federal poverty level. That is about $19,000 a year for a family of three.
The federal government picks up about two-thirds of the cost.
Under the Affordable Care Act, if Arizona boosts eligibility to 138 percent Washington would initially pick up virtually all of the extra cost, eventually scaling back to about 90 percent. Brewer told Republican colleagues who control the state House and Senate it makes no sense to pass up those dollars.
“We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured,'' the governor said. Brewer said joining the federal program will create enormous economic benefit, inject $2 billion into the Arizona economy, save and create thousands of jobs and provide health care to hundreds of thousands of low-income individuals.
The governor said going along will save money. She said the costs of providing care to the uninsured are not simply absorbed by hospitals but passed along.
“Health care premiums are raised year after year to account for expenses incurred by our hospitals. This amounts to a hidden tax estimated at nearly $2,000 per family per year.
Conversely, Brewer said it won't raise taxes in Arizona.
She said the state's share will be paid for by a “bed tax'' on hospitals. And Brewer said if Washington cuts funding, the state law would include a “circuit breaker'' to automatically roll back enrollment.
“I won't allow Obamacare to become a bait and switch.”
GOP lawmakers remain skeptical.
“There's a lot of questions that need to be answered,'' said Senate President Andy Biggs. He questioned how the state could ensure that local taxpayers don't end up on the financial hook.
Rep. John Kavanagh, R-Fountain Hills, who chairs the House Appropriations Committee, said he did not like the idea of that hospital bed tax.
“What you will have is a major shift of consumer money and hospital money from middle and upper-income class communities to poverty communities,'' he said, because Medicaid patients are all in hospitals in poverty areas while the tax will be collected on admissions in all hospitals statewide.
“Someone's paying for this,'' Kavanagh said. “It's not like it's coming out of nowhere.''
On the other side of the political aisle, House Minority Leader Chad Campbell was cheered by the governor's proposal. But he, like Biggs, was curious about exactly how a law could be written to have Arizona back out of Obamacare if federal dollars dry up.
Addressing lawmakers from her own party, Brewer told them they should not let their philosophical opposition deter them from going along.
“Saying ‘no' to this plan would not save these federal dollars from being spent or direct them to deficit reduction,'' she said. “No, Arizona's tax dollars would simply be passed to another state, generating jobs and providing health care for citizens in California, Colorado, Nevada, New Mexico or any other expansion state.''
What will cost more tax dollars is Brewer's call for 200 more caseworkers for Child Protective Services, on top of the approximately 1,075 caseworkers, supervisors and support staff.
“Arizona's abused and neglected children need help,'' the governor said.
On top of that, Brewer promised to seek additional cash to boost foster care, adoption services and emergency placement of children needing rescue.
“We cannot strike evil from the hearts of those who would harm an innocent child. But these commonsense steps will help at-risk children get the assistance they need before it's too late.''
The governor also held out an olive branch of sorts to the Obama administration with whom she has fought — and criticized — almost incessantly over the issue of illegal immigration: She promised to work for immigration reform.
But Brewer's cooperation is conditional on first having the border secured.
She said the record shows that can be done, citing the improvements made in the Yuma Sector – from the western edge of Pima County into the Imperial Sand Dunes of California — where illegal border crossings have been slowed to a trickle.
“The steep decline in illegal crossings is proof that our border can be secured when the federal government employs the right mix of fencing, manpower and technology,'' the governor said.
Brewer said she now wants the president to “finish the job'' by securing the Tucson Sector which covers the rest of Arizona's southern border. “Fulfill your promise to the American people, and I'll make good on mine,'' she said.
The governor also established a new Natural Resources Review Council to provide input on how to best use the state's resources located on federal land. That includes the national forests, where there has been criticism of federal logging policies that some have said has led to the devastating fires of the past few years.
Brewer last year vetoed legislation that would have required the state to demand the federal government turn over its holdings to the state. While describing herself in that veto message as a “staunch advocate'' for state sovereignty, “we still must be mindful and respectful of our federal system.''
The council she is forming is instead designed to provide input into what the federal government does with the lands.
And Brewer said she was issuing an executive order setting up a task force to fight human trafficking.
“This is truly a crime against humanity, a modern-day slavery in which men, women and children are sold into forced labor or prostitution,'' the governor said. She also credited Cindy McCain, wife of Sen. John McCain, with being “a leading voice'' on that issue.