Surrounded by what could be the new, more moderate legislative majority, Gov. Jan Brewer signed legislation Monday to expand Medicaid in Arizona.
The governor noted the measure was approved by an unusual coalition of 14 Republicans working with all of the Democrats in the Legislature. Potentially more significant, it was enacted despite opposition from the majority of Republicans who control both chambers, as well as the House speaker and the Senate president.
And it came even as foes of expansion have threatened to do everything possible to ensure that this will be the last term in office for the Republicans who supported it. Brewer, in signing the measure, took note of their actions.
"They displayed something we don't see a lot of in politics today,'' she said. "And that is courage.''
And the governor personally thanked them.
"You have my gratitude and respect,'' said Brewer, who announced her support of Medicaid expansion five months earlier in her State of the State speech. "You put people before politics and you stayed strong in the face of personal attacks.''
Most immediately, the new law is designed to swell the rolls of the Arizona Health Care Cost Containment System, the state's Medicaid program, from about 1.3 million to more than 1.6 million.
The federal government, using provisions from the Obama administration's Affordable Care Act, will kick in about $1.6 billion a year, with Arizona's $240 million share coming from what amounts to a tax on hospitals. Despite that, the Arizona Hospital and Healthcare Association signed on in support, with the premise that more people with health coverage means fewer people unable to pay their bills.
But the real lasting legacy could be that some of the more politically moderate legislators in the Republican Party ignored their own far more conservative leadership and instead found common ground with the Democrats. And that leads to the possibility that the conservatives, who have gotten their way for years at the Capitol, may find themselves in the minority.
At the very least, it has opened the door for more cooperation -- and less partisan bickering.
"We need to have more respect for each other,'' said Sen. Steve Pierce, R-Prescott. "It's been gone down there.''
He said Brewer can help restore that. And he predicted more bipartisan cooperation next session.
That's also the assessment of House Minority Leader Chad Campbell. The Phoenix Democrat, who for years has found his caucus largely ignored as the GOP majority did what it wanted, said he and his colleagues found natural allies with some Republicans.
"We put aside the politics,'' he said.
"We put aside the rhetoric,'' Campbell continued, but quickly adding, "at least some of us put aside the rhetoric.''
Despite all the self-congratulations, Monday's signing is just another act in a political drama that continues to play out.
Former state Sen. Frank Antenori said he may be ready as early as today to file a referendum to put the question of Medicaid expansion to voters.
Antenori and former Sen. Ron Gould need 86,405 valid signatures on petitions by Sept. 12 to hold up enactment of the law until it goes to the ballot. And the next scheduled general election is not until November 2014, 11 months after Brewer's expansion plan is scheduled to kick in.
Gubernatorial press aide Matthew Benson said the governor's legal advisers do not believe the measure is subject to referendum because it is part of the budget. But Antenori said the lawyers with whom he has consulted agree that the policy of expanding eligibility for free care, from 100 percent of the federal poverty level to an adjusted figure of 138 percent, is subject to voter review.
The only question is whether the $240 million hospital assessment can also be referred to the ballot. But that issue could be the subject of a lawsuit since it was not approved by a two-thirds vote of both the House and Senate, a constitutional requirement for new taxes or increases in state revenues.
Brewer, outside the press event on Medicaid, also signed the other nine bills that make up the $8.8 billion spending plan for the coming year.