Two former Republican state senators are maneuvering to give voters the last word on whether Arizona expands its Medicaid program.
Frank Antenori, who represented Tucson, said Tuesday he already has written commitments from 500 GOP precinct committeemen to gather signatures this summer to refer the issue to the ballot if the proposal by Gov. Jan Brewer is approved by the Legislature. He and Ron Gould of Lake Havasu City need just 86,405 valid signatures within 90 days of the end of the session -- whenever that happens -- to force the issue to a public vote.
The plan could be the only chance for direct public input.
House Speaker Andy Tobin said Tuesday he has given up on his own bid to make approval of Brewer's plan contingent on voter approval at a special election. Tobin said he cannot line up support in his chamber.
That removes a major political hurdle from Brewer's plan to add about 300,000 to the 1.3 million already enrolled in the Arizona Health Care Cost Containment System, the state's Medicaid program. The Senate already has given its approval. And Rep. Heather Carter, R-Cave Creek, said she has enough backers from her own party to push it through the House if all 24 Democrats there go along.
Antenori said, though, it should be no problem finding enough Arizonans to sign referendum petitions -- especially if the measure is sold as a way to kill "Obamacare.''
Just getting the signatures would be a setback for Brewer. The Arizona Constitution says any measure referred to the ballot cannot take effect until voters get a chance to either ratify or reject what lawmakers have approved.
The earliest that could happen is the 2014 general election. Antenori said that delay works in his favor.
"An overwhelming number of people, by November 2014, will have a different picture of what's going on with Obamacare,'' he said. "They will see what's happened with the states that have adopted it and the amount of money they're going to end up on the hook for and how it's going to impact their budget.''
Brewer said she's not concerned.
"I don't think it's going to get referred,'' she said. "We're to get it passed and we're going to do what's right for Arizona.''
But the governor already is preparing a legal challenge to cut off any referral at the knees.
Press aide Matthew Benson said while questions of policy can be referred to the ballot, the Arizona Constitution bars voter veto of any program "for the support and maintenance of the departments of the state government and state institutions.'' That is because of the fact that a referendum holds up enactment of the law until the next general election.
Benson said the Arizona Court of Appeals concluded in a 1992 ruling that exemption is broad, applying not only to state spending but also revenue measures needed to support government operations. And he said that includes the $240 million assessment on hospitals that would pay for the AHCCCS expansion.
"It's part of the budget,'' Benson said, making it off-limits to being referred to the ballot.
Gould said Brewer is off base.
"Using that definition, you couldn't refer anything'' to the ballot. "Everything costs money.''
Brewer's plan would provide coverage for everyone up to an adjusted figure of 138 percent of the federal poverty level. AHCCCS, the state's own Medicaid program, covers most individuals up to 100 percent of the poverty level, about $19,530 a year for a family of three.
The governor said the federal government will kick in about $1.6 billion a year to restore coverage to some who were kicked off in prior years because of budget cuts and the rest because of the higher income. The state's $240 million share would be paid for by what amounts to a tax on hospitals who hope to recoup the cost because fewer people would show up in emergency rooms without insurance.
Gould said if he and Antenori get the necessary signatures it should be no problem to find money to kill Brewer's plan.
"National conservative groups are going to come in and want to get a piece of it because this will be a referendum against Obamacare,'' he said. More to the point, Gould said, it would be the only one in the entire country.
Forcing a referendum on Medicaid expansion does come with a political risk.
In essence, a referendum takes what the Legislature approved and places it in front of voters. A "yes'' vote is to affirm what lawmakers did; a "no'' vote becomes a veto.
But the Arizona Constitution also says that any measure which has been approved by voters cannot later be repealed or sharply altered by legislators without taking the issue to the ballot. So if voters approve Medicaid expansion over what Antenori and Gould are trying to do, it may become permanent until another public vote.
"That is my worry,'' Antenori conceded. But he said there has never been a test case on whether the Voter Protection Act, originally approved to shield voter-proposed initiatives, also applies to referenda.