PHOENIX - Republican Gov. Jan Brewer is working to spin her hard-fought victory over legislative conservatives who opposed her Medicaid expansion plan. She insists it isn't "Obamacare."
In an interview after pushing an expansion of Arizona's Medicaid program through the Legislature, and in news releases sent from her office, Brewer made the distinction that growing the state's health care program for the poor isn't the same as embracing President Barack Obama's health care overhaul law.
"This business that this is Obamacare is a little bit interesting," she told reporters after the Legislature approved the expansion Thursday. "It is a very, very, very tiny portion of the Obama health care."
However, expanding Medicaid coverage is a key part of the Affordable Care Act, and it will have a big impact on millions of people.
Nearly half of the 30 million Americans who are uninsured are expected to gain coverage through Medicaid because of the federal overhaul. Under Thursday's approval, Arizona will add more than 300,000 people to the 1.3 million now on the state's plan, called the Arizona Health Care Cost Containment System.
About half the Arizonans getting new insurance are childless adults living in poverty. They were previously covered by the plan under an optional expansion voters approved more than a decade ago, but about 150,000 lost coverage in the past two years after the state froze the program to save money during the recession.
Now, Brewer will restore those people and add tens of thousands more -- people making between 100 percent and 138 percent of the federal poverty level.
Brewer was an early critic of the Affordable Care Act and among a group of governors who lost the Supreme Court case that fought it, so it was a surprise when she announced she supported Medicaid expansion. She noted that rejecting an expansion would mean Arizona taxpayers would subsidize care for those in other states while receiving no benefits themselves.
"I never liked Obama health care, I think you all know that," she said earlier this year. "I've led the charge from Arizona to oppose it -- sued, we lost, they won, it's the law of the land."
A.J. LaFaro, chairman of the Maricopa County Republican Committee and a fierce critic of Brewer's expansion plan, said the governor's efforts to distance herself from Obama's law are infuriating.
"Medicaid expansion is the cornerstone of Obamacare," LaFaro said. "Now the governor has said all along that Obamacare is the law of the land. Well that might be true, but the Supreme Court ruled that Medicaid expansion was an option and that states did not have to join in on the Medicaid.
"And the other part that's really upset me is the governor and her representatives have said this is just restoration," he said. "And it's not just restoration, it's a two-part thing."
Brewer, 68, is in her second and last term as governor and leaves office at the end of 2014. She hasn't said if she intends to seek another office or retire from politics, so it isn't known if she's trying to restore her conservative credentials with the spin or keep the door open for another opportunity.
"I firmly believe the governor is feathering her nest for when she's leaving the governor office," LaFaro said. "And she's lining her nest with 24 karat gold."
Many Republican governors did reject Medicaid expansion.
In all, 15 states have turned it down, while 23 states plus Washington, D.C., are moving to increase their Medicaid rolls. Another 12 states are still weighing options.
Nearly all the states refusing are led by Republicans. Several of the states accepting have Republican governors, but most are led by Democrats.
Washington will pick up the entire cost of the expansion for the first three years, then 90 percent over the longer haul. It's estimated that less than $100 billion in state spending could trigger nearly $1 trillion in federal dollars over a decade.
Arizona will have some costs other states don't because of its optional expansion. Those will be paid by hospitals under part of the new Arizona law that levies an assessment expected to bring in about $250 million a year.
The expansion is expected to help reduce the amount of uncompensated care hospitals must pay for and help cut what Brewer has called a hidden health care tax that people with insurance pay, through higher premiums, to cover others' care. She also framed the debate by saying it would save lives by bringing health care to people who urgently need it, a nod to her anti-abortion views.
Arizona lawmakers, led by conservative Republicans who revolted at the Medicaid expansion proposal, dug in their heels and refused to move the required legislation. Finally, minority Democrats teamed with a handful of Republicans to move it out of the Senate last month, but the speaker of the House delayed taking it up for weeks.
Brewer flexed her executive muscle Tuesday, ordering the Legislature into special session to take up a budget plan and Medicaid expansion, and a bipartisan coalition in the House and Senate approve the plan Thursday.