The latest wrinkle in the effort to stop Gov. Jan Brewer from expanding Arizona's Medicaid program is a proposed referendum that would put the program on hold until voters had a chance to approve it in November 2014.
Former state lawmaker Frank Antenori has announced plans to lead the referendum effort along with fellow hard-right Republicans Christine Bauserman (who served as a strategist to Antenori's unsuccessful 2012 re-election campaign) and former state lawmaker Ron Gould of Lake Havasu (who lost a primary race for Congress last year).
The stakes are high: If Antenori and Co. can collect just under 87,000 valid signatures within 90 days after the Legislature adjourns this year, the expansion can't move forward—and that would, in turn, complicate the legal agreement between the state's AHCCCS program and the federal government.
Antenori said last week that he doesn't buy the Brewer administration's legal argument that expansion can't be referred to the ballot because it is connected to a budget measure.
Antenori has been in touch with attorneys—whom he declined to name because he says Brewer's allies "have been torpedoing my efforts to get legal help"—who assure him that the matter can be referred to the ballot.
"Every opinion that I've gotten is that everything is referable except for the bed tax," Antenori said.
Local attorney Jeff Rogers, who has served as chairman of the Pima County Democratic Party, was also skeptical of the Brewer administration's argument.
"I absolutely agree that Frank's right," Rogers said. "They're on firm legal footing."
Rogers questioned whether opponents of the expansion can gather the signatures without financial support and paid signature gatherers.
"That's a real heavy lift—over a thousand signatures each day, as well as a buffer," Rogers says. "If the Koch brothers or somebody like that says, 'Let's make the real battle in Arizona and we'll send whatever it takes,' then they could probably do it. But you're going to have a lot of trouble getting that many signatures with just volunteers."
Antenori said Bauserman was already coordinating efforts among conservative activists and that the effort will be easier thanks to a change in state law that allows half of the signatures to be collected online.
If Antenori's group is successful in gathering the signatures, it will mean that the expansion can't happen until voters decide the question in November 2014. That delay creates a number of significant legal wrinkles because the current agreement regarding matching funds for the state's Medicaid program expires at the end of 2013. The federal government could cease funding a portion of the program if the state does not agree to full expansion in January 2014.
"It puts everything on hold for a year and half," Rogers said. "Do we then have to spend millions of state dollars to keep the same people who are insured now on the program or do we kick more people off the rolls than we have already?"
The threat of a referendum is the latest twist in a push by Brewer—along with the health care industry and most of the state's chambers of commerce—to expand Medicaid under the federal government's Affordable Care Act. Brewer has argued that the expansion will result in an additional 240,000 Arizonans getting health insurance through the state's AHCCCS program and an additional $4.1 billion in federal dollars flowing into the state between now and fiscal year 2016.
But opponents such as Antenori argue that the expansion amounts to support of "Obamacare," will cost too much money and will make more people dependent on the government.
Last month, six Republican state senators crossed party lines to join with Democrats to pass a budget that includes the expansion.
House Speaker Andy Tobin, who opposes the expansion, has taken no action on the budget plan since it arrived in his chamber.
Rep. Bruce Wheeler told the Weekly on Tuesday, June 4, that he had been told there was a chance the Medicaid issue and related budget bills would get a hearing this Thursday in the House Appropriations Committee, where Chairman John Kavanagh was expected to strip out the Medicaid expansion before allowing the bills to advance to the full House.
But Wheeler, a central-Tucson Democrat who serves as House minority whip, predicted that enough House Republicans will vote with Democrats to restore the program to the legislation on the House floor and get the package through the chamber.
Antenori said last week that he also expected the expansion would pass through the House, which is one reason he has turned to the referendum process.
The referendum is just one avenue that conservatives will use to try to knock down the expansion. Antenori predicted that other opponents of the plan will file a lawsuit saying that the proposed new fee for hospitals that will cover the state's share of the expansion requires a two-thirds vote of the Legislature because it is essentially a tax hike.
The hospital fee "will probably fall the minute it hits the courtroom," Antenori said. "It's all going to go down. I'll take out the policy side and the court battle will take down the bed-tax side and the whole thing will fall apart."
Wheeler said the Legislature is on firm legal ground with just a majority vote to enact the new fee, but he wouldn't be surprised to see a legal challenge.
"I'm sure they will try to do that and the court will have to decide on it," Wheeler said. "There are still many obstacles. I remain optimistic, but cautiously so."