Still far short of the votes she needs, Gov. Jan Brewer finally gave lawmakers a peek Tuesday at details of her plan to expand the state's Medicaid program in a bid to whip up support.
The legislation contains the basics of what she proposed in January in her surprise announcement during her State of the State speech: Boost eligibility for the free care to what amounts to 138 percent of the federal poverty level -- about $26,000 a year for a family of three -- up from 100 percent for most.
It would cost the state about $240 million the first year. But that would be paid through what amounts to a tax on hospitals.
The trade-off is that Washington will provide $1.6 billion in federal dollars, and about 300,000 people will be added to the Arizona Health Care Cost Containment System, the state's Medicaid program, which already has about 1.2 million Arizonans enrolled.
But Brewer has so far been unable to convince a majority of the legislators from her own Republican Party to go along.
Democrats are generally supportive. But they make up just 13 of the 30 Senate seats and 24 of 60 in the House.
And while Brewer might be able to cobble together a few Republican votes, House Speaker Andy Tobin said it is unlikely he would allow a measure to be brought to the floor without a majority of his GOP caucus in support.
At this point the governor is relying on turning votes her way, one by one, both by personal persuasion and building support among the constituents of recalcitrant lawmakers.
"I'm going to work as hard as I know how,'' Brewer said Tuesday following a rally on the Capitol lawn.
"I believe that by educating and talking to people and sitting down, spreading what this all means to the state of Arizona could very well change their minds also,'' she continued. "So we're just going to keep working away.''
But Tobin pronounced the draft that Brewer provided lawmakers on Monday dead on arrival. That apparently left Brewer confounded.
"What does Speaker Tobin want?'' she asked.
What Tobin wants, he told Capitol Media Services, is an assurance that hospital bills will stop going up if Medicaid is expanded.
He noted that proponents contend there is a "hidden health care tax'' of about $2,000 per Arizonan. That is what hospitals increase their bills to those who can pay, both individuals and insurance companies, to make up for what they lose from the uninsured who cannot pay their own bills.
Tobin said he wants assurances in the legislation that if hospitals, many of which are for-profit operations, have less "uncompensated care'' they will stop transferring costs to the private sector.
He conceded it may be difficult to rein in existing costs which have hospitals charging several dollars for an aspirin to balance their books. "But wouldn't you think for a moment that they shouldn't be able to increase them to the commercial sector?''
There are other objections to the governor's plan.
One is Brewer's end-run around a constitutional provision which requires a two-thirds vote for any tax hike. Both Tobin and Senate President Andy Biggs say that's exactly what is being imposed on hospitals to pay the state's share.
Brewer, however, has structured the legislation to allow the AHCCCS director to impose an annual "assessment'' on hospitals, with that agency entitled to decide how much each must pay. Aides contend that means the legislation needs only an easier-to-obtain simple majority.
Tobin, however, said he believes it is unconstitutional to put that much power in the hands of a state agency chief without legislative oversight.
Brewer, however, hopes to sell the expansion as a deal too good to pass up.
On one hand, she figures tapping into the federal Affordable Care Act will generate $8 billion in federal dollars over the next four years.
"It will throw a lifeline, a safety net to rural hospitals struggling with the cost of caring for the uninsured,'' Brewer said. And the governor even had an answer for those who complain that this is not free money and that Arizona's participation will only make the nation's nearly $17 trillion deficit worse.
"It will keep Arizona's tax dollars at home rather than allowing them to go to Washington to be spent on who knows what,'' she said.
If that's the carrot, the stick is that the Affordable Care Act sets new standards for state Medicaid programs.
What that means is that if Arizona does not go along with the higher eligibility standards, the federal government will no longer subsidize funding for childless adults below the federal poverty level. And that would leave 60,000 Arizonans who now have insurance without any this coming January.
Even as Brewer is trying to line up votes, Republican party workers around the state are working to convince GOP lawmakers to oppose what she is trying to do.
A.J. LaFaro, chairman of the Maricopa County Republican Committee, sent letters to GOP lawmakers pointing out that its Executive Guidance Committee voted 26-2 last week in opposition to what Brewer is trying to do.
"The insanity of the progressive socialists, liberal Democrats and Obama has to stop,'' he wrote.
That opposition could weigh on the minds of some Republicans, as it is those party workers, including precinct committeemen and committeewomen, who are the drones who go out and help candidates get signatures on nominating petitions, raise money and get people out to vote.
But some Republicans already have decided to back Brewer. Leading that effort is Rep. Heather Carter of Phoenix who also chairs the House Health Committee. She argued that, despite what foes say, AHCCCS is not socialized medicine now -- and its expansion will not make it so.
Carter pointed out that AHCCCS contracts with private insurance companies to provide care, as those enrolled have choices.
"They have the choice of a doctor,'' she said. "And they are treated in the same medical facilities that we are all treated in.
The plan also has picked up the support of Sen. Steve Pierce, R-Prescott, who might be able to bring along some votes from rural lawmakers.
"If we don't do something to help out the rural hospitals, they're going to be closed when I need it or anyone needs it,'' he said.
Pierce said it would be a problem if a hospital closes in a metro area. "But if it closes in Prescott, that's the only hospital there.''