The Republic | azcentral.com Tue Apr 30, 2013 11:25 PM
Democrats are growing frustrated over Gov. Jan Brewer’s struggle to get her Medicaid-expansion proposal into the Legislature and say efforts to appease reluctant Republican lawmakers with anti-abortion legislation threaten their support.
The governor’s team is working to craft abortion legislation under pressure from one of the state’s most powerful lobbying groups, which holds sway over GOP votes that Brewer desperately needs.
The abortion issue has added more uncertainty to sputtering negotiations over Medicaid expansion — Brewer’s top legislative priority — as talk about putting the question of expansion to Arizona voters has ramped up.
Democrats form the base of support for Brewer’s plan to expand health-care eligibility for Arizona’s poor and disabled under the state-federal program.
But House Minority Leader Chad Campbell, D-Phoenix, said their support is not guaranteed if expansion is weighed down with other policy issues.
Brewer’s office is preparing language, to be amended onto a separate bill, that would ensure no federal expansion funding goes to health-care providers that perform abortions.
The move is a response to lobbying from Cathi Herrod, president of the Center for Arizona Policy, who says Medicaid expansion would subsidize abortions — a claim that puts in a political vise anti-abortion GOP lawmakers who back the governor’s proposal.
“In response to some of the concerns raised by lawmakers, the governor has been willing to revisit this issue,” Brewer spokesman Matthew Benson said Tuesday. “It’s become clear that it would be difficult to move forward with Medicaid restoration until some of these legislative concerns about abortion are addressed.”
Brewer and other GOP governors who are backing expansion face stiff opposition from fellow Republicans, who see broadening Medicaid eligibility as an unsustainable, fiscally irresponsible endorsement of what they call “Obamacare.”
She has collected some GOP votes but needs support from every Democrat in the House and Senate to get expansion passed.
But although an abortion-related bill would be separate from Medicaid expansion, reaction from Democrats ranged from squeamish to furious. Some are angry that they weren’t consulted by Brewer’s office; others said their support depends on what ends up in the bill.
Campbell said the Governor’s Office didn’t warn him about the abortion measure, which rumors said would be added to a health-care bill in a conference committee Tuesday.
The committee never discussed the bill, however.
Campbell questioned whether Brewer and her supporters, which include the Arizona Chamber of Commerce and the health-care industry, have ever had a strategy to get expansion through the Legislature.
“It’s very hard for us to trust the Governor’s Office, at this point,” Campbell said. “She never had a plan for this. And now, to try to pander to Cathi Herrod, she’s jeopardizing Democratic support.”
Brewer and legislative leaders have said they oppose punting the Medicaid issue to a special-election ballot. But as the session drags on without an expansion agreement or a fiscal 2014 state budget deal, some lawmakers are saying they don’t see another way out.
“The way this will turn out all right, I think unfortunately, is if it’s a referral (to the ballot),” Campbell said. “I don’t see a pathway to (legislative) victory for this.”
Herrod first raised the abortion issue in late March in a letter to Brewer, using an opinion from a Christian legal-defense organization to argue that the draft Medicaid legislation should be amended to disqualify the non-profit women’s health provider Planned Parenthood and other abortion providers from receiving public money.
Brewer last year signed legislation to defund abortion providers, but Planned Parenthood and the ACLU filed suit and, in February, a federal judge put House Bill 2800 on hold.
In hopes of avoiding another legal challenge, Herrod has suggested language that would apply only to expansion funds, prohibiting those dollars from being used to “perform, assist or encourage abortion or to directly or indirectly subsidize abortions services or administrative expenses relating to abortions or to refer for abortions.”
It’s unclear whether such a bill would have much practical impact. Federal and state laws prohibit public funding for abortions except in cases of rape, incest or when the mother’s life is at risk.
And Medicaid expansion would not affect pregnant women, who are covered under a separate category within the Arizona Health Care Cost Containment System, the state’s Medicaid program.
But political observers say there could be a larger political risk in not placating Herrod, whose conservative, Christian-based group wields significant influence with GOP lawmakers.
The question becomes whether Democrats will be willing to vote against an abortion bill, in whatever form it takes, and still vote for expansion.
Rep. Eric Meyer, D-Paradise Valley, an emergency-room physician, said that, depending on how it’s written, the measure could jeopardize federal Medicaid funding for a hospital or any other health-care provider that performs an emergency abortion to save a woman’s life.
“You’re making a deal with the devil,” he said. “You put hospitals and providers in this position of making a choice between providing appropriate medical care that’s guaranteed under the U.S. Constitution and taking Medicaid dollars.
“The reality is, this is directly tied to the (Medicaid) restoration. We’re supportive of the restoration, but we don’t want all these strings attached. And this is one of those strings.”
Meyer, Campbell and others said Brewer should have acted more quickly on her top legislative priority, calling legislators into a special session months ago and forcing a vote on Medicaid expansion.
They say that the governor has lost momentum on the issue since her surprise announcement in her January State of the State speech and that the additional time has given expansion opponents more opportunity to work on undecided GOP lawmakers, who fear a political backlash in the 2014 primary election.
“I certainly think the votes were there early on. Which is why I’m grateful that we’ve taken so long,” said Rep. Paul Boyer, R-Phoenix, an early expansion supporter who has since peeled off because of the abortion issue.
Boyer, however, said he’s still talking with Brewer’s staff about possible amendments that could bring him back onto the expansion side.
Brewer could have called a special session months ago, but she couldn’t have forced lawmakers to vote, Benson said.
Florida GOP Gov. Rick Scott tried a hurry-up strategy that backfired, with a legislative committee spiking the proposal before the session even started. Expansion prospects there are looking dimmer.
In Ohio, GOP Gov. John Kasich is fighting a similar battle against his own party.
Like Brewer, the governors opposed the rest of the federal health-care overhaul and sued to stop it.
Benson said the strategy all along has been to help educate lawmakers and the public about the complicated issue so they could feel comfortable supporting it. “Even after 100-plus days, there are still legislators who don’t understand all of the aspects of this issue,” Benson said. “To call them into special session in January or February and ask them for a vote would’ve been asking them to vote on faith.”
Rep. Heather Carter, R-Cave Creek, who’s leading the Medicaid-expansion push in the House, agreed that a go-slow approach is warranted given that billions of dollars and thousands of lives are at stake.
But she said that as the impasse continues to hold up a new state budget, that makes life uncertain for teachers, state workers and others who depend on it.
Schools, in particular, need to complete their spending plans and let staff know if they’ll have jobs next fall, she said.
“When we’re looking at the most important decision that Arizona has made since the original Medicaid (was approved), this takes time. And it should take time,” Carter said. “(But) the rest of the state needs to continue to function.”
Though Carter said she’s confident lawmakers will reach an agreement on Medicaid expansion, others see striking parallels with the 2009 battle over a temporary 1-cent-per-dollar sales-tax hike. Brewer vetoed parts of two legislative budgets before GOP leaders agreed to put the tax hike before voters in May 2010.
Jim Drake, assistant secretary of state, said he has fielded a couple of queries from legislators and staff about a possible Medicaid ballot measure.
His office needs about 90 days and roughly $8 million to prepare for and conduct a statewide special election. It would require separate legislation to set the date, appropriate the funds and make other changes to allow consolidated polling places and other streamlining.
If possible, he said, it should be held on one of four dates already set aside for municipal, county and school issues.
It could piggyback, for example, on Phoenix city elections scheduled for November.
But Senate President Andy Biggs, R-Gilbert, a staunch expansion opponent, has said he won’t allow the Senate to refer the issue to the ballot.
And Benson said the governor also opposes the idea.
“The governor believes that legislators were sent to the Capitol to make the tough decisions,” he said.
Reach the reporter at maryk.reinhart@arizonarepublic.com.
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