Act Arizona, a Single Payer Health System

With Proposition 101 Defeat, Health-Care Debate will Rage On

PHOENIX (By Jon Garrido, The Jon Garrido News Network) December 2, 2008 — Vote counts affirm Arizona Proposition 101, dubbed the health-care choice initiative, was defeated.

The most recent count shows 50.3 percent voted against the measure backers said would prevent a government-run universal health plan in Arizona.

Opponents said the initiative was poorly worded and would have created problems for the state's medical community.

"It really could have created chaos for the health-care system for many, many years," said John Rivers, chief executive of the Arizona Hospital and Healthcare Association. "Arizona voters did the right thing by saying 'no.'"

Others opposed to the measure included Arizona Chamber of Commerce and Industry and Arizona Academy of Family Physicians.

Supporters included Republicans U.S. Sen. Jon Kyl and Rep. John Shadegg.

Even though the proposition has been defeated, Arizona lawmakers concede any Arizona reform bill is still a long shot. Arizona Rep. Phil Lopes (D-Tucson) concedes his effort to create universal health coverage in Arizona faces an uphill battle.

"I may get a second wind, but getting it passed is still going to be very difficult," Lopes said of Prop. 101's defeat. "The insurance companies oppose it, organized medicine opposes it, hospitals oppose it. Universal health care is going to be very tough to pass."

National Health Care Reform's Moment May Be Now

Now it's Barack Obama's turn. With the economy staggering, the Federal Government spending billions to help prop it up and the nation still engaged in two costly overseas wars, timing for health-care reform seems dreadful and yet, it could still happen. Obama ranks health-care reform third on his list of top priorities — behind addressing the financial crisis and passing an energy bill.

Health Care Reform certainly has its supporters. Despite suffering from a malignant brain tumor, Senator Ted Kennedy has returned to Capitol Hill. Principally, Kennedy says, because he wants to orchestrate passage of health-care legislation, "There's real momentum behind getting something big done." An adviser to the President-elect summed it with, "This could be the best chance we've ever had."

Three key developments over the past 15 years have made this moment possible. First, the number of uninsured Americans now tops 45 million.

Most important, the cost of health insurance to both the employers who provide it and the employees who pay premiums has continued to soar. Because of that, companies of all sizes — from corporate behemoths to corner stores — have switched sides on the issue of comprehensive reform. Having fought to defeat Clinton's plan in 1993, they are now some of reform's loudest advocates. "This is the No. 1 priority for small businesses," says Todd Stottlemyer, president of the National Federation of Independent Business. "We see it as a matter of national economic security."

An expected spike in unemployment will increase the rolls of the uninsured, driving more of them into emergency rooms and boosting premiums on the insured. Struggling companies may be forced to cut or kill their employee coverage just to survive.

Obama's plan does not mandate universal coverage except for children. It subsidizes low-income Americans who want to buy insurance and creates an exchange to give people access to health care at affordable prices — all reasonable and pragmatic steps. Still, a fight is inevitable. Health care represents 16% of the nation's economy, with vast and competing interests as stakeholders.

Is the Time Right for Turn Arizona Blue!?

Barack Obama has one overriding task: he must restore the strength and confidence of the American economy, and the sooner the better. But keep your eye on health care.

When FDR came into office in March 1933 after an even longer and even more unnerving transition period than this one, he had one overriding task and he set about it with great energy and creativity. He proved America could cope with the Great Depression, even though it took years and World War II to find great prosperity.

But the real story of the New Deal was one signature program ― Social Security. Passed in 1935 it reframed the crisis of the economy by focusing on the long-term security of the elderly. It has been America’s most successful and popular social program. And retirement security for the elderly helped keep the economy on an even keel through good times and bad.

In 1965, Lyndon Johnson signed the second great pillar of American social policy and created the Medicare program. But the third pillar, universal health care, has languished. Democratic presidents from Harry Truman to Bill Clinton tried and failed to pull the sword from the stone. These three programs are really the heart and soul of the Democratic Party, to turn principles into reality or to defend them once created.

Obama seems to be inclined to get to health care now and not later, although his timing is different than FDR. The economic crisis is so bad now constraints on spending are likely to be suspended. Only a huge economic stimulus can help the economy now. If Obama can make the connection between the economy and health care, the momentum may become irresistible. The most powerful argument, though, is one Obama made on the campaign trail in talking about his mother’s final days, that she spent her time not coping with her situation but on the phone arguing with health insurance companies. This really hits close to home.

Rising Hope For Fixing Health Care

Things are looking up for substantive reform of America's troubled health-care system.

No one who knows the history of such efforts, from Harry Truman's administration through Bill Clinton's, needs to be reminded of the difficulties that inevitably confront any plan to overhaul one-seventh of the U.S. economy and bring high-quality medicine to millions of the uninsured.

When Barack Obama's transition team let out word that former Senate majority leader Tom Daschle would be his choice to run the Department of Health and Human Services and to quarterback his work on health reform, it signaled Obama is serious about his campaign promise to make that issue a first-term priority.

Daschle would not leave a lucrative job at a law firm to twiddle his thumbs. Only with a clear understanding the new president will put his own political capital at risk in this cause would the South Dakotan sign up for the job.

Daschle can be of great help to Obama in achieving the goal. He has made his own in-depth study of health-care issues and brings a genuine passion to the subject. And he knows the Senate, where past efforts have foundered.

Senate Leaders Hold Closed-Door Meeting To Discuss Health Care Overhaul Legislation

There are positive signs within the Senate as well. Max Baucus of Montana, the chairman of the Finance Committee, one of the two main centers of Senate action, moved first by releasing a detailed outline of his preferred piece of legislation. Edward M. Kennedy of Massachusetts, the chairman of the other committee of jurisdiction ― Health, Education, Labor and Pensions ― quickly asserted his right to be at the center of action. He organized three task forces within his committee and reached out to Baucus to suggest their staffs start exchanging ideas as well.

Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and Senate Finance Committee Chair Max Baucus (D-Mont.) in a meeting last week included other Senate leaders that discussed plans for health care overhaul legislation to be proposed next year, CongressDaily reports. Baucus after the meeting said, "All are dedicated toward getting meaningful health care reform enacted in this next year."

Baucus said, "We all agreed there has not been a better time in modern American health care to" overhaul the nation's health system. He added, "I think we have to move very quickly to seize the opportunity and build momentum because it's difficult to anticipate what else is going to come up next year that will involve the Congress." Baucus last week announced details of his universal health care proposal. Also present at the meeting were Senate Banking Committee Chair and second-ranking Democrat on the HELP Committee Chris Dodd (D-Conn.), HELP Committee ranking member Mike Enzi (R-Wyo.), Sen. Orrin Hatch (R-Utah), Sen. John Rockefeller (D-W.Va.); and Finance Committee ranking member Chuck Grassley (R-Iowa).

Kennedy and Baucus both have said a health care overhaul bill likely would not include offsets for its full cost. Grassley on Wednesday said, "I think for a lot of us, pay-go is a big issue," referring to rules all measures passed include funding offsets. Baucus said, "You have to invest in order to reap long-term savings," adding, "That's understood by senators; that's understood by outside groups. I talked to Congressional Budget Office Director Peter Orszag and that's understood clearly by him."

House Majority Leader Steny Hoyer (D-Md.) said while a health care system overhaul could increase the national deficit in the short-term, in the long-term it would stop adding to the deficit, according to The Hill. "Hoyer's comments are notable because he is considered the chief advocate of the Blue Dog Coalition and the pay-go policy in the House Democratic leadership," The Hill reports. Hoyer said, "Our objective is going to be to have a pay-go compliant policy over the longer term," but that "may not be possible in the short term, given where we are." He noted addressing health care problems and inefficiencies could reduce costs and limit the impact of an overhaul on the deficit. In addition, Hoyer said, "When it comes to health care, we can no longer think of entitlement reform and expanded access as two separate issues."

At a Finance Committee hearing last week, Baucus said a health care system overhaul "must be part of any successful economic recovery plan." He said, "Health care costs and the economy are linked: The key challenges of our health care system are high costs, low quality and insufficient access," factors that affect family budgets, competitiveness of U.S. businesses abroad and government spending.

The architects of the Clintons' defeat were Newt Gingrich and Bob Dole, then leaders of GOP forces in the House and Senate. Gingrich has now become an advocate for systemic change in the way health care is financed and delivered. His approach differs from Obama's, but it starts from the same premise: The current system is too wasteful and unproductive to be sustained.

And Dole, who in 1994 moved belatedly to opposing the Clinton effort as his own presidential ambitions rose, said last week today's circumstances make a repetition of those scorched-earth Republican tactics inappropriate.

Dole and Daschle have both worked for the firm of Alston and Bird for the past few years, and it would not surprise me if Dole finds ways to be helpful to Daschle and Obama in the coming fight.

Some have argued Obama will be forced to delay his promised effort at health-care reform, either because of the urgency of the economic problems facing the country or because there will be no money in the budget to pay for such an enterprise.

But every indication is he will not wait. Indeed, he could well argue the current plight of the Big Three automakers stems in part from the burden Ford, General Motors and Chrysler are carrying for the failures of our employer-based health-care system. One of their basic competitive disadvantages stems from the fact Japanese and other foreign carmakers are operating in countries where government and society as a whole ― not individual companies ― pay the costs of health care.

Finally, the Republican party is much weaker today than then. After Clinton won, conservatives could say Bush, Sr. messed things up for conservatives by raising taxes. This year, the collapse of the Bush regime has been so total and the Bush regime was so conservative, the Republicans are at a loss for direction. The logic for moving quickly on health care is also to act before the Republicans get themselves together again.

And so we may be seeing history made again following an historic presidential election ― perhaps the most significant change in American social policy since Medicare. The key to its success will be to remember the best programs are simple and have a clear justification not just for the numbers crunchers but in terms of what is fair and who is deserving. That is one reason FDR insisted Social Security be a contributory program, a recognition of the work performed in one’s lifetime. What the equivalent values are in health care may be a mandate everyone must have coverage but we do know it is important to find what they are.

5 Myths About Our Ailing Health-Care System

With Congress ready to spend $2 trillion to prop up the U.S. economy, enacting health-care reform may seem about as likely as the Dow hitting 14,000 again before the end of the year. But it may be more doable than you think, provided a few myths be dispelled about how health care works and how much reform Americans are willing to stomach.

1. America has the best health care in the world.

The United States is No. 1 in the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic. Life expectancy at birth? We rank near the bottom of countries in the Organization for Economic Cooperation and Development, just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments pay for the lion's share of health care. Infant mortality in the United States is 6.8 per 1,000 births, more than twice as high as in Japan, Norway and Sweden and worse than in Poland and Hungary.  The obesity epidemic is out of control, our death rate from prostate cancer is only slightly lower than the United Kingdom's, and in at least one study, American heart attack patients did no better than Swedish patients, even though the Americans got twice as many high-tech treatments.

Moreover, the quality of health care is different in different parts of the country. The Centers for Medicare and Medicaid Services have issued a list of 26 measures of quality, such as making sure heart-attack patients being discharged from the hospital get a prescription for a beta blocker or aspirin to help reduce the risk of a second attack. It turns out that quality is all over the map, and it isn't necessarily better in the places we might expect, such as academic medical centers. Worse still, according to the Congressional Budget Office (CBO), there appears to be no connection between how much Medicare and other payers spend on patients in different parts of the country and the quality of the care the patients receive. You are no more likely to get that beta blocker or aspirin in Los Angeles than in Portland, even though Medicare spends twice as much per beneficiary in Los Angeles.

2. Somebody else is paying for your health insurance.

Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.

Rising health-care costs are partly to blame for stagnant wages. Over the past five years, health insurance premiums have risen 5.5 times faster on average than inflation, 2.3 times faster than business income and four times faster than workers' earnings. Four times. That's why wages have been nearly flat since the 1980s, even as U.S. productivity has been going up. In effect, about half the money you should be earning for being more productive is being sucked up by ever more expensive health-insurance premiums.

If you pay taxes, you're also paying for the health care provided through state and federal programs such as Medicare, Medicaid, the Veterans Administration and the military. All told, the average family of four is coughing up $29,000 a year for health care through taxes, lower wages and out-of-pocket medical expenses.

3. We would save a lot if we could cut the administrative waste of bureaucracy

It is not administrative red tape that is driving health-care costs up faster than inflation. Most of the relentless rise can be attributed to the expansion of hospitals and other health-care sectors and the rapid adoption of expensive new technologies — devices, tests and procedures. What is the single ever increasing cost that drives the increase of all other health care costs ― prescription drugs and the ever increased use of prescription drugs to treat patients.

For the past 20 years the cost of prescription drugs has increased by 20% per year.

Prescription-drug prices soared in the US far outstripping the general inflation rate, according to a report from the University of Minnesota. Of the 195 drugs in the sample, 153 have been on the market for the past five years. "Cumulatively, the average manufacturer price increase for these 153 brand-name drugs was more than two-and-one-half times the general inflation rate — 35.1% compared with 13.5%," the report states.

With a 20% per year increase in prescription drugs cost, this drives all other health care costs to increase by 12% per year. These increases are major factors in the ever increasing costs of health care making health care across America unaffordable causing 47 million persons to drop out of the health care system and enroll in the category called "uninsured."

What drives prescription drug prices? It is the way prescription drugs are approved by the U.S. Food and Drug Administration (FDA) all in the name of "protecting the public welfare."

The FDA is responsible for approving every drug administered in the United States. This is done by approving the use of a prescription drug by granting approval to a drug company to manufacture a specific prescription drug.

It begins with the U.S. National Institutes of Health (NIH) and the annual budget is in excess of $26 billion for drug research by primarily private drug companies. Once a potential drug is discovered using NIH funds, the drug company applies to the FDA for approval. The FDA to protect the licensing of any potential drug issues a 20 year monopoly to the drug company to manufacture the drug. This is supposedly to protect the drug company investment in the research that discovered the drug but is a myth because it was the NIH that provided the research grant to the drug company that discovered pharmaceutical drug.

Pharmaceutical drug companies justify the annual NIH $26 billion to provide for research because of the high cost of research. The real reason is because instead of using private drug company funds being applied to research, the drug companies use their funds primarily for consumer marketing.

Now armed with a 20 year monopoly to manufacture the drug approved by FDA, the monopoly gives the drug company an exclusive preventing other drug companies from manufacturing the same drug. With control of the FDA sanctioned monopoly, the drug company can set the price of the drug justifying any price because of the required substantial research funds used in discovering the drug even though US taxpayers funded the research using research funds from the U.S. National Institutes of Health (NIH).

For 20 years, the prescription drug price is determined by the marketplace and the marketplace is driven by the drug companies marketing branded prescription drugs as the drug of choice to American consumers.

After 20 years, other drug companies anxiously await for the monopoly to expire so they too can manufacture the same branded drug as a generic drug.

But then just before expiration of the original monopoly, the drug company holding the monopoly approaches the FDA with a change in the original drug. By using the FDA "orange book," the FDA is authorized to extend the original 20 year monopoly with 6 month extensions for every change in the original drug approval. Examples of these changes are: shape of the original drug is changed from round to oval (or any other of a multitude of shapes is changed).  Dosage changes are other examples. With each change the FDA approves an additional 6 months which means an additional $4-6 billion in additional revenue for the drug company.

With the pharmaceutical companies controlling the price of every branded prescription drug, the only way of circumventing the asking drug price is to buy in bulk.

The most noted buyer of prescription drugs in the United States is the U.S. Veterans Administration (VA). The purchasing power of the VA enables the VA to buy prescription drugs in bulk driving down the price to a discount price of 40%.

This is how the VA can significantly reduce the price of prescription drugs provided to US veterans. 

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 47 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.

Single Payer Health Insurance

Dr. Rocky White, a former Republican, has become a leading advocate of single-payer, national health insurance.

You wouldn’t know it from the candidates’ debates or reports on the major television networks, but a majority of Americans favor a government-run health insurance system similar to Canada’s.

Those lining up to support single-payer health care include medical professionals, business people, and many Republicans. Dr. Rocky White has been all of those things.

White is a former Republican, from a conservative, evangelical background, who got interested in health care reform nine years ago when his own medical practice slipped into the red. His research into the health care system led him to conclude the problem wasn’t just in his practice — the health care system itself is broken, and a single-payer program is the most efficient way to fix it.

Under the single-payer system, doctors’ offices and hospitals remain private for-profit or non-profit institutions. But the federal government covers the bills for patient services, with funds coming from taxes. The patient gets the health care they need. Paperwork and billing are kept to a minimum. Employers no longer have the difficult task of choosing, administering, and paying for health insurance for employees. Everyone is covered.

The current setup is as complicated as single-payer is simple. Today, the discerning consumer must wade through a complex system of pre-existing condition exemptions, co-pays, and deductibles — if they have coverage at all. Arguments over billing among doctors’ offices, insurance companies, patients, and their lawyers eat up millions of dollars. An estimated $25 out of each $100 spent goes to paperwork, profits, and executive pay and bonuses. And disagreement over medical coverage is one of the most common sources of labor disputes for employers who have seen insurance premiums double since 2000.

With these inflated costs, it’s little wonder that in 2006, the last year for which government figures are available, 47 million Americans had no insurance at all, including 8.7 million children, or that 68 percent of bankruptcies in the U.S. come as a direct result of medical expenses among people who do have insurance.

A CNN/Opinion Research Poll last year showed 64% of Americans would be willing to pay higher taxes for a national health care system.

When White learned about Physicians for a National Health Program and their plan for a single-payer health care system, he saw it was similar to his own idea and he joined their effort.

Other medical professionals have had a similar reaction. The American College of Physicians — the largest organization of medical specialists in the country — endorses single-payer health care as does the California Nurses Association, the largest organization of registered nurses.

And so do 55 percent of Americans, according to a CBS News poll conducted in September. In another poll, 64 percent said they would be willing to pay higher taxes for a national health care insurance program.

In Congress, HR 676, the “Medicare for All” bill introduced by Representative John Conyers, Jr. of Michigan, currently has 90 co-sponsors — more than any other health care reform proposal — and the endorsement of the U.S. Conference of Mayors.

Support for single-payer health care is not just strong among progressives. George Swan, for instance, is a health care administrator, self-described “Purple Republican,” and a founder of Republicans for Single Payer.

“It’s about being American and doing what’s right,” Swan says. “What’s right is not paying a 30 percent premium to the insurance system and receiving sub-standard health care.”

Business owners are also supporting single-payer health care. For 25 years, Jack Lohman owned a company that provided cardiac monitoring services to hospitals. Today, he’s a co-founder of the Business Coalition for Single Payer. A “lifelong Republican,” Lohman argues conservatives should support single-payer because it’s pro-business.

“For the same 16 percent of GDP we are spending on health care in the U.S.,” he says, “we could provide first-class health care to 100 percent of the people.” And single-payer would “get health care off the backs of corporations so they can be more competitive with products made overseas.”

John Arensmeyer spent 12 years running an e-commerce company with 35 employees. Then he founded the Small Business Majority to advocate for the interests of small businesses, particularly on health care issues. Sharp rises in health care costs for small businesses are hurting their ability to survive, Arensmeyer says. “It’s antithetical to what we’re all about as a country, which is to allow people the freedom to go out and start new enterprises.”

Small business has often been portrayed as opposing health care reform, but SBM’s research shows small businesses are interested in being part of the solution — even if it means paying higher taxes.

Walter Maher, former vice-president of public policy at the DaimlerChrysler Corporation, sees the problems in similar ways, although he looks at health care costs through the lens of large corporate employers.

General Motors, he says, is paying people to leave their jobs so they can hire replacements at 50 cents on the dollar with reduced health benefits. “It’s sad,” he says. “You have a giant albatross around your neck because you choose to provide a good standard of living for your employees.”

Money in Politics

If the current system is so unpopular among medical professional, patients, and business owners, what’s keeping it in place? Most advocates for single-payer agree money in politics is the greatest obstacle to change. During the 2006 election cycle, the health care industry spent $99.7 million on campaign contributions. Lobbying on health care issues topped $446 million in 2007.

For Jack Lohman, that’s the crux of the problem. “Obama’s plans for health care is lousy,” he says. “Although Obama claims he is not taking lobbyist money, somehow this money is getting through. Obama is supporting health care that keeps the insurance industry involved.”

And all that money can buy a lot of misinformation and scaremongering. Rocky White says he finds people get interested in the single-payer approach if they understand what’s actually being proposed: “When people realize all that it is,” he says, “is a publicly owned insurance company, all of a sudden business people start to lose that fear that ‘Oh my God, we’re going to become the Soviet Union.’ Even Republicans say, ‘This really makes a lot of sense.’”

While White would like to see reform happen on a national level, he believes it’s more realistic to work at the state level for now. And for him, that means Colorado. White sits on the board of Health Care for All Colorado, a nonprofit, volunteer-run group with 250 members that includes Democrats, Republicans, physicians, business people, college professors, and economists. And he is running for a Democratic seat in the state legislature to add “the voice of medicine” to the debate.

“Any time a state has studied it, they find single-payer is the most cost-effective and covers everyone,” White says. His proposal for a single-payer system in Colorado is being studied by a blue ribbon commission created by the Colorado Legislature.

In May, the 6,000 delegates to the Colorado Democratic Party Convention endorsed a pro-single-payer resolution that will be forwarded to the national convention in Denver in August.

If one state can make a single-payer plan work, White believes, it could start a cascading effect similar to what took place in Canada during the 1940s and ‘50s.

“People are discouraged, they’re angry, they’re upset,” White says. “But politics is the process that drives policy, and if we don’t get involved in the political process we’ll never make a difference.”

Turn Arizona Blue! for Arizona Proposed

Jan Brewer Entry Clears Way for GOP to Define State Agenda

Gov. Janet Napolitano's appointment to the incoming Obama administration would put a Republican at the state's helm, potentially leading to harsher budget cuts and a U-turn on state policy governing everything from gun restrictions to abortion.

One thing is certain: It would dramatically alter the Arizona political landscape.

Napolitano's departure would place Republican Secretary of State Jan Brewer, 64, in control of the Governor's Office. It would be the first time since 2002 the GOP has controlled both the executive and legislative branches of state government, giving the party its best opportunity in years to enact a conservative agenda.

Brewer would serve the remaining two years of Napolitano's term, inheriting a state with a budget more than $1 billion out of balance, a flagging economy and a host of tough choices in terms of spending cuts.

The change in leadership could be most dramatic in how the state handles that shortfall.

Napolitano has blunted deep cuts with borrowing and fiscal maneuvers and has pledged to protect education and state services for children and vulnerable populations. Legislative Republicans have pushed for deeper cuts that might bring more pain in the short term but that they argue would be more fiscally responsible and potentially spare the need for big cuts later on.

The incoming leaders of the House and Senate said Brewer would offer the prospect of smoother budget negotiations, if only because all negotiators would be Republicans.

"Philosophically, we'll be a lot more in parallel with her," said Sen. Bob Burns, Senate president-elect.

The governor's handling of social issues such as abortion also figures to illustrate the philosophical shift from Napolitano to Brewer. Napolitano has repeatedly vetoed attempts to limit abortion, and some of those measures may be revived for Brewer.

Political ideology aside, Arizona State University pollster Bruce Merrill said Brewer's style "may be much more effective than Janet Napolitano has been in terms of working with legislators and reaching a budget deal."