Arizona Gov. Jan Brewer (R) (Credit: Shutterstock)

The vote signifies the final skirmish in a five-month long battle to expand Medicaid that pit the combative Brewer against members of her own party and conservative constituents. The window for passing the expansion and a budget would have closed on July 1st. With that deadline looming, Brewer called a surprise, special legislative session on Tuesday without getting permission from — or even informing — lawmakers in her party.

Studies by the Kaiser Family Foundation (KFF) have shown that expanding Medicaid will cut Arizona’s uninsurance rate by nearly third. That means approximately 50,000 low-income Arizonans will be covered for medical benefits such as doctor’s visits, prescription drugs for chronic conditions like diabetes, and mental health care services.

Brewer made expanding Arizona’s Medicaid program under the health law a top priority for this legislative session. After becoming the third GOP governor to endorse expansion in January, she held rallies throughout the state meant to shore up support for the controversial Obamacare measure, and implored Republican moderates to vote for it. Brewer often used personal rhetoric that emphasized the consequences failing to expand Medicaid would have on Arizona’s poor. “The human cost of this tragedy can’t be calculated,” she said during a rally in March.

Thursday’s victory came only after significant tensions threatened to derail the entire process. Brewer played political hardball to push the expansion, even following through on a threat to shut down lawmaking entirely until she had a budget and the Medicaid expansion bill on her desk. She refused to compromise with Republican House Speaker Andy Tobin, who had proposed a far more conservative alternative plan that would have put a time limit on how long poor Arizona residents could qualify for the expanded program.

The tough tactics earned her scathing reviews from conservatives, with the chairman of the Maricopa County Republican Committee calling her a “rogue governor.” Republican lawmakers who opposed the expansion also slammed Brewer for her aggressive methods in speeches on the House floor Thursday.

Arizona will now be the 21st state to expand Medicaid under Obamacare.

Arizona Gov. Jan Brewer (R)

Under pressure from Gov. Jan Brewer (R-AZ), who is refusing to sign any laws until her party expands Medicaid under Obamacare, Arizona’s Republican House Speaker Andy Tobin surrendered his fight to block the governor’s expansion proposal on Tuesday. Tobin was pushing for a more conservative plan that would have put a time limit on how long poor Arizonans could qualify for the expanded Medicaid pool.

Now, the governor’s preferred proposal — which passed the state Senate in May — will proceed through the committee process in the House, with a full vote possible as early as next week.

Time is an important factor for passing the expansion. Arizona’s state constitution requires a budget to be finalized by July 1st — an outcome that was in question as tensions flared over the Medicaid issue. Tobin said that he relented after realizing how much daylight there was between his alternative proposals and Brewer’s far more expansive plan.

“The counteroffers that we heard from [Brewer's] staff were so far away from where I was at, that it just became apparent that because you have to have Medicaid with the budget that the time was running out. I didn’t think there was enough room to negotiate a closer deal,” said Tobin in an interview with the Associated Press.

Brewer is far from the only Republican official to endorse expansion. But the combative governor’s tenacious — and often aggressive — pursuit of expanding Medicaid has taken many political observers by surprise.

While promoting Medicaid expansion in March, Brewer warned that the “human cost” of failing to expand the program “can’t be calculated.” At another rally, she sounded defiant in the face of Republican political blowback. “This is a fight worth fighting for. Are we going to win? Darn right, we are going to win,” she told a cheering crowd.

The Kaiser Family Foundation estimates that expanding Medicaid would cut Arizona’s uninsurance by almost a third. That means that about 50,000 poor Arizonans would have access to basic and specialty health care, including diagnostic and clinical services, as well as care for the disabled and the mentally ill.

Brewer has followed up on her tough rhetoric with action. She recently vetoed five bills in quick succession to show her displeasure with the legislature’s inaction, following through on a threat she made to shut down lawmaking until Medicaid and the budget issue was resolved.

The arm-twisting appears to have worked, despite sharp criticism from conservatives in her own party. The chairman of the Maricopa County Republican Committee called Brewer a “rogue governor” in a letter warning Republican state senators not to buck the traditional party line on Medicaid. Tea Party activists have dismissed her actions as “tyranny.”

Although expansion is not quite a done deal yet, Republicans opposed to the measure admit that it’s likely to pass. “I don’t know if we have the numbers to stop it. But we are going to continue to fight,” said state Rep. Bob Thorpe (R).

On Tuesday, the U.S. Court of Appeals for the Ninth Circuit permanently struck down Arizona’s “fetal pain” law that would have criminalized abortion services after 20 weeks of pregnancy. The panel of judges determined that the 20-week ban is unconstitutional under Roe v. Wade, which guarantees the right to legal abortion until the point of viability at about 24 weeks of pregnancy.

Representatives from the American Civil Liberties Union and the Center for Reproductive Rights, who filed the lawsuit against the 20-week ban, praised the judges’ decision. “We’re glad the court has reaffirmed that states cannot place unlawful burdens on a woman’s right to access safe reproductive health care,” Talcott Camp, the deputy director of ACLU’s Reproductive Freedom Project, said in a statement. Nancy Northrup, the president of the Center for Reproductive Rights, called the decision a “huge victory in the fight to protect women’s fundamental reproductive rights,” and noted that the Ninth Circuit’s decision should send a clear message to the other states that are attempting to limit abortion access before the point of viability.

Indeed, Arizona’s “fetal pain” measure — based on the scientifically-disputed notion that fetuses can feel pain after 20 weeks — is just one of several similar pieces of legislation to land in court. 20-week bans in Idaho and Georgia have also been blocked under the same constitutional logic. Arizona’s own law has actually been blocked since August, when the appeals court issued a temporary injunction right before the law was scheduled to take effect.

Imposing fetal pain measures is a popular anti-choice tactic to effectively chip away at Roe and narrow the window in which women may access legal abortion. Bans on late-term abortions are an especially big anti-choice priority right now, as abortion opponents attempt to capitalize on the high-profile case of illegal abortion provider Kermit Gosnell to misconstrue all later abortions as dangerous procedures. Just this week, Arizona Rep. Trent Franks (R), who has repeatedly attempted to impose a 20-week abortion ban on the District of Columbia, announced his intention to amend his legislation to push for a nationwide restriction.

When Arizona first passed its fetal pain law, it represented the most stringent abortion ban in the nation. Since the state defined gestation differently than other states, calculating from the moment of the woman’s missed period, the law could have potentially cut off legal abortion services at just 18 weeks of pregnancy. However, since Arizona first passed that piece of legislation last March, states have moved the goalposts even further. Arkansas banned abortions after 12 weeks, and North Dakota placed the cut-off at just six weeks of pregnancy.