Gov. Jan Brewer rallied doctors and nurses at the Capitol on Tuesday in her bid to get the necessary votes to expand the state's Medicaid program.
"Right now, in several communities, there are children with chronic medical and dental health needs that are not getting the care that they need,'' said Delphus Richardson, a doctor who is the vice president of the Arizona Academy of Pediatrics. "There are kids missing school with labored breathing, with pain that disrupts their sleep because of an ear infection or a broken bone and they are not getting the care they need.''
Some of that, he said, would change if Arizona agrees to participate in the federal Affordable Care Act which would make all individuals up to 138 percent of the federal poverty level eligible for free health care. Current state law provides coverage up to 100 percent for most, about $19,530 for a family of three.
The rally comes as Brewer has been having trouble convincing members of her own Republican Party that the plan makes sense. And at least part of the concern is the cost.
But Bill Thrift, president of the Arizona Medical Association, said the governor's plan actually helps the state financially. He said it would bring in $1.6 billion in federal dollars, with the state's $250 million a year match covered by a levy on hospitals.
The governor said the rally, part of an ongoing series of events being organized by her office and supporters, is part of an ongoing effort to build the necessary political support among legislators.
"That gives us time to educate them, give them more information, hopefully the constituents reaching out to them,'' Brewer said. "They can do the math.''
But the math, by itself, has so far been insufficient to bring around many Republicans. Rep. John Kavanagh, R-Fountain Hills, said just because the expansion can be done without additional tax dollars does not make the plan -- and the entire Affordable Care Act -- good policy.
"We're all still citizens of the U.S. and the federal government is going bankrupt with these runaway entitlements,'' said Kavanagh who chairs the House Appropriations Committee. "I'm not about to pass on debt to my grandchild.''
And House Speaker Andy Tobin said that, philosophical issues aside, lawmakers are worried about what happens when the federal money dries up.
Brewer has promised the legislation will contain a "circuit breaker'' provision, ending the state's participation once federal dollars go below a certain level. But the governor has yet to put anything in writing about exactly how that would work.
Even if it does work, Tobin said, that would put lawmakers in the difficult position of scaling back the program some years down the road.
"Somebody getting kicked out of a hospital is different than somebody not getting on (health care) in the first place,'' he said.
There's also a numbers problem.
Brewer is likely to have the support of most Democrats. And several Republicans, like Sen. Steve Pierce, R-Prescott, say the plan makes sense.
But the Arizona Constitution says any tax hike or increase in state revenues requires a two-thirds vote of both the House and Senate. That would allow just 20 of 36 House Republicans or 10 of the 17 GOP senators to scuttle the plan.
The governor, however, thinks she's found a way around the problem.
"It's not a tax, it's an assessment,'' argued Brewer press aide Matthew Benson.
He said the plan would not set out a specific levy on hospitals based on things like the number of beds or patients each has. Instead, it would give the Arizona Health Care Cost Containment System, the state's Medicaid program, the authority to collect what's needed each year from the hospitals to secure the federal match.
With that interpretation, Brewer needs only 31 representatives and 16 senators, a simple majority.
Tobin conceded that lawmakers have adopted a similar end-run to the constitution in the past, allowing state agencies to collect fees for their operations without a two-thirds vote.
But he said those have raised relatively small amounts, versus a quarter-billion dollars a year. And he said such a move is virtually certain to provoke a legal challenge which, if successful, could undermine the whole program.
After Tuesday's rally, Brewer told reporters she remains an opponent of the Affordable Care Act. But the governor said that "elections have consequences'' and that her Republican colleagues need to recognize that voters returned Barack Obama to the White House even after the controversial measure was approved.
"Why would they cut off their nose to hurt their face?'' she said of opposition to taking the federal dollars.
She also pointed out that most parts of the law were upheld by the U.S. Supreme Court.