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The Medicaid roles in Arizona are growing faster than anyone predicted. Right now, one in five people in the state depend on the health care program that was created to serve the poor and disabled. Lawmakers in Washington are talking about expanding Medicaid as part of a health care overhaul. But Arizona's having trouble paying for the program at its current level and policy makers say they can't afford to cover more people. NPR's Jeff Brady reports.

JEFF BRADY: Nationally, about a third of Medicaid dollars go toward nursing home come. But the growth of the program in Arizona is primarily due to the economy. Twenty-two-year-old Yani Roderica(ph) is a single mother of two. She recently signed up for the state's Medicaid program. Roderica worries she maybe suffering from the same cervical cancer that killed two of her aunts.

Ms. YANI RODERICA: They both died, they both went through chemo and they didn't make it. And maybe for the past two months I started feeling my legs go weird.

BRADY: Roderica says a doctor wondered that a medical test a year and a half back didn't look quite right. At the time she was pregnant and planned to follow up later. But then with a new baby, time just got away from her.

Ms. RODERICA: It's been the ninth months of this pregnancy and now he's eight months. And I was really (unintelligible) how long it's been and how much it could've been (unintelligible).

BRADY: Roderica says she's ready to get care now and she's thankful Medicaid exists. Stories like hers are familiar to Tony Rodgers. He's the director of the state's Medicaid program. It's called the Arizona Health Care Cost Containment System. Most folks use the acronym, AHCCCS.

Mr. TONY RODGERS (Arizona Health Care Cost Containment System): I would say in a normal year we might see 60,000 additional members. Well, we're probably going to see close to 300,000 additional members by the end of the year.

BRADY: Rodgers says that's a crisis for Arizona. Tax revenue is down, since the state depends on the slumping construction and service industries. Medicaid costs are going up, and at the same time, Rodgers's agency had to lay off 70 employees.

Mr. RODGERS: This is kind of a financial tsunami for us. And we're just trying to hold onto any log that's rolling along and trying to save ourselves till the wave stops.

BRADY: The Medicaid problem has contributed to a budget standoff between Republican Governor Jan Brewer and the GOP-controlled state legislature. The governor wants a one percent sales tax increase. But legislative leaders say they don't have the votes for that. Lawmakers are concerned about more than just money. State Representative Nancy Barto says she's uncomfortable with the large role Medicaid already plays in the health care business.

Representative NANCY BARTO (Republican, Arizona): We have currently over one out of five persons in Arizona on AHCCCS. That to me says right now we're already - government's already doing too much.

BRADY: Arizona was the last state in the union to embrace the Medicaid program. For more than 15 years, from the mid-'60s until 1982, Arizona forfeited its share of federal Medicaid money rather than create a state program. That history has supporters of expanding Medicaid worried. Eddie Sissons is executive director of the Arizona Foundation for Behavioral Health. She says if Congress expands Medicaid and that requires Arizona to contribute more money…

Ms. EDDIE SISSONS (Arizona Foundation for Behavioral Health): We'd probably walk away. Right now, because of the state's fiscal crisis, I think we could very easily just say, not now, we can't do that. And we'd have to wait for either a change in our economy and possibly even a change in the political environment in Arizona.

BRADY: Even if the federal expansion of Medicaid includes extra money for strapped states, as most expect it will, fiscal conservatives in Arizona are skeptical. Their concern has helped revive a ballot measure that would try to block key parts of a health care overhaul in the state.

Jeff Brady, NPR News.

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