Ms. Brewer, who has become something of a conservative icon for her aggressive opposition to Mr. Obama’s policies, surprised many Legislature watchers at her State of the State address last week by saying she wanted to expand the state’s Medicaid program to include anyone who makes up to 133 percent of the federal poverty level, or $14,856 for an individual. The risk if Arizona does otherwise, she said, is losing the federal funds and the health care jobs that come with the changes.
It could be simply a case of math trumping ideology: In 2014, the first full year of the expansion, Arizona stands to gain $1.6 billion in federal matching funds, Ms. Brewer said. (The federal government would cover the full cost of the new beneficiaries in the early years and 90 percent of the cost after 2020.)
This provides some reason to be optimistic that the damage done by the Supreme Court’s limitation of the Medicaid expansion can be contained. Obviously, some states will continue to resist the expansion. But the use of the federal spending power — even when confined to new as opposed to existing spending — upends the usual politics of health care. Providers, normally the most important obstacle to reform, suddenly become a powerful voice on the side of reform. Eventually, even very reactionary state governments are unwilling to pass up federal money over the long-term — immediate complaints followed by quietly taking the funds once the issue has died down is how things usually work. The fact that the very reactionary governor of the last state to implement the original Medicaid program has to be considered an encouraging sign, although any optimism should remain very cautious until we see if she can bring the legislature along.