There's a lot that makes sense about expanding health care coverage to the working poor.
-- People with insurance get more timely preventive care like checkups instead of waiting for health crises that send them to costly emergency rooms.
-- Hospitals have much less uncompensated care, which lowers insurance premiums for everyone.
-- Healthy employees make better workers.
Those are the main reasons health care providers and business groups are supporting an expansion of Medicaid in Arizona under Obama-care.
But now a new reason has emerged that should appeal to the fiscal conservatives who make up the bulk of the die-hard Obamacare opponents: Arizona can't afford not to.
That's because Arizona, unlike most other states, already is required by Prop. 204 to offer free care to childless adults earning up to 100 percent of the poverty level.
The fact that the Legislature has been allowed by the courts to back out of this obligation is considered temporary -- once the economy improves, lawmakers won't have the excuse that funds aren't "available" to pay for the mandate. They will have to add back the 120,000 people who lost coverage in 2010.
Obamacare proposes to expand that mandate to 133 percent of the federal poverty level for single adults as well as families and pay for 90 percent for the first three years before falling to 80 percent.
Additionally, the state's hospitals have proposed to pick up the 10 percent state match by imposing a so-called "bed tax." In exchange for raising about $230 million a year, the state will get $2 billion to pay for the expanded Medicaid rolls.
But if the state opts out entirely, both the hospital payment and the federal share go away, sticking Arizona taxpayers with a bill of up to $1.4 billion if Prop. 204 is enforced again by the courts.
At this point, the Senate has endorsed the expansion and House Speaker Andy Tobin has dropped his own plan that included requiring voter approval. That approach would have delayed implementation until November 2014, the earliest it could make the statewide ballot.
There are still Republicans in the House who are dead-set against any compliance with Obamacare, even though it is the law of the land. They want to force a supermajority vote for passage, contending the hospital fee is actually a new tax, even though it is collected only from hospitals and will not increase patient costs. (The fee is calculated according to bed-nights in the hospital, but it is not actually assessed against the patient occupying that bed.)
That requirement would kill the plan, as there aren't 40 votes in the House out of 60.
Republican opponents are surely aware that Medicaid expansion under Obamacare enjoys broad voter support in Arizona -- and that was before it became clear how costly opting out could be. It's bad enough to oppose expansion purely on partisan political grounds. It's another to do so knowing you will cost state taxpayers $1.4 billion a year. It's time Republican opponents are forced to account for that number and tell voters how they plan to come up with the money.