PHOENIX -- Gov. Jan Brewer brought supporters Tuesday to the state Capitol to rally behind her plan to expand Medicaid to about 300,000 more Arizonans.
The move was meant to ramp up pressure on lawmakers to vote for the expansion that she fought tooth and nail up until last year's Supreme Court decision upholding the federal health care overhaul.
The rally of health care professionals is the latest effort by the Republican governor to sway lawmakers to back her plan. She held a series of press conferences with health care providers after announcing in January that she wanted to expand Medicaid.
But Brewer likely will have major problems getting her way, based on recent interviews with the top leaders in the Republican-controlled Arizona Senate and House.
House Speaker Andy Tobin and Senate President Andy Biggs said the governor's reliance on the hospital assessment, which she hopes to impose as a fee, is a tax that requires two-thirds votes in the Legislature to approve. That raises the bar substantially for passage.
To get Tobin's support, issues such as lawsuit reform and assurance that hospitals don't pass on the so-called "bed tax" costs to insurance companies will be on the table.
"I'm not on board with this the way it's written," Tobin said last week. "I've made that clear."
Biggs is even more adamant.
"I've been up front with the governor all along, I said, 'Look, I personally oppose it, I'm not going to go back on something I campaigned for,' " Biggs said Friday.
Brewer's plan would take advantage of $1.6 billion in new federal funding by assessing hospitals about $250 million a year to pay for the state's share of costs. She has lined up support from health care providers and the business community as well.
Surrounded by dozens of doctors and nurses at the rally in the shadow of the House of Representatives on Tuesday, Brewer touted the benefits of expanding Medicaid to those making up to 138 percent of the federal poverty line and restoring insurance to more than 100,000 childless adults who've lost coverage since the recession caused the state to scale back its program. She spoke of a "hidden health care tax" she estimated at $2,000 a year for families that all Arizonans pay in extra premiums to cover providers' uncompensated care.
Speaking to reporters after her speech, Brewer said "elections have consequences" and that she's implementing President Barack Obama's health care law in the way she believes is best for Arizona.
"It passed, it was upheld as unconstitutional and now we're faced with resolving the issues that Arizona needs to resolve in regards to all that," Brewer said. "I never liked the Affordable (Care) Act. But, we don't cut off our nose to spite our face."
When asked how she was going to win over members of her own party in the Legislature who are opposed to the expansion, Brewer said she hopes they look at the numbers and see them as she does.
"They haven't exactly told me that, that they're against it," Brewer said. "I feel as we move through the process we have a lot of educating to do, I'm hopeful that they will listen to their constituents, because indeed it is the right thing to do."
If the assessment is considered a tax, the two-thirds vote required by 1998's Proposition 108 could be insurmountable.
"If it's a 108, I think it would be pulled, it would never pass," Rep. John Kavanagh, head of the House Appropriations Committee, said Monday. "It's shaky it can pass with a majority."
Like Biggs, Kavanagh is opposed to any expansion. He said he was pleased to hear Tobin's suggestions for making an expansion more palatable, but that the federal government can't afford the added burden of nationwide expansion. The federal government would pay for most of the expansion.
"Seventeen billion in national debt and climbing, and this Medicaid expansion and Obamacare keep fueling the national debt, and I don't believe in making my grandchildren pay my bills," he said, referring to the federal Affordable Care Act.
The governor's proposal included some revenue in her budget from the hospital tax, so that part will likely be included in the state budget currently being negotiated. But some lawmakers believe any expansion of Medicaid, called the Arizona Health Care cost Containment System, or AHCCCS, would be done in a separate bill.
The Legislature has raised revenue repeatedly in recent years by allowing agencies to raise fees, but never on the scale envisioned by Brewer this year. In the budget year of 2015-2016, her budget expects $256 million in revenue from the bed tax.
To pass with 50 percent, the expansion requires 31 votes in the House and 16 in the Senate. If it's considered a tax, it will require 41 votes in the House and 21 in the Senate.
Halfway into the legislative session, there's still no clear picture of legislation allowing the expansion. Kavanagh thinks the proposal is losing ground among members.
"I think the momentum is in the opposite direction, and Republican district committees are voting against it," he said. "I see momentum shifting against it, not for it."