PHOENIX — Gov. Jan Brewer called it "one of the most difficult decisions" of her 30 years in public service.
If she chose to expand Medicaid, the federal and state program that provides health care to poor and disabled people, she risked antagonizing her conservative base, steadfast opponents of President Obama's health care law. If she did not, she risked missing a solid chance of shifting the way she is viewed by a Latino population of increasing political influence, beyond her stern positions on immigration.
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.)
Her fellow Republican governors in the Southwest, Susana Martinez of New Mexico and Brian Sandoval of Nevada, used a similar argument to justify their decisions to do the same thing. But it was Ms. Brewer whom National Review Online, the conservative publication, singled out for criticism in an editorial, saying she exemplified "that unfortunately common strain of Republican leadership that is uncompromising in rhetoric but opportunistic in reality." Americans for Prosperity, the conservative advocacy group, also circulated a paragraph-by-paragraph rebuttal of the arguments she used to support her choice.
Expanding Medicaid is a central element in Mr. Obama's plan to provide health coverage for virtually every American, as it could add as many as 17 million people to the rolls. Last month, his administration made it an all-or-nothing proposition, saying it would not cover partial expansions, a move that left many Republican governors who were hoping for such a middle-of-the-way option looking for a different way.
Both demography and geography are playing a role in which governors are choosing to expand Medicaid and which are not, observers said. Republican governors bucked the party line in the Southwest, where Latinos are at once a significant slice of the poor population and a powerful voting bloc. But in the South, Republican governors have stayed in unwavering opposition to expanding Medicaid or embracing any of the voluntary aspects of Mr. Obama's health care law.
"The South is Republican, and it's getting more Republican, so there is very little political risk there in letting the hard-right Republican philosophy take over" despite the region's substantial number of poor residents without health insurance, said Richard White, a professor of history at Stanford University.
The expansion in Arizona, which requires state legislative approval, is popular among Latino voters, who lean heavily Democratic, and among Latinos in general, who stand to gain the most from it. A report by NCLR, a Latino advocacy organization also known as the National Council of La Raza, said the national expansion of Medicaid would account for about half of the Latinos newly insured under the health care law across the country, with about 3.1 million additional Latinos covered by the program.
Gabriel Sanchez, the research director at Latino Decisions, a polling group, said the future of politics in the West "is largely connected to expansion of the Latino electorate," so siding with issues that matter to them "is sometimes a matter of survival" in politics.
In Nevada, where the expansion is projected to enroll 78,000 people and bring in more than $700 million in federal funds over the first three years, Mr. Sandoval immediately received the support of the Republican leadership in the State Senate. In New Mexico, where the expansion would add 208,000 people to the program and bring in roughly $5 billion through 2022, no one was surprised that Ms. Martinez decided to go the way she did.
Ms. Martinez and Mr. Sandoval walk a fine line: They are Republican governors in increasingly Democratic states that voted for Mr. Obama twice. The argument they used to defend their decisions, that expanding Medicaid could bring more money and more jobs, is an easy sell in New Mexico and Nevada, which continue to battle the effects of the economic downturn.
As of last week, the only other Republican governor to back the Medicaid expansion was Jack Dalrymple of North Dakota.
Ms. Brewer, though, casts a different profile. She is the finger-wagging governor respected in conservative circles for her outspoken criticism of Mr. Obama and unfaltering support of Arizona's strict immigration legislation, which she fought for all the way to the Supreme Court.
But on Wednesday, as she stood surrounded by health care executives at a news conference that seemed more like a pep rally, she was repeatedly called "compassionate," not a word often used to describe her. The health care industry had lobbied hard for her support of the Medicaid expansion, hiring her former budget director, Peter Burns, and Chuck Coughlin, her campaign strategist, to guide their efforts.
Ms. Brewer's plan includes a "circuit breaker" to automatically freeze coverage for childless adults if the federal government drops its share of matching funds below 80 percent.
When first announcing her decision on Monday, she said, "I will not allow Obamacare to become a bait and switch." By Wednesday, she had a more benign assessment, "There's no way you can look at this issue and say this is not the right thing for Arizona at this time."
Under the expansion, Arizona is expected to add about 240,000 people to its Medicaid rolls.
Barrett Marson, a public relations consultant who has worked for several Arizona Republicans, said Ms. Brewer's decision was, in part, "about saying, 'I want to show America who I really am,' and that person is a compassionate conservative who thinks there should be a safety net for people in the bottom rung."
She wants to prove she is "not all about immigration," he said.
Several hard-line Republicans decided not to seek re-election for the Arizona Legislature or were voted out of office last year. One was Russell K. Pearce, a senator who was the sponsor and chief champion of the state's immigration bill. That, and the fact that there are several Republican legislators whose positions are vulnerable, may also have weighed in the governor's calculation.
"In the South, you can continue to flog the immigration horse," said Professor White of Stanford, "but no longer in the Southwest."
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