Arizona has change of heart on Medicaid expansion

Jan Brewer's finger is wagging no more.

In what is the first significant healthcare reform-related story of 2013, Brewer said in her State of the State address that Arizona will participate in the expansion of the Medicaid program as part of the Patient Protection and Affordable Care Act. That means about 300,000 low-income Arizonans--nearly 5 percent of the state's population--will have insurance coverage come next year.

This is a remarkable story for a variety reasons. There has been a hard red line of Republican governors who have steadfastly said they wouldn't participate in Medicaid expansion under ACA. Even though the feds would foot the expansion bill for years after the implementation, they professed being scared they would not only be wasting money but also advancing the scourge of socialized medicine.

That stance has softened a bit since the November elections, but only the governors of Nevada and New Mexico have said they would open up their Medicaid rolls. That makes perfect sense, since Nevada's Brian Sandoval and New Mexico's Susana Martinez govern in states with a plurality of Democrats and huge Latino populations. Taking any other path would put them at risk of alienating the large number of voters in their states who have historically been underinsured.

But of the remaining hard red line, Arizona could be said to be the most brittle. It was the very last state in the union to participate in the Medicaid program, not joining until 1978--more than a dozen years after the program was launched.

Brewer also made national headlines last year for wagging her finger at President Obama in a scolding manner on an airport tarmac in Phoenix, onlyweeks after first excoriating him in a book she published in late 2011.

Arizona voters put not only Brewer into office but my favorite elected official in the country, Maricopa County Sheriff Joe Arpaio. His tenure has been jam-packed with chain gangs for jail prisoners, arrests of overtly snoopy journalists, racketeering lawsuits against other elected officials, posses that have raided entire neighborhoods, and most recently, accusing Obama of forging his birth certificate. Voters have returned him to office three times.

Indeed, Brewer had to put a decidedly pro-Republican spin on her decision for political cover. She noted he expansion would add jobs to Arizona's economy, and that forgoing the additional funds means they would go to other states.

She also said that she would install a "circuit breaker" to ensure Medicaid enrollment would automatically shrink should funding from the federal government decrease.

"I will not allow Obamacare to become a bait and switch," she said.

Remarkably though, Brewer conceded that not all of the ACA was the bane of mankind.

"We cannot wag our finger at the federal government," she said. "Trust me, I tried that once."

Now if Brewer could only take her finger and gesture in a come-hither way to the 10 other states that are still sitting on the sidelines; it would be an enormous victory for the finances of the nation's hospitals. - Ron (@FierceHealth)

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