I fought hard to expand Arizona's Medicaid program. We all pay if it's scaled back

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08-05-2025

Restoring health care coverage for Arizonans who lost it during the Great Recession stands out as one of my proudest moments as governor.
It wasn't easy, but it was the right thing to do for the people of Arizona — and we got it done, despite a lot of people telling me I shouldn't, or couldn't.
Now, more than a decade later, that same coverage is once again in jeopardy. And Arizona's members of Congress will play a critical role in determining whether folks can still count on that care.
The House Energy and Commerce Committee, which oversees Medicaid, has been tasked with finding $880 billion in savings to help fund an extension of the 2017 tax cuts.
That's a big number. And there's no question — Medicaid is on the table.
Some of the proposals being floated would mean deep cuts to state Medicaid programs, including the Arizona Health Care Cost Containment System (AHCCCS). If these ideas move forward, our state could lose close to $2 billion in federal funding.
That kind of shift would dump massive costs onto the state without a roadmap for how to cover them. And as every governor knows — Democrat or Republican — we can't just print more money.
If the federal dollars disappear, the state is left with a handful of bad choices: cut eligibility, cut services, cut payments to providers or raise taxes.
I've sat in that chair. I've faced those choices. I had to make all of them as governor during one of Arizona's hardest times. We were in the middle of a deep recession, and I inherited a budget crisis unlike our state had ever seen.
Some in Washington say they don't want to hurt those who depend on Medicaid. They say they want to stop waste and fraud and make sure that people who can work, do.
But here in Arizona, we've already done that. We already have work requirements — there has been a law on the books since 2015.
And most AHCCCS recipients are working. In fact, more than 200,000 people left the program in 2023 — most because they got jobs. That's something to celebrate.
Arizona voters made it clear nearly 25 years ago who should qualify for Medicaid in this state with the passage of Proposition 204. That wasn't a decision made by politicians — it was made by the people. So, regardless of what Congress does, Arizona is still required by law to cover this population.
If Congress forces states to find savings, Arizona won't be trimming fat — it'll be cutting muscle. Tens of thousands of Arizonans will lose coverage. I've seen what happens when that lifeline disappears. It's not theoretical. It's real.
In 2024, AHCCCS helped 64,000 Arizonans battling cancer. It treated 67,500 people fighting opioid addiction. It supported 180,000 residents managing diabetes.
But sick people just don't disappear if they don't have coverage. They show up in emergency rooms, the most expensive place to get care. Under federal law, hospitals are required to treat them.
Opinion: You'll pay more for health care if Republicans ax AHCCCS expansion
Hospitals and the health care industry can't provide services for free, so they end up passing the costs on to health care insurance companies who end up raising all our premiums to cover the cost of service, something called the 'hidden health care tax,' which creates a drag on the whole economy.
That's not just bad health policy. It's bad economics. Hospitals will struggle. Some may close.
Health care workers like doctors and nurses will lose their jobs. Insurers will raise premiums to make up for the losses. Employers and families will pay more — and Arizona's economy will feel the strain.
These cuts don't just hurt AHCCCS members. They ripple through every part of our state.
I know what it's like to be a lawmaker faced with a tough vote. I know what it's like to stand up to your own party when it matters. And I know how hard it is to do the right thing — especially when it's not the popular thing.
But I hope our delegation remembers what's at stake. This isn't about politics. It's about people. And it's about protecting something that works — for patients, providers and taxpayers.
Because at the end of the day, leadership is about more than just holding the line — it's about doing what's right for Arizona.
Jan Brewer, a Republican, is a former Arizona lawmaker and secretary of state who served as governor from 2009 to 2015. Reach her on X @GovBrewer.
This article originally appeared on Arizona Republic: Jan Brewer: Scaling back AHCCCS hurts all of Arizona | Opinion