This won’t be the end of the Medicaid fight for Brewer. Brewer wins Medicaid expansion

Arizona Gov. Jan Brewer muscled her way to victory in her crusade for Medicaid expansion Thursday, outmaneuvering conservative opposition to push through a key piece of President Barack Obama’s agenda.

Over the objection of Republican legislative leaders, a coalition of moderate Republicans and Democrats sent Brewer a bill on Thursday, extending Medicaid to an estimated 300,000 low-income uninsured Arizonans, transforming the state into the unlikeliest of Obamacare allies at a critical time for the White House.


The vote is the end of a chapter, though not the book, on Obamacare in Republican-led Arizona, where Brewer defied — and sometimes confounded — her base. She not only supported the Medicaid expansion but took extraordinary measures to push for its passage. Other GOP governors who backed Medicaid were not nearly so emphatic in fighting against balky legislatures.

( PHOTOS: The eight GOP governors who said yes to Medicaid expansion)

Brewer, however, spoke loudly and carried a big stick — crisscrossing the state to promote expansion and shame detractors. This month, she started vetoing a stream of unrelated bills to pry her top priority loose from Republicans, and she brought them back into special session.

Very early Thursday morning, the House approved Medicaid expansion. By late afternoon, the Senate had too.

“As an elected official of more than 30 years, I know that this process was not easy or without political risk,” Brewer said in a statement. “By joining me in extending health coverage to hundreds of thousands of Arizonans, legislators of my own party have come under sharp criticism in some quarters. Some have had threats made not just against their political future but also their personal livelihood.”

Brewer, whose finger-wagging moment on the tarmac with Obama almost 18 months ago for a time came to represent conservative opposition to the president, sold the expansion plan as a sensible option for conservatives in Arizona. She said it’s good for people, health care providers and the state’s bottom line because the federal government pays the whole cost the first three years, then gradually cuts back to 90 percent.

National advocates of the president’s health care law embraced her stance.

“As chief executive of Arizona, Gov. Brewer understands the importance of the Medicaid expansion for residents in her state, and she has stood firm in her call for its legislative approval,” said Ron Pollack, head of Families USA. “Brewer’s foresight and fortitude stand in marked contrast to the actions of some other Republican governors, who may well understand the value of the Medicaid expansion to the health and well-being of their states but who succumb to rigid ideology and anti-Obama partisanship.”

The right wing of her party remains opposed. And some are predicting that Republicans who joined Brewer in bucking the party base will suffer for it in their next campaign.

“Anybody aligned with this effort is going to be pounded in the primary,” said Frank Antenori, a former state lawmaker who’s spearheading an effort to undo Medicaid expansion through a voter referendum in 2014. “She’s probably cost at least a half a dozen, maybe more senators and representatives their political futures to get this done.”

But Brewer often pointed out that voters in Arizona have twice before supported ballot initiatives expanding the state’s Medicaid program. She also drew the backing of an unusual mix of allies: the Chambers of Commerce, hospitals, religious organizations, labor unions, public health advocates and doctors.

One of the first Republican governors to embrace the expansion, Brewer’s surprise announcement in January was soon followed by other conservative champions like Govs. Rick Scott in Florida and John Kasich in Ohio. But those two both notably failed to win over like-minded lawmakers.

No other governor, Democratic or Republican, put as much on the line to win support for Medicaid expansion. In Michigan, Gov. Rick Snyder now appears close to succeeding in his effort to persuade GOP lawmakers to support expansion but without a public schism or hardball tactics.

Gov. Jack Dalrymple, the Republican governor of North Dakota, also won his bid to pass expansion through a conservative Legislature, but with little acrimony. It’s also been smooth sailing for GOP governors supporting expansion in Democrat legislatures, like Govs. Chris Christie in New Jersey and Susana Martinez in New Mexico.