Brewer faces political struggle to expand Medicaid

By Robert Robb
The Republic |

From the political note­book: A lot of attention has been paid to the substance of Gov. Jan Brewer’s Medicaid­expansion proposal. Less atten­tion has been paid to a political and legal question that may be more important in determining its fate: How many Republican votes does it need in the Legis­lature to be enacted?

The assumption is that all the Democrats in the Legisla­ture will vote for it. They may be tempted to attempt to bar­gain for something else in exchange for their support. If they are serious about the priority they claim to put on the expansion, they will forgo that temptation.

Republican votes for expan­sion will be tricky to come by. If Brewer has to sell not only the expansion but what Demo­crats want in exchange for their votes in favor, it might become a bridge too far.

So, assume Democrats play it straight and Brewer can pocket their votes. If the ex­pansion only needs a simple majority to be enacted, that would require just three Re­publican votes in the Senate and seven in the House. Not much of a hill.

But Brewer’s Medicaid­expansion proposal arguably needs more than a simple ma­jority. Brewer is asking the Legislature to give the state agency that administers Medi­caid authority to levy a provid­er assessment to pay the state’s cost of providing Medi­caid coverage for childless adults.

In 1992, voters approved an initiative that requires a two­thirds approval from both houses of the Legislature for any “net increase in state reve­nues.” It explicitly includes “the imposition of any new state fee or assessment or the authorization of any new ad­ministratively set fee.”

That would certainly seem to cover what the governor is proposing. The Governor’s Office, however, is arguing that the assessment falls with­in an exception to the rule for “fees and assessments that are authorized by statute but are not prescribed by formula, amount or limit, and are set by a state officer or agency.”

That’s a stretch. While there might not be an amount set in the authorization to the penny, there’s a clear understanding about its size. The number is in the governor’s budget and proposal. Claiming that excep­tion would be a dubious wink and a nod at a voter-approved constitutional requirement.

If the two-thirds approval applies, that raises the number of Republican votes Brewer needs to seven in the Senate and 16 in the House. The hill just became steeper.

There is an informal rule in both the Senate and the House that leadership will not bring any bill to the floor that doesn’t have the support of a majority of the majority. That would require nine Republican votes in favor in the Senate and 18 in the House. Even steeper.

Put another way, if “the majority of the majority” requirement prevails, just nine of 30 senators or 19 of 60 House members could block the expansion.

The governor might be able to bargain for an agreement from leadership to bring Medicaid expansion to a vote without “the majority of the majority” requirement as part of a broader deal. But it would require pretty bruising negotiations. Permitting a vote on a Medicaid expansion opposed by a majority of his caucus would be particularly difficult for Senate President Andy Biggs.

My bet is that sequestration at the federal level occurs. Those are the budget cuts Congress adopted on a standby basis if the so-called supercommittee didn’t come up with an alternative way to cut the deficit. They were designed to be so unpalatable that the supercommittee couldn’t fail. It did anyway, and Congress and President Barack Obama are no closer today than then to agreeing on an alternative.

Republicans don’t like the sequestration cuts because they fall disproportionately on defense. The House has passed an alternative that puts more of the burden on domestic spending.

Democrats aren’t willing to come up with alternative cuts. They insist on more revenue and fewer cuts overall. It’s becoming increasingly obvious to Republicans that the choice isn’t between sequestration cuts and some alternative set of spending reductions. The real choice is between sequestration cuts and no cuts.

Despite deep misgivings about the effect on defense, I think Republicans will opt for the sequestration cuts rather than no cuts. At this point, deficit hawks in the Republican Party are stronger than the defense hawks.

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