The Medicaid expansion plan approved by the Senate late Thursday is pretty much dead on arrival at across the courtyard, House Speaker Andy Tobin said Friday.
"I do not believe the Senate plan, as passed, is going to be voted out,'' said Tobin, who has his own alternative. He contends that, unlike the Senate, not enough Republicans are willing to go counter to the wishes of the GOP majority -- and, more to the point, the speaker himself -- to align with the Democrats to provide the necessary votes.
That, however, remains to be seen.
Senate Majority Leader John McComish, who put together the coalition of Republicans and Democrats that pushed the bill through his chamber, said the ideal situation would be if Tobin allows a vote on that plan. McComish said, though, he and the other four Republicans who went against the wishes of the Senate GOP majority would not have done so -- and exposed themselves to political risk -- if they thought the plan would wind up in the House trash bin.
"I believe that it's not a secret that there's a coalition (in the House) that has enough numbers to vote that out,'' McComish said, just as they did in the Senate.
That also the assessment of Matthew Benson, press aide to Gov. Jan Brewer. He notes that if all 24 Democrats remain in support, it would take just seven of the 36 Republicans to break ranks and, in effect, roll over Tobin and the rest of the GOP caucus
Benson said Brewer does not want it to come to that.
"She going to continue to work with the speaker of the House to address his concerns and those of his members,'' Benson said.
That's also the preference of Rep. Kate Brophy McGee, a Phoenix Republican who supports the governor's Medicaid expansion program and said she'd like a chance to vote on the plan. She wants to work with the speaker and not around him.
"We need his leadership going forward,'' Brophy McGee said, "as opposed to rolling over him.''
And Rep. Heather Carter, R-Cave Creek, who is carrying the governor's measure in the House, said the dynamics in the House are different than the Senate where President Andy Biggs essentially drew a line in the sand and said he would do everything in his power to block any Medicaid expansion plan from coming to the floor for a vote. That, Carter said, took Biggs out of the equation and forced supporters to go around him.
That's not the case here, she said.
"The speaker has a plan of his own and I give him kudos for that,'' Carter said. She said Tobin should be given a chance to try to line up the votes for his plan.
Tobin's plan has some material differences from what Brewer wants and the Senate approved. While some are technical, one is major: a requirement for expansion to be approved at the ballot.
And Carter said if -- and when -- Tobin falls short, the votes are there to approve what Brewer wants without referring it to voters.
Brewer and Tobin want the same thing: tap into the federal Affordable Care Act to expand coverage to everyone up to an adjusted figure of 138 percent of the federal poverty level. The current state program, known as the Arizona Health Care Cost Containment System, includes most individuals below the federal poverty level, about $19,530 a year for a family of three.
Arizona would impose a tax on hospitals of about $240 million a year. But that would bring in about $1.6 billion in federal dollars, adding 300,000 or more to the current 1.3 million on AHCCCS rolls.
Tobin's plan has a few more bells and whistles. For example, he wants some method to ensure that the hospitals do not simply pass on their assessment costs to everyone else, including health insurance companies and patients without insurance.
But that key hang-up remains that public vote. Tobin said this is too important an issue not to have reviewed by the voters.
Potentially more significant, putting the issue on the ballot might prove more politically palatable to some Republicans than approving Medicaid expansion -- and that hospital levy -- themselves.
A public vote also circumvents a virtually certain lawsuit.
The Arizona Constitution spells out it takes a two-thirds vote of both the House and Senate for any new tax, tax hike or increase in state revenues.
Brewer, however, insists the assessment on hospitals is more akin to a fee which is not covered by the constitutional mandate. That's because the legislation would give the AHCCCS director the authority to not only to impose the levy but also determine the amount.
Tobin said he's no lawyer.
"But I think people should be weighing the risk'' of a lawsuit, he said. Senate President Andy Biggs, a foe of expansion -- and a believer the assessment is a tax -- said such a legal action is virtually certain if the plan passed by the Senate, without a two-thirds vote, becomes law.
"If, in fact, we're wrong and we leave (the legislative) session, then what happens?'' Tobin asked. "We come back on October or November? And then what?''
There is a risk of a public vote: It could turn into not a debate on how many people should get government-provided care but instead become a referendum of how Arizonans feel about President Obama and what they have dubbed Obamacare.
"I think Arizona voters are smarter than that,'' Tobin said. And he said he thinks he can convince voters that his plan is really a good deal.
"We get our taxes back that we sent to Washington,'' he said. And Tobin said Arizona can use those dollars, in effect, to pay down the state's debt.
"I think it's the way you sell the plan,'' Tobin said.