House approves Medicaid expansion, $8.8 billion budget

By Mary K. Reinhart, Yvonne Wingett Sanchez, Alia Beard Rau and Mary Jo PitzlThe Republic | azcentral.comThu Jun 13, 2013 10:15 AM
Five months after Gov. Jan Brewer vowed to expand Medicaid, a bipartisan Arizona House coalition voted early today to approve her high-stakes proposal, along with a budget that gives significant new funding to education and child welfare.
The mostly 33-27 votes followed nine hours of debate and vitriolic speeches by conservative Republicans, who lashed out at fellow GOP members and Brewer for teaming with Democrats to steamroll them to approve a key piece of the federal health-care overhaul and the governor's top legislative priority.
And the vote on House Bill 2010, the health-related budget bill, moves Arizona one step closer to becoming the 21st state to expand Medicaid.
House Speaker Andy Tobin, R-Paulden, and the rest of House leadership joined conservatives to oppose the 2014 budget, offer more than 50 amendments and hours of speeches in an effort to kill Medicaid expansion and wear down what has become a rock solid 33-member bipartisan group.
The voting, which wrapped up about 3:40 a.m. in a special session called by Brewer late Tuesday, sends the bills to the Senate, which plans to vote on them this morning. A bipartisan Senate coalition pushed through identical bills Wednesday evening, in less than half the time.
Legislators were expected to adjourn the special session today, and perhaps the regular session as well.
Conservative GOP members, stripped of control in a special session abruptly called without their consent or even their knowledge, offered hours of blistering floor speeches. That could make it a challenge to come back together and sweep up the final bills of the regular session.
“I feel like I’ve been punched in the gut,” said Rep. Debbie Lesko, R-Peoria. “And I feel like I’ve been betrayed.”
Among the measures that could fall by the wayside is another top Brewer priority — simplifying the state’s system for collecting sales tax. Lawmakers, cities, the governor's staff and other stakeholders have been working for months to cut through the clutter of the current process, but the effort quickly bogged down with objections from many local governments.
Republicans also wanted a slew of changes to election law that included dropping names from the permanent early voting list, limiting who can return ballots on behalf of a voter and tightening procedures for citizen initiatives and referendums.
During hours of debate Wednesday on 10 identical budget bills, frustrated conservatives railed against their GOP governor and colleagues, saying they were ashamed to be Arizona legislators and branding the power play by Brewer, 14 Republicans and the Democrats the darkest day in state politics.
“I have never once ever been ashamed of what we’ve done in this body. I’ve disagreed, but I’ve never been ashamed,” said Rep. Eddie Farnsworth, R-Gilbert. “But I can tell you this process, from the governor on down, is an embarrassment ... This is not policy making, this is dictating.”
But stoic coalition members stuck together through hours of speeches Wednesday, rarely responding to Republicans’ demands for answers.
Shortly before 2 a.m., Rep. Debbie McCune Davis, D-Phoenix, offered the first full-throated defense of the proposal. She dedicated her vote to the late Msgr. Edward Ryle, a lobbyist for the Catholic Diocese who worked to establish the state’s Medicaid program.
“We have proven over the last 20 years that the system works,” McCune Davis said. “There are incentives to reduce costs and to keep people healthy. The experience has been good for providers and patients, and that’s wlell documented ... I wonder if people really understand the system that we have in place in Arizona.”
Brewer, once one of the most ardent opponents of the Affordable Care Act, was among 28 states to sue over the the health-care overhaul. She changed her position partly in the wake of the re-election of Obama and a U.S. Supreme Court ruling that gave states the ability to opt-out of Medicaid expansion without penalty.
Late Wednesday, frustrated with months of delay, Brewer again pressured lawmakers to act.
“Majority,” the governor said in a statement. “That word has meaning in our republic. I trust that over the next 24 hours or so, a majority of the House and Senate will put an end to the games.”
If successful, Brewer becomes only the second Republican governor to push Medicaid expansion through a Republican-led legislature.
The Senate coalition took less than three hours to beat back 26 hostile amendments, giving preliminary approval to the $8.8 billion fiscal 2014 budget and expanding the health-insurance program to include an additional 350,000 low-income Arizonans under the federal health-care overhaul.
The House worked through the night, with conservatives blasting their GOP colleagues for teaming with Democrats, accusing them of betraying their party and state by expanding Medicaid and passing a budget they considered excessive.
The Medicaid amendments, all beaten back by the bipartisan coalition, included a repeal of the hospital assessment that helps fund the expansion, an anti-abortion provision, a requirement for a two-thirds majority approval and various proposals that would rollback expansion if federal funding falls short of what’s promised.
Conservatives, some now calling themselves the “minority party” though they outnumber Democrats, complained the process shut out the public and most members of the GOP, which hold majorities in both chambers. They said the bills were not fully vetted in committees and caucuses, and they were forced to make important policy decisions on more than 600 pages of amendments in a matter of hours.
To make matters worse, they said, the coalition members refused to answer questions from the conservatives.
“How are you not embarrassed for yourselves?” said Rep. Javan Mesnard, R-Chandler. “Is anyone going to stand up and give a defense?”
But time after time, in both the House and Senate, no one did. The coalition mostly watched and waited while Republicans tried to bait, badger, cajole and guilt them into responding
Several members of the coalition noted that many of the budget provisions were issues that legislators had been working on for months. Some Republicans had voted for the same issues they rejected Wednesday night.
“A lot of the bills we’re voting are bills that we have been debating for the last six months,” said Rep. Heather Carter, R-Cave Creek, a leader of the bipartisan coalition that supports Brewer’s budget and Medicaid proposals.
Brewer rankled many in her party by calling aspecial session Tuesday evening, bypassing leaders in her own party who called the move disrespectful, reckless and “less than what was expected of her and more than should be tolerated.”
The governor’s move came after House Speaker Andy Tobin, R-Paulden, had adjourned the lower chamber until Thursday, stalling the efforts of the bipartisan House coalition to pass Brewer’s 2014 budget and Medicaid expansion. Tobin said he wanted to give members a day to cool off and review the many budget amendments being prepared for consideration.
Brewer went around him.
“I think it’s pretty bad for a Republican governor to call a special around majority leadership,” Tobin said earlier Wednesday. “We all recognize we have to govern, and clearly it’s late. But this is a huge decision on Medicaid and I believe that I was making sure that the process was going to move forward — both sides wanted their Medicaid fight.”
The coalition worked from a budget plan approved in May by a bipartisan coalition in the Senate, but the final product is expected to be $22 million leaner. The spending plan gives Brewer several key items she sought, including an additional $69 million for the state’s child-welfare system and $82 million for K-12 education.
But lawmakers chopped her request for a new school funding model, which would tie some dollars to school performance at a cost of $54.3 million in the first year. Lawmakers have said the program didn’t appear ready to launch on July 1, and instead included $2.4 million to get the program started.
To shore up the state’s beleaguered Child Protective Services, Brewer called for another $77 million for 150 additional caseworkers, services for foster children and their families, and funding for growing numbers of kids in crisis shelters, group homes and family foster homes. The latest budget falls about $8 million short of what the governor has requested for CPS.
The budget also includes various reforms to CPS procedures that had been contained in another bill, which is at risk of falling through the cracks of adjournment. New provisions will create a two-track system for investigating suspected child abuse and neglect, beef up a special investigations unit that handles the most severe child abuse cases, and allows certain professionals to make abuse reports online instead of through the child-abuse hotline.
On the education front, the spending plan contains the first significant increase in funding for schools in five years. The $82 million boost is equivalent to the 2-percent inflation funding the schools have not received for the past three years. While districts have welcomed the additional dollars, it won’t go very far in recouping money lost during the recession, when state support for schools dropped 18.9 percent.
Brewer had proposed about $107 million in new funding for schools, with much of it directed to helping schools prepare for the Common Core, a tougher set of academic standards that will entail more teacher training and increased classroom equipment, as students testing will use computers, not pencil and paper.
The proposed budget does include an additional $3.6 million for school safety, $14 million for School Facilities Board building renewal grants and $4.5 million for adult education.
There is also an additional $5 million for university performance pay and $8 million for the University of Arizona Health Sciences Center.
A key issue of contention has been funding for state School Superintendent John Huppenthal to upgrade the state’s aging school data system. The Senate gave him $24 million in its initial budget. But the budget approved Wednesday provides just $7 million to upgrade the data system, and it will be overseen by the Department of Administration, not the Department of Education.
The proposal also eliminates the 90-day waiting period for state workers to get health insurance, and allows the arts commission and state parks to split the interest earnings from the rainy-day fund.
The budget is expected to be structurally balanced, meaning ongoing spending will match tax collections, by the end of the 2016 fiscal year.
Lawmakers opted to not put any money in the state’s rainy-day fund, leaving it intact at $450 million.
The budget also included some elements of a budget proposed earlier in the session by Tobin, including $2 million for rural community colleges, $1.8 million to the Department of Health Services to house sexually violent individuals and $250,000 for mental health first aid.
It also adds $150,000 to the Prescott Historical Society, which is in the districts of Tobin and Sen. Steve Pierce, who is among the contingent of Senate Republicans who joined in support of Medicaid expansion.
Carter said the bipartisan group that came together over Medicaid and education funding only became stronger as pressure mounted on Republicans to cave.
“We have a cohesive, incredible group that is focused on the priorities of Arizona, which No. 1, is presenting a balanced budget that is constitutionally required,” Carter said. “This year that includes a decision about what we do with our Medicaid population.”
The Senate coalition approved the budget and nine amendments with 16 or 17 votes, with Sen. Steve Yarbrough, R-Chandler, moving between the two sides on various issues.
Sen. Steve Pierce, R-Prescott, introduced all the amendments and refused to answer most questions about them. Democrats also refused to answer questions, leaving Republicans in some instances to ask and answer their own questions.
“It’s tragic we can’t have an open debate and discussion on these issues,” Biggs said, adding that he had little time to read the budget bills and dozens of amendments.
Biggs did have time to introduce 17 of his own amendments. All failed.
Senate Minority Leader Leah Landrum Taylor, D-Phoenix, said the amendments that did pass were a compromise between the governor and the legislative coalition. She denied, as some critics said, that this was a “Democratic” budget.
“We feel it’s truly the people’s budget,” she said.

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