Jan Brewer has never hidden her contempt for the President or his policies, but she seems to know a good deal (and a done deal) when she sees one. On Monday, Arizona’s Republican governor announced she would stop fighting Obamacare and actively embrace one of its key provisions: an expansion of Medicaid to cover citizens earning up to 133% of the federal poverty level ($26,344 for family of three last year).
The Affordable Care Act (ACA) gives states a strong incentive to expand their Medicaid programs. The federal government has promised to pick up all of the cost from 2014 to 2016, gradually raising the states’ contribution to 10% in 2020. By opting into the program, the states could provide basic coverage to 17 million of the 49 million Americans who now lack any health insurance.
Projections suggest the expansion could benefit both the states and the federal treasury money in the long run, by reducing the number of people receiving uncompensated care in hospital emergency rooms. Even so, more than a dozen governors, including a block that stretches from Texas to South Carolina, have vowed to decline the offer—“a brazen intrusion into the sovereignty of our state,” in Texas Gov. Rick Perry’s memorable phrase.
Arizona took part in a failed 2012 lawsuit to overturn Obamacare and later proposed a watered-down Medicaid expansion, which the federal government rejected. Now, in light of the legal rulings and the President’s re-election, Brewer says she’s ready to deal. In her annual state of the state address, she conceded that refusing federal assistance would neither help her constituents nor reduce the federal deficit. Having wagged her finger in the President’s face when he visited her state last year, she now says, “Trust me: I tried that once.” To secure the feds’ promised funding assistance, Brewer says she’ll propose a “circuit breaker” provision to roll back Arizona’s Medicaid program if the federal contribution declines in the future.
Now the question is whether other intransigent states will follow her lead. For all its ferocity, the effort to kill health care reform has yet to achieve much—the House has passed more than two dozen fruitless efforts to repeal it—and tough-talking governors are meeting resistance from their own constituents. If Jan Brewer can swallow her pique, maybe Rick Perry and Florida’s Rick Scott can too.
Geoffrey Cowley